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  1. Article ; Online: Practices to prevent non-ventilator hospital acquired pneumonia: a narrative review.

    Livesey, Alana / Quarton, Samuel / Pittaway, Harriet / Adiga, Aditya / Grudzinska, Frances / Dosanjh, Davinder / Parekh, Dhruv

    The Journal of hospital infection

    2024  

    Abstract: Nosocomial infection has significant consequences in healthcare, at the individual level driving increased morbidity and mortality, but also at the organisational level due to increased costs. Hospital acquired pneumonia(HAP) is the most common ... ...

    Abstract Nosocomial infection has significant consequences in healthcare, at the individual level driving increased morbidity and mortality, but also at the organisational level due to increased costs. Hospital acquired pneumonia(HAP) is the most common nosocomial infection and is associated with high excess mortality, frequent use of broad spectrum anti-microbials and increased length of stay. In this review we explore the preventative strategies that have been examined in non-ventilator acquired hospital associated pneumonia (NVHAP). We discuss management of aspiration risk, interventions for oral hygiene, the role of mobilisation and physiotherapy, modification of environmental factors, and vaccination. Many of these interventions are low risk, acceptable to patients and have good cost-benefit ratios. However, the evidence base for prevention of NVHAP is weak. We identify lack of a unified research definition, under-recruitment to studies, and variation in intervention and outcome measures as limitations in the existing literature. Given the core risk factors for acquisition of NVHAP are increasing there is an urgent need for research to address the prevention of NVHAP. In this review we call for a unified definition, identification of a core outcome set for studies in NVHAP and suggest future directions for research in NVHAP. Improving care for people with NVHAP will reduce morbidity, mortality, and healthcare costs significantly.
    Language English
    Publishing date 2024-04-23
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 779366-2
    ISSN 1532-2939 ; 0195-6701
    ISSN (online) 1532-2939
    ISSN 0195-6701
    DOI 10.1016/j.jhin.2024.03.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Cardiovascular Subphenotypes in ARDS: Diagnostic and Therapeutic Implications and Overlap with Other ARDS Subphenotypes.

    Chotalia, Minesh / Patel, Jaimin M / Bangash, Mansoor N / Parekh, Dhruv

    Journal of clinical medicine

    2023  Volume 12, Issue 11

    Abstract: Acute respiratory distress syndrome (ARDS) is a highly heterogeneous clinical condition. Shock is a poor prognostic sign in ARDS, and heterogeneity in its pathophysiology may be a barrier to its effective treatment. Although right ventricular dysfunction ...

    Abstract Acute respiratory distress syndrome (ARDS) is a highly heterogeneous clinical condition. Shock is a poor prognostic sign in ARDS, and heterogeneity in its pathophysiology may be a barrier to its effective treatment. Although right ventricular dysfunction is commonly implicated, there is no consensus definition for its diagnosis, and left ventricular function is neglected. There is a need to identify the homogenous subgroups within ARDS, that have a similar pathobiology, which can then be treated with targeted therapies. Haemodynamic clustering analyses in patients with ARDS have identified two subphenotypes of increasingly severe right ventricular injury, and a further subphenotype of hyperdynamic left ventricular function. In this review, we discuss how phenotyping the cardiovascular system in ARDS may align with haemodynamic pathophysiology, can aid in optimally defining right ventricular dysfunction and can identify tailored therapeutic targets for shock in ARDS. Additionally, clustering analyses of inflammatory, clinical and radiographic data describe other subphenotypes in ARDS. We detail the potential overlap between these and the cardiovascular phenotypes.
    Language English
    Publishing date 2023-05-26
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12113695
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The authors reply.

    Chotalia, Minesh / Patel, Jaimin M / Parekh, Dhruv / Bangash, Mansoor N

    Critical care medicine

    2023  Volume 51, Issue 2, Page(s) e66–e67

    Language English
    Publishing date 2023-01-20
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005761
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Characterising right ventricular dysfunction in acute respiratory distress syndrome due to COVID-19: which measurements are best?

    Chotalia, Minesh / Patel, Jaimin / Parekh, Dhruv / Bangash, Mansoor

    Intensive care medicine

    2022  Volume 48, Issue 8, Page(s) 1104–1105

    MeSH term(s) COVID-19/complications ; Humans ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; Ventricular Dysfunction, Right/etiology ; Ventricular Function, Right
    Language English
    Publishing date 2022-05-20
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-022-06742-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Mechanisms of Post-critical Illness Cardiovascular Disease.

    Owen, Andrew / Patel, Jaimin M / Parekh, Dhruv / Bangash, Mansoor N

    Frontiers in cardiovascular medicine

    2022  Volume 9, Page(s) 854421

    Abstract: Prolonged critical care stays commonly follow trauma, severe burn injury, sepsis, ARDS, and complications of major surgery. Although patients leave critical care following homeostatic recovery, significant additional diseases affect these patients during ...

    Abstract Prolonged critical care stays commonly follow trauma, severe burn injury, sepsis, ARDS, and complications of major surgery. Although patients leave critical care following homeostatic recovery, significant additional diseases affect these patients during and beyond the convalescent phase. New cardiovascular and renal disease is commonly seen and roughly one third of all deaths in the year following discharge from critical care may come from this cluster of diseases. During prolonged critical care stays, the immunometabolic, inflammatory and neurohumoral response to severe illness in conjunction with resuscitative treatments primes the immune system and parenchymal tissues to develop a long-lived pro-inflammatory and immunosenescent state. This state is perpetuated by persistent Toll-like receptor signaling, free radical mediated isolevuglandin protein adduct formation and presentation by antigen presenting cells, abnormal circulating HDL and LDL isoforms, redox and metabolite mediated epigenetic reprogramming of the innate immune arm (trained immunity), and the development of immunosenescence through T-cell exhaustion/anergy through epigenetic modification of the T-cell genome. Under this state, tissue remodeling in the vascular, cardiac, and renal parenchymal beds occurs through the activation of pro-fibrotic cellular signaling pathways, causing vascular dysfunction and atherosclerosis, adverse cardiac remodeling and dysfunction, and proteinuria and accelerated chronic kidney disease.
    Language English
    Publishing date 2022-07-15
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2781496-8
    ISSN 2297-055X
    ISSN 2297-055X
    DOI 10.3389/fcvm.2022.854421
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Definition and evolution of right ventricular dysfunction in critically ill COVID-19 patients.

    Chotalia, Minesh / Bangash, Mansoor N / Patel, Jaimin M / Parekh, Dhruv

    Annals of intensive care

    2022  Volume 12, Issue 1, Page(s) 82

    Language English
    Publishing date 2022-08-30
    Publishing country Germany
    Document type Letter ; Comment
    ZDB-ID 2617094-2
    ISSN 2110-5820
    ISSN 2110-5820
    DOI 10.1186/s13613-022-01055-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: The clinical challenge of diagnosing Non-Ventilator Hospital Acquired Pneumonia and identifying causative pathogens - a narrative review.

    Quarton, Samuel / Livesey, Alana / Pittaway, Harriet / Adiga, Aditya / Grudzinska, Frances / McNally, Alan / Dosanjh, Davinder / Sapey, Elizabeth / Parekh, Dhruv

    The Journal of hospital infection

    2024  

    Abstract: Non-ventilated hospital acquired pneumonia (NV-HAP) is associated with significant healthcare burden, arising from high incidence and associated morbidity and mortality. However, accurately identifying cases remains challenging. At present there is no ... ...

    Abstract Non-ventilated hospital acquired pneumonia (NV-HAP) is associated with significant healthcare burden, arising from high incidence and associated morbidity and mortality. However, accurately identifying cases remains challenging. At present there is no gold-standard test for the diagnosis of NV-HAP, requiring instead the blending of non-specific signs and investigations. Causative organisms are only identified in a minority of cases. This has significant implications for surveillance, patient outcomes and antimicrobial stewardship. Much of the existing research in HAP has been conducted among ventilated patients. The paucity of dedicated NV-HAP research means conclusions regarding diagnostic methods, pathology and interventions must largely be extrapolated from work in other settings. Progress is also limited by the lack of a widely agreed definition for NV-HAP. The diagnosis of NV-HAP has large scope for improvement. Consensus regarding a case definition will allow meaningful research to improve understanding of both aetiology and the heterogeneity of outcomes experienced by patients. There is potential to optimise the role of imaging and to incorporate novel techniques to identify likely causative pathogens. This would facilitate both antimicrobial stewardship and surveillance of an important healthcare-associated infection. This narrative review considers the utility of existing methods to diagnose NV-HAP, with a focus on the significance and challenge of identifying pathogens. It discusses the limitations in current techniques and explores the potential of emergent molecular techniques to improve microbiological diagnosis and outcomes for patients.
    Language English
    Publishing date 2024-04-13
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 779366-2
    ISSN 1532-2939 ; 0195-6701
    ISSN (online) 1532-2939
    ISSN 0195-6701
    DOI 10.1016/j.jhin.2024.02.029
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: The authors reply.

    Chotalia, Minesh / Ali, Muzzammil / Alderman, Joseph / Kalla, Manish / Parekh, Dhruv / Bangash, Mansoor / Patel, Jaimin

    Critical care medicine

    2023  Volume 50, Issue 4, Page(s) e395–e396

    Language English
    Publishing date 2023-02-03
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005452
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: COVID-19 and the liver: little cause for concern.

    Bangash, Mansoor N / Patel, Jaimin / Parekh, Dhruv

    The lancet. Gastroenterology & hepatology

    2020  Volume 5, Issue 6, Page(s) 529–530

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Humans ; Liver Diseases/virology ; Pandemics ; Pneumonia, Viral/complications ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-03-20
    Publishing country Netherlands
    Document type Letter
    ISSN 2468-1253
    ISSN (online) 2468-1253
    DOI 10.1016/S2468-1253(20)30084-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The authors reply.

    Chotalia, Minesh / Ali, Muzzammil / Alderman, Joseph / Kalla, Manish / Parekh, Dhruv / Bangash, Mansoor / Patel, Jaimin

    Critical care medicine

    2022  Volume 50, Issue 4, Page(s) e398–e399

    Language English
    Publishing date 2022-02-09
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005453
    Database MEDical Literature Analysis and Retrieval System OnLINE

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