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Article ; Online: De novo pancytopaenia in an older adult with severe COVID-19 infection.

Lee, Helena / Thein, Onn Shaun / Muneer, Tazeen

BMJ case reports

2022 Volume 15, Issue 11

Abstract: During the COVID-19 pandemic, it was recognised that SARS-CoV-2 can cause multisystem illness. Non-respiratory complications observed early in the pandemic were haematological in nature. A rare but serious haematological complication of COVID-19 ... ...

Abstract	During the COVID-19 pandemic, it was recognised that SARS-CoV-2 can cause multisystem illness. Non-respiratory complications observed early in the pandemic were haematological in nature. A rare but serious haematological complication of COVID-19 infection is pancytopaenia. We describe a case of an older adult without pre-existing haematological disease or risk factors for cell dyscrasia with severe pancytopaenia induced by COVID-19, who developed critical illness requiring respiratory support in intensive care and died. Our case report highlights that de novo pancytopaenia may only present with mild dermatological manifestations and may indicate severe COVID-19 infection. Management is primarily supportive and early involvement of haematology should be sought.
MeSH term(s)	Humans ; Aged ; COVID-19/complications ; Pandemics ; SARS-CoV-2 ; Critical Care ; Pancytopenia
Language	English
Publishing date	2022-11-15
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2022-252609
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Pneumocystis pneumonia causing cavitating lung nodules in an immunocompetent individual.

Ojuawo, Olutobi / Htwe, Thidar / Thein, Onn Shaun / Sahal, Adeel

BMJ case reports

2021 Volume 14, Issue 4

Abstract: Pneumocystis jirovecii pneumonia (PCP) is a potential life-threatening pulmonary infection which commonly manifests in immunosuppressed patients especially with HIV, with underlying malignancies, severe malnutrition as well as those on immunosuppressive ... ...

Abstract	Pneumocystis jirovecii pneumonia (PCP) is a potential life-threatening pulmonary infection which commonly manifests in immunosuppressed patients especially with HIV, with underlying malignancies, severe malnutrition as well as those on immunosuppressive treatments. There have been case reports of symptomatic PCP in individuals with a normally functioning immune system with typical clinical features and radiologic findings of bilateral and diffuse interstitial opacities. However, PCP in immunocompetent individuals presenting with lung nodules had been rarely reported. We report a 53-year-old immunocompetent gentleman who presented with subacute cough, progressive shortness of breath and radiographic findings of multiple lung nodules with central cavitation. The diagnosis of PCP was made by detection of PCP DNA PCR in bronchoalveolar lavage sample following fibreoptic bronchoscopy. This case also highlights the atypical radiographic findings of multiple cavitating lung nodules as a presentation of PCP in an immunocompetent patient.
MeSH term(s)	Bronchoalveolar Lavage ; Humans ; Immunocompromised Host ; Lung ; Middle Aged ; Pneumocystis carinii ; Pneumonia, Pneumocystis/diagnosis ; Pneumonia, Pneumocystis/diagnostic imaging
Language	English
Publishing date	2021-04-27
Publishing country	England
Document type	Journal Article ; Case Reports
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2020-241061
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Article ; Online: Pneumomediastinum in patients with SARS-CoV-2 treated with non-invasive ventilation.

Thein, Onn Shaun / Niazi, Muhammad / Ali, Abdisamad / Sahal, Adeel

BMJ case reports

2021 Volume 14, Issue 3

Abstract: SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. ... ...

Abstract	SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19.Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later.We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.
MeSH term(s)	Aged, 80 and over ; COVID-19/therapy ; Conservative Treatment ; Diagnosis, Differential ; Fatal Outcome ; Female ; Humans ; Male ; Mediastinal Emphysema/diagnostic imaging ; Mediastinal Emphysema/etiology ; Mediastinal Emphysema/therapy ; Middle Aged ; Noninvasive Ventilation/adverse effects ; Positive-Pressure Respiration/adverse effects ; Radiography ; SARS-CoV-2 ; Tomography, X-Ray Computed
Language	English
Publishing date	2021-03-23
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-241809
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Article ; Online: Raised FGF23 Correlates to Increased Mortality in Critical Illness, Independent of Vitamin D

Thein, Onn Shaun / Ali, Naeman Akbar / Mahida, Rahul Y. / Dancer, Rachel C. A. / Ostermann, Marlies / Amrein, Karin / Martucci, Gennaro / Scott, Aaron / Thickett, David R. / Parekh, Dhruv

Biology (Basel). 2023 Feb. 14, v. 12, no. 2

2023

Abstract: Background: Fibroblast Growth Factor (FGF23) is an endocrine hormone classically associated with the homeostasis of vitamin D, phosphate, and calcium. Elevated serum FGF23 is a known independent risk factor for mortality in chronic kidney disease (CKD) ... ...

Abstract	Background: Fibroblast Growth Factor (FGF23) is an endocrine hormone classically associated with the homeostasis of vitamin D, phosphate, and calcium. Elevated serum FGF23 is a known independent risk factor for mortality in chronic kidney disease (CKD) patients. We aimed to determine if there was a similar relationship between FGF23 levels and mortality in critically ill patients. Methods: Plasma FGF23 levels were measured by ELISA in two separate cohorts of patients receiving vitamin D supplementation: critical illness patients (VITdAL-ICU trial, n = 475) and elective oesophagectomy patients (VINDALOO trial, n = 76). Mortality data were recorded at 30 and 180 days or at two years, respectively. FGF23 levels in a healthy control cohort were also measured (n = 27). Results: Elevated FGF23 (quartile 4 vs. quartiles 1–3) was associated with increased short-term (30 and 180 day) mortality in critical illness patients (p < 0.001) and long-term (two-year) mortality in oesophagectomy patients (p = 0.0149). Patients who died had significantly higher FGF23 levels than those who survived: In the critical illness cohort, those who died had 1194.6 pg/mL (range 0–14,000), while those who survived had 120.4 pg/mL (range = 15–14,000) (p = 0.0462). In the oesophagectomy cohort, those who died had 1304 pg/mL (range = 154–77,800), while those who survived had 644 pg/mL (range = 179–54,894) (p < 0.001). This was found to be independent of vitamin D or CKD status (critical illness p = 0.3507; oesophagectomy p = 0.3800). FGF23 levels in healthy controls were similar to those seen in oesophagectomy patients (p = 0.4802). Conclusions: Elevated baseline serum FGF23 is correlated with increased mortality in both the post-oesophagectomy cohort and the cohort of patients with critical illness requiring intensive care admission. This was independent of vitamin D status, supplementation, or CKD status, which suggests the presence of vitamin D-independent mechanisms of FGF23 action during the acute and convalescent stages of critical illness, warranting further investigation.
Keywords	blood serum ; calcium ; fibroblast growth factors ; homeostasis ; kidney diseases ; mortality ; phosphates ; risk factors ; vitamin D
Language	English
Dates of publication	2023-0214
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article ; Online
ZDB-ID	2661517-4
ISSN	2079-7737
ISSN	2079-7737
DOI	10.3390/biology12020309
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Dysfunctional neutrophil response in COVID-19 infection vary by subtype.

Thein, Onn Shaun / Belchamber, Kylie / Hazeldine, Jon / Faniyi, Aduragbemi / Grudzinska, Frances / Hughes, Michael / Jasper, Alice / Yip, Kay Por / Crowley, Louise / Lugg, Sebastian / Sapey, Elizabeth / Parekh, Dhruv / Thickett, David / Scott, Aaron

Clinical medicine (London, England)

2024 Volume 23, Issue Suppl 6, Page(s) 69–70

MeSH term(s)	Humans ; COVID-19 ; Neutrophils
Language	English
Publishing date	2024-01-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2048646-7
ISSN	1473-4893 ; 1470-2118
ISSN (online)	1473-4893
ISSN	1470-2118
DOI	10.7861/clinmed.23-6-s69
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Article ; Online: Pyrexia of unknown origin: inferior vena cava agenesis.

Thein, Onn Shaun / Braganza Menezes, Darryl A / Moran, Ed

BMJ case reports

2018 Volume 2018

Abstract: A 26-year-old woman presented with a 5-day history of fever after returning from Bali. She denied sexual contact abroad. On examination, there was suprapubic tenderness and a widespread maculopapular rash. Malaria serology was negative and blood tests ... ...

Abstract	A 26-year-old woman presented with a 5-day history of fever after returning from Bali. She denied sexual contact abroad. On examination, there was suprapubic tenderness and a widespread maculopapular rash. Malaria serology was negative and blood tests were normal except for an elevated C reactive protein. Treatment was initially with ceftriaxone, metronidazole and doxycycline, but her symptoms failed to improve. A CT pelvis suggested a possible tubo-ovarian abscess, a suspected inferior vena cava (IVC) anomaly and left internal iliac/femoral venous thrombosis. A gynaecology review demonstrated left tubo-ovarian tenderness and fullness. An MRI suggested pelvic inflammatory disease and thrombophlebitis affecting the pelvic veins; deep vein thrombosis (DVT) treatment was commenced. Further family history revealed thrombosis throughout multiple generations. Further imaging analysis demonstrated agenesis of the IVC with compensatory dilation of pelvic collaterals and an acute DVT of the deep pelvic venous system. The patient was discharged with direct oral anticoagulant therapy.
MeSH term(s)	Adult ; Female ; Fever of Unknown Origin/etiology ; Humans ; Pelvis/blood supply ; Vascular Malformations/complications ; Vena Cava, Inferior/abnormalities ; Venous Thrombosis/etiology
Language	English
Publishing date	2018-06-23
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2018-224739
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Article ; Online: Mepolizumab rescue therapy for acute pneumonitis secondary to DRESS.

Thein, Onn Shaun / Sutton, Benjamin / Thickett, David R / Parekh, Dhruv

BMJ case reports

2019 Volume 12, Issue 10

Abstract: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome represents a severe adverse drug reaction driven by eosinophilia. Treatment is focused on withdrawal of medication, supportive care and immunosuppression such as high-dose ... ...

Abstract	Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome represents a severe adverse drug reaction driven by eosinophilia. Treatment is focused on withdrawal of medication, supportive care and immunosuppression such as high-dose corticosteroid therapy. Here we report a 56-year-old male patient who initially presented with breathlessness and eosinophilia, subsequent development of respiratory failure and admission to ITU for non-invasive ventilation. The patient continued to deteriorate despite high-dose prednisolone and methylprednisolone. Other causes of hypereosinophilia were normal. He was diagnosed with DRESS syndrome secondary to pregabalin and was treated with subcutaneous mepolizumab. We observed the rapid resolution of eosinophilia and clinical improvement; the patient was discharged home within a month of administration. This represents the successful use of mepolizumab in the acute setting of pulmonary failure secondary to DRESS. A similar approach could be adopted in other acute conditions with refractory eosinophilic inflammation where standard steroid therapy has failed.
MeSH term(s)	Antibodies, Monoclonal, Humanized/therapeutic use ; Diagnosis, Differential ; Drug Hypersensitivity Syndrome/complications ; Eosinophilia/complications ; Eosinophilia/drug therapy ; Humans ; Male ; Middle Aged ; Pneumonia/drug therapy ; Pneumonia/etiology ; Pregabalin/adverse effects
Chemical Substances	Antibodies, Monoclonal, Humanized ; Pregabalin (55JG375S6M) ; mepolizumab (90Z2UF0E52)
Language	English
Publishing date	2019-10-10
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2019-231355
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Raised FGF23 Correlates to Increased Mortality in Critical Illness, Independent of Vitamin D.

Thein, Onn Shaun / Ali, Naeman Akbar / Mahida, Rahul Y / Dancer, Rachel C A / Ostermann, Marlies / Amrein, Karin / Martucci, Gennaro / Scott, Aaron / Thickett, David R / Parekh, Dhruv

Biology

2023 Volume 12, Issue 2

Abstract	Background: Fibroblast Growth Factor (FGF23) is an endocrine hormone classically associated with the homeostasis of vitamin D, phosphate, and calcium. Elevated serum FGF23 is a known independent risk factor for mortality in chronic kidney disease (CKD) patients. We aimed to determine if there was a similar relationship between FGF23 levels and mortality in critically ill patients. Methods: Plasma FGF23 levels were measured by ELISA in two separate cohorts of patients receiving vitamin D supplementation: critical illness patients (VITdAL-ICU trial, Results: Elevated FGF23 (quartile 4 vs. quartiles 1-3) was associated with increased short-term (30 and 180 day) mortality in critical illness patients ( Conclusions: Elevated baseline serum FGF23 is correlated with increased mortality in both the post-oesophagectomy cohort and the cohort of patients with critical illness requiring intensive care admission. This was independent of vitamin D status, supplementation, or CKD status, which suggests the presence of vitamin D-independent mechanisms of FGF23 action during the acute and convalescent stages of critical illness, warranting further investigation.
Language	English
Publishing date	2023-02-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2661517-4
ISSN	2079-7737
ISSN	2079-7737
DOI	10.3390/biology12020309
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Article ; Online: Metabolic and Endocrine Challenges.

Martucci, Gennaro / Bonicolini, Eleonora / Parekh, Dhruv / Thein, Onn Shaun / Scherkl, Mario / Amrein, Karin

Seminars in respiratory and critical care medicine

2020 Volume 42, Issue 1, Page(s) 78–97

Abstract: This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. ... ...

Abstract	This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated syndrome, they are a rare and extreme manifestation. As they are uncommon, these can typically challenge both with diagnosis and management. Acute exacerbations may be elicited by triggers such as infections, trauma, surgery, and hemorrhage. In this complex scenario, early diagnosis and prompt treatment require knowledge of the specific endocrine syndrome. Here, we review diabetic coma, hyponatremia, hypercalcemia, thyroid emergencies, pituitary insufficiency, adrenal crisis, and vitamin D deficiency, highlighting diagnostic tools and tricks, and management pathways through defining common clinical presentations.
MeSH term(s)	Adrenal Insufficiency/diagnosis ; Adrenal Insufficiency/etiology ; Adrenal Insufficiency/therapy ; Critical Care ; Emergencies ; Endocrine System Diseases/complications ; Endocrine System Diseases/diagnosis ; Endocrine System Diseases/therapy ; Humans ; Hypercalcemia
Language	English
Publishing date	2020-09-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1183617-9
ISSN	1098-9048 ; 1069-3424
ISSN (online)	1098-9048
ISSN	1069-3424
DOI	10.1055/s-0040-1713084
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 1555: Show issues

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Oxygen prescription: improving compliance using methods from

Thein, Onn Shaun / Chan, Cathleen Man Ting / McCance, Eleanor / Mullins, Maria / Dosanjh, Davinder

BMJ open quality

2018 Volume 7, Issue 2, Page(s) e000288

Abstract: Oxygen is an important drug frequently used in the management of acutely unwell hospital patients. However, oxygen overuse can have fatal side effects particularly for those patients at risk of iatrogenic hypercapnia. British Thoracic Society Guidelines ... ...

Abstract	Oxygen is an important drug frequently used in the management of acutely unwell hospital patients. However, oxygen overuse can have fatal side effects particularly for those patients at risk of iatrogenic hypercapnia. British Thoracic Society Guidelines state that oxygen must be prescribed for all patients, with target saturations stipulated on the prescription for patient safety. A quality improvement project was undertaken with the aim to improve the oxygen prescription rate across the respiratory ward at a district general hospital, over a period of 3 months. Quality improvement methods were implemented based on data analysis at each stage, following discussion with senior doctors and specialist nurses, and after reviewing previous quality improvement projects published on
Language	English
Publishing date	2018
Publishing country	England
Document type	Journal Article
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2017-000288
Database	MEDical Literature Analysis and Retrieval System OnLINE

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