Rehan Quadery - Academia.edu (original) (raw)

Papers by Rehan Quadery

Research paper thumbnail of Management of acute pulmonary embolism

British journal of hospital medicine, Oct 2, 2015

Purpose: Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prom... more Purpose: Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prompt diagnosis and management. While non-surgical approaches have supplanted surgery as primary treatment, surgical pulmonary embolectomy (SPE) remains a vital option for select patients. We review the current management of acute PE, with a focus on surgical therapy. Methods: A PubMed search was performed to identify literature regarding PE and treatment. Results were filtered to include the most comprehensive publications over the past decade. Results: PE is stratified based on presenting hemodynamic status or degree of mechanical pulmonary arterial occlusion. Although systemic or catheter-guided fibrinolysis is the preferred first-line treatment for the majority of cases, patients who are not candidates should be considered for SPE. Studies demonstrate no mortality benefit of thrombolysis over surgery. Systemic anticoagulation is a mainstay of treatment regardless of intervention approach. Following surgical embolectomy, direct oral anticoagulants (DOACs) have been shown to reduce recurrence of thromboembolism. Conclusions: Acute PE presents with varying degrees of clinical stability. Patients should be evaluated in the context of various available treatment options including medical, catheter-based, and surgical interventions. SPE is a safe and appropriate treatment option for appropriate patients.

Research paper thumbnail of Non-invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease: Results from an anonymous survey of physicians

Future healthcare journal, Feb 1, 2020

Non-invasive ventilation (NIV) is an evidence-based treatment modality for patients with acute ex... more Non-invasive ventilation (NIV) is an evidence-based treatment modality for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure (AHRF). It has been shown to reduce mortality, in-hospital complications, length of stay and is cost effective compared to invasive ventilation. Despite this, data from UK has shown higher mortality and a wide variation in practice in the use of NIV in AHRF.

Research paper thumbnail of Effective strategies in recruitment and clinical orientation programme to manage NHS junior doctor workforce shortfall: a district general hospital experience

Future healthcare journal, Feb 1, 2020

Research paper thumbnail of The Beneficial Effects of Oral Trimethoprim or Cotrimoxazole in Patients with Severe COVID-19: A Case Series

Social Science Research Network, 2020

COVID-19 may become a critical illness which is thought to be mediated by a cytokine storm syndro... more COVID-19 may become a critical illness which is thought to be mediated by a cytokine storm syndrome. There is no effective anti-viral treatment to date and the mainstay of treatment is supportive. We treated 22 patients with severe COVID-19 with oral trimethoprim (TMP) or cotrimoxazole (CTX) in addition to standard antibiotic therapy (ST) and compared this with 22 patients with severe COVID-19 receiving standard therapy alone. We observed that the patients with severe COVID-19 receiving TMP/CTX in addition to ST had significantly better outcomes including reduced in-patient mortality (5% versus 32%), length of hospital stay (mean, 9 versus 22 days), and the need for ventilatory support (numbers, 3 versus 16) with improved clinical parameters within 48 hours of starting treatment. This may be due to the anti-cytokine effects of TMP/CTX. Urgent clinical trials are recommended.

Research paper thumbnail of P0138 Fatal Laryngeal Swelling in Intensive Care Unit: A Case Report and Discussion of Ace-I Induced Angioedema

European Journal of Internal Medicine, May 1, 2009

when applying Framinghan charts (or the Spanish version DORICA) only points out less than 20% of ... more when applying Framinghan charts (or the Spanish version DORICA) only points out less than 20% of the population with high risk. Conclusions: Distribution of the different levels of global cardiovascular risk, evaluated individually, is slightly different in the patients that have MS, in which where the risk profile appears to be somewhat higher. If we consider that the MS is a high risk situation (as agreed upon by international consensus) the traditional instruments to calculate the risk underestimate it.It must be attributed to the fact that risk factors considered as diagnosis criteria are not included in most of the models for calculating the global CV risk.

Research paper thumbnail of The impact of high dose oral cotrimoxazole in patients with COVID-19 with hypoxic respiratory failure requiring non-invasive ventilation: A Case Control Study

medRxiv (Cold Spring Harbor Laboratory), Jan 15, 2021

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Research paper thumbnail of Serial cardiac MRI for assessment of cardiac morphology and function in CTEPH patients after PEA or vasodilator therapy

Research paper thumbnail of P183 Impact of patient choice on survival in patients with chronic thromboembolic pulmonary hypertension offered pulmonary endarterectomy

Research paper thumbnail of Chronic thrombo-embolic pulmonary hypertension: Long-term outcomes in operated and non-operated patients

Introduction: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a life shortening conditio... more Introduction: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a life shortening condition that may be cured by pulmonary endarterectomy.However, patients may not undergo surgery due to disease distribution, comorbidities or patient choice. Aims and objectives: To compare long term survival of patients with CTEPH undergoing pulmonary endarterectomy (CTEPH-surgical-operated), surgically accessible disease not undergoing endarterectomy due to comorbidities/patient choice (CTEPH-surgical-not-operated) and surgically inaccessible disease (CTEPH-non-surgical). Methods: Data was retrieved from the Sheffield ASPIRE Registry for consecutive, treatment-naive patients with CTEPH diagnosed between 2001 and 2015. Results: 613 patients, mean age(±standard deviation), 62±15 years, mean pulmonary arterial pressure 46±11mmHg and pulmonary vascular resistance 622±348dynes were identified and followed for 4.5±3.5 years. 5 year survival was significantly (p Conclusions: For patients with opera...

Research paper thumbnail of Physicians’ Knowledge Of The Use Of Non Invasive Ventilation In Chronic Obstructive Pulmonary Disease

Research paper thumbnail of Iatrogenic haemothorax – does extra benefit go hand-in-hand with extra risk? A case report and review of literature

Clinical Medicine, Mar 1, 2020

Research paper thumbnail of P28 Chronic thromboembolic pulmonary hypertension: long term outcomes in surgical and non-surgical patients

Thorax, Nov 15, 2016

Table 1 Baseline characteristics and results of invasive and non-invasive investigations. Gender ... more Table 1 Baseline characteristics and results of invasive and non-invasive investigations. Gender M/F 11 (69)/5 (31)

Research paper thumbnail of CMR Measures of Left Atrial Volume Index and Right Ventricular Function Have Prognostic Value in Chronic Thromboembolic Pulmonary Hypertension

Frontiers in Medicine, Mar 14, 2022

Providing prognostic information is important when counseling patients and planning treatment str... more Providing prognostic information is important when counseling patients and planning treatment strategies in chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to assess the prognostic value of gold standard imaging of cardiac structure and function using cardiac magnetic resonance imaging (CMR) in CTEPH. Consecutive treatment-naive patients with CTEPH who underwent right heart catheterization and CMR between 2011 and 2017 were identified from the ASPIRE (Assessing-the-Specturm-of-Pulmonary-hypertensIon-ata-REferral-center) registry. CMR metrics were corrected for age and sex where appropriate. Univariate and multivariate regression models were generated to assess the prognostic ability of CMR metrics in CTEPH. Three hundred and seventy-five patients (mean+/-standard deviation: age 64+/-14 years, 49% female) were identified and 181 (48%) had pulmonary endarterectomy (PEA). For all patients with CTEPH, left-ventricular-stroke-volume-index-%predicted (LVSVI%predicted) (p = 0.040), leftatrial-volume-index (LAVI) (p = 0.030), the presence of comorbidities, incremental shuttle walking test distance (ISWD), mixed venous oxygen saturation and undergoing PEA were independent predictors of mortality at multivariate analysis. In patients undergoing PEA, LAVI (p < 0.010), ISWD and comorbidities and in patients not undergoing surgery, right-ventricular-ejection-fraction-%predicted (RVEF%pred) (p = 0.040), age and ISWD were independent predictors of mortality. CMR metrics reflecting cardiac function and left heart disease have prognostic value in CTEPH. In those undergoing PEA, LAVI predicts outcome whereas in patients not undergoing PEA RVEF%pred predicts outcome. This study highlights the prognostic value of imaging cardiac structure and function in CTEPH and the importance of considering left heart disease in patients considered for PEA.

Research paper thumbnail of Decision-making in pulmonary endarterectomy surgery

The European respiratory journal, 2019

We would like to thank N.H. Kim and E. Mayer for their editorial based on our recent paper "The i... more We would like to thank N.H. Kim and E. Mayer for their editorial based on our recent paper "The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension" [1, 2]. We agree with many of their comments pertaining to the importance of referring patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) for assessment by a pulmonary endarterectomy (PEA) programme. We would, however, like to correct certain factual errors in their editorial which we feel create an incorrect picture of our practice at a large tertiary pulmonary hypertension referral centre. First, N.H. Kim and E. Mayer state that following remote assessment by a surgeon at our national PEA centre, 278 (50%) out of 550 of patients were deemed not to be candidates for PEA surgery. In fact, figure 1 in our original article [1] shows that 81% (448 out of 550) of patients were deemed by our national CTEPH multidisciplinary team (MDT) to have potentially surgical disease, while 19% (102 out of 550) were felt to have inoperable disease due to disease distribution. This figure was very similar to the 21% (140 out of 679) of the international CTEPH registry patients who were not offered surgery because of disease distribution when compared to pulmonary haemodynamic derangement [3]. Overall, the proportion of patients in our study who did not undergo PEA for reasons other than disease distribution and patient choice was not dissimilar to that observed in the international CTEPH registry (17% versus 12%).

Research paper thumbnail of Physicians’ Knowledge Of The Use Of Non Invasive Ventilation In Chronic Obstructive Pulmonary Disease

B36. CHRONIC OBSTRUCTIVE PULMONARY DISEASE NON-PHARMACOLOGIC TREATMENTS AND QUALITY OF LIFE, 2010

Research paper thumbnail of Vitamin D levels are inversely proportional to the “common cold”

Thorax, 2009

The role of vitamin D in bone metabolism and associated pathology is well established. This paper... more The role of vitamin D in bone metabolism and associated pathology is well established. This paper is the first high-powered population study to demonstrate an inverse relationship between vitamin D levels and recent upper respiratory tract infection (URTI). Vitamin D levels were measured in 18 883 participants in the Third National Health and Nutrition Examination Survey in the USA and they were …

Research paper thumbnail of An unusual presentation of left ventricular free wall rupture following a silent myocardial infarction

British Journal of Medical Practitioners, 2009

Left ventricular free wall rupture is a serious complication of myocardial infarction (MI) with a... more Left ventricular free wall rupture is a serious complication of myocardial infarction (MI) with a mortality rate without intervention close to 100%. Its presentation is classically late following an MI but in some cases can present within 24 hours. There can be sudden overt clinical symptoms or it can present insidiously and therefore there must be a high index of suspicion. This report highlights the case of a gentleman with no prior history of ischaemic heart disease that presented with non-specific symptoms. A diagnosis of left ventricular (LV) free wall rupture near the atrial appendage, post MI was made and he was managed successfully. Clinical Presentation We present the case of a 75 year old gentleman who collapsed suddenly whilst riding his bicycle. According to an eye-witness he was unresponsive & confused for a few minutes after the episode. Paramedics attended and brought him to the Accident and Emergency department at a local hospital and he was subsequently transferred ...

Research paper thumbnail of P183 Impact of patient choice on survival in patients with chronic thromboembolic pulmonary hypertension offered pulmonary endarterectomy

Pulmonary vascular disease: monitoring and managing, 2017

Research paper thumbnail of Effective strategies in recruitment and clinical orientation programme to manage NHS junior doctor workforce shortfall: a district general hospital experience

Future Healthcare Journal, 2020

Research paper thumbnail of Long term outcome, aetiological factors and predictors of mortality in chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension occurs when blood clots in the lungs do not resolve... more Chronic thromboembolic pulmonary hypertension occurs when blood clots in the lungs do not resolve. This causes the pressure in the lungs to rise and without treatment it is a serious condition which reduces life expectancy. It occurs in approximately 1 in 20 patients who have had a lung clot (also known as a pulmonary embolism). The condition can be potentially cured by an operation called pulmonary endarterectomy where the chronic lung clots are removed. However, not all patients are suitable for the operation and some patients who are suitable for the operation decline surgery. This study identifies a number of tests that can be used to identify patients at highest risk of dying and shows that surgery provides very good long term results which are superior to those who decline surgery. The results of this study will help doctors and patients with CTEPH when discussing treatment options. The authors conclude that more work is required to ensure that patients are counselled and supp...

Research paper thumbnail of Management of acute pulmonary embolism

British journal of hospital medicine, Oct 2, 2015

Purpose: Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prom... more Purpose: Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prompt diagnosis and management. While non-surgical approaches have supplanted surgery as primary treatment, surgical pulmonary embolectomy (SPE) remains a vital option for select patients. We review the current management of acute PE, with a focus on surgical therapy. Methods: A PubMed search was performed to identify literature regarding PE and treatment. Results were filtered to include the most comprehensive publications over the past decade. Results: PE is stratified based on presenting hemodynamic status or degree of mechanical pulmonary arterial occlusion. Although systemic or catheter-guided fibrinolysis is the preferred first-line treatment for the majority of cases, patients who are not candidates should be considered for SPE. Studies demonstrate no mortality benefit of thrombolysis over surgery. Systemic anticoagulation is a mainstay of treatment regardless of intervention approach. Following surgical embolectomy, direct oral anticoagulants (DOACs) have been shown to reduce recurrence of thromboembolism. Conclusions: Acute PE presents with varying degrees of clinical stability. Patients should be evaluated in the context of various available treatment options including medical, catheter-based, and surgical interventions. SPE is a safe and appropriate treatment option for appropriate patients.

Research paper thumbnail of Non-invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease: Results from an anonymous survey of physicians

Future healthcare journal, Feb 1, 2020

Non-invasive ventilation (NIV) is an evidence-based treatment modality for patients with acute ex... more Non-invasive ventilation (NIV) is an evidence-based treatment modality for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure (AHRF). It has been shown to reduce mortality, in-hospital complications, length of stay and is cost effective compared to invasive ventilation. Despite this, data from UK has shown higher mortality and a wide variation in practice in the use of NIV in AHRF.

Research paper thumbnail of Effective strategies in recruitment and clinical orientation programme to manage NHS junior doctor workforce shortfall: a district general hospital experience

Future healthcare journal, Feb 1, 2020

Research paper thumbnail of The Beneficial Effects of Oral Trimethoprim or Cotrimoxazole in Patients with Severe COVID-19: A Case Series

Social Science Research Network, 2020

COVID-19 may become a critical illness which is thought to be mediated by a cytokine storm syndro... more COVID-19 may become a critical illness which is thought to be mediated by a cytokine storm syndrome. There is no effective anti-viral treatment to date and the mainstay of treatment is supportive. We treated 22 patients with severe COVID-19 with oral trimethoprim (TMP) or cotrimoxazole (CTX) in addition to standard antibiotic therapy (ST) and compared this with 22 patients with severe COVID-19 receiving standard therapy alone. We observed that the patients with severe COVID-19 receiving TMP/CTX in addition to ST had significantly better outcomes including reduced in-patient mortality (5% versus 32%), length of hospital stay (mean, 9 versus 22 days), and the need for ventilatory support (numbers, 3 versus 16) with improved clinical parameters within 48 hours of starting treatment. This may be due to the anti-cytokine effects of TMP/CTX. Urgent clinical trials are recommended.

Research paper thumbnail of P0138 Fatal Laryngeal Swelling in Intensive Care Unit: A Case Report and Discussion of Ace-I Induced Angioedema

European Journal of Internal Medicine, May 1, 2009

when applying Framinghan charts (or the Spanish version DORICA) only points out less than 20% of ... more when applying Framinghan charts (or the Spanish version DORICA) only points out less than 20% of the population with high risk. Conclusions: Distribution of the different levels of global cardiovascular risk, evaluated individually, is slightly different in the patients that have MS, in which where the risk profile appears to be somewhat higher. If we consider that the MS is a high risk situation (as agreed upon by international consensus) the traditional instruments to calculate the risk underestimate it.It must be attributed to the fact that risk factors considered as diagnosis criteria are not included in most of the models for calculating the global CV risk.

Research paper thumbnail of The impact of high dose oral cotrimoxazole in patients with COVID-19 with hypoxic respiratory failure requiring non-invasive ventilation: A Case Control Study

medRxiv (Cold Spring Harbor Laboratory), Jan 15, 2021

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Research paper thumbnail of Serial cardiac MRI for assessment of cardiac morphology and function in CTEPH patients after PEA or vasodilator therapy

Research paper thumbnail of P183 Impact of patient choice on survival in patients with chronic thromboembolic pulmonary hypertension offered pulmonary endarterectomy

Research paper thumbnail of Chronic thrombo-embolic pulmonary hypertension: Long-term outcomes in operated and non-operated patients

Introduction: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a life shortening conditio... more Introduction: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a life shortening condition that may be cured by pulmonary endarterectomy.However, patients may not undergo surgery due to disease distribution, comorbidities or patient choice. Aims and objectives: To compare long term survival of patients with CTEPH undergoing pulmonary endarterectomy (CTEPH-surgical-operated), surgically accessible disease not undergoing endarterectomy due to comorbidities/patient choice (CTEPH-surgical-not-operated) and surgically inaccessible disease (CTEPH-non-surgical). Methods: Data was retrieved from the Sheffield ASPIRE Registry for consecutive, treatment-naive patients with CTEPH diagnosed between 2001 and 2015. Results: 613 patients, mean age(±standard deviation), 62±15 years, mean pulmonary arterial pressure 46±11mmHg and pulmonary vascular resistance 622±348dynes were identified and followed for 4.5±3.5 years. 5 year survival was significantly (p Conclusions: For patients with opera...

Research paper thumbnail of Physicians’ Knowledge Of The Use Of Non Invasive Ventilation In Chronic Obstructive Pulmonary Disease

Research paper thumbnail of Iatrogenic haemothorax – does extra benefit go hand-in-hand with extra risk? A case report and review of literature

Clinical Medicine, Mar 1, 2020

Research paper thumbnail of P28 Chronic thromboembolic pulmonary hypertension: long term outcomes in surgical and non-surgical patients

Thorax, Nov 15, 2016

Table 1 Baseline characteristics and results of invasive and non-invasive investigations. Gender ... more Table 1 Baseline characteristics and results of invasive and non-invasive investigations. Gender M/F 11 (69)/5 (31)

Research paper thumbnail of CMR Measures of Left Atrial Volume Index and Right Ventricular Function Have Prognostic Value in Chronic Thromboembolic Pulmonary Hypertension

Frontiers in Medicine, Mar 14, 2022

Providing prognostic information is important when counseling patients and planning treatment str... more Providing prognostic information is important when counseling patients and planning treatment strategies in chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to assess the prognostic value of gold standard imaging of cardiac structure and function using cardiac magnetic resonance imaging (CMR) in CTEPH. Consecutive treatment-naive patients with CTEPH who underwent right heart catheterization and CMR between 2011 and 2017 were identified from the ASPIRE (Assessing-the-Specturm-of-Pulmonary-hypertensIon-ata-REferral-center) registry. CMR metrics were corrected for age and sex where appropriate. Univariate and multivariate regression models were generated to assess the prognostic ability of CMR metrics in CTEPH. Three hundred and seventy-five patients (mean+/-standard deviation: age 64+/-14 years, 49% female) were identified and 181 (48%) had pulmonary endarterectomy (PEA). For all patients with CTEPH, left-ventricular-stroke-volume-index-%predicted (LVSVI%predicted) (p = 0.040), leftatrial-volume-index (LAVI) (p = 0.030), the presence of comorbidities, incremental shuttle walking test distance (ISWD), mixed venous oxygen saturation and undergoing PEA were independent predictors of mortality at multivariate analysis. In patients undergoing PEA, LAVI (p < 0.010), ISWD and comorbidities and in patients not undergoing surgery, right-ventricular-ejection-fraction-%predicted (RVEF%pred) (p = 0.040), age and ISWD were independent predictors of mortality. CMR metrics reflecting cardiac function and left heart disease have prognostic value in CTEPH. In those undergoing PEA, LAVI predicts outcome whereas in patients not undergoing PEA RVEF%pred predicts outcome. This study highlights the prognostic value of imaging cardiac structure and function in CTEPH and the importance of considering left heart disease in patients considered for PEA.

Research paper thumbnail of Decision-making in pulmonary endarterectomy surgery

The European respiratory journal, 2019

We would like to thank N.H. Kim and E. Mayer for their editorial based on our recent paper "The i... more We would like to thank N.H. Kim and E. Mayer for their editorial based on our recent paper "The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension" [1, 2]. We agree with many of their comments pertaining to the importance of referring patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) for assessment by a pulmonary endarterectomy (PEA) programme. We would, however, like to correct certain factual errors in their editorial which we feel create an incorrect picture of our practice at a large tertiary pulmonary hypertension referral centre. First, N.H. Kim and E. Mayer state that following remote assessment by a surgeon at our national PEA centre, 278 (50%) out of 550 of patients were deemed not to be candidates for PEA surgery. In fact, figure 1 in our original article [1] shows that 81% (448 out of 550) of patients were deemed by our national CTEPH multidisciplinary team (MDT) to have potentially surgical disease, while 19% (102 out of 550) were felt to have inoperable disease due to disease distribution. This figure was very similar to the 21% (140 out of 679) of the international CTEPH registry patients who were not offered surgery because of disease distribution when compared to pulmonary haemodynamic derangement [3]. Overall, the proportion of patients in our study who did not undergo PEA for reasons other than disease distribution and patient choice was not dissimilar to that observed in the international CTEPH registry (17% versus 12%).

Research paper thumbnail of Physicians’ Knowledge Of The Use Of Non Invasive Ventilation In Chronic Obstructive Pulmonary Disease

B36. CHRONIC OBSTRUCTIVE PULMONARY DISEASE NON-PHARMACOLOGIC TREATMENTS AND QUALITY OF LIFE, 2010

Research paper thumbnail of Vitamin D levels are inversely proportional to the “common cold”

Thorax, 2009

The role of vitamin D in bone metabolism and associated pathology is well established. This paper... more The role of vitamin D in bone metabolism and associated pathology is well established. This paper is the first high-powered population study to demonstrate an inverse relationship between vitamin D levels and recent upper respiratory tract infection (URTI). Vitamin D levels were measured in 18 883 participants in the Third National Health and Nutrition Examination Survey in the USA and they were …

Research paper thumbnail of An unusual presentation of left ventricular free wall rupture following a silent myocardial infarction

British Journal of Medical Practitioners, 2009

Left ventricular free wall rupture is a serious complication of myocardial infarction (MI) with a... more Left ventricular free wall rupture is a serious complication of myocardial infarction (MI) with a mortality rate without intervention close to 100%. Its presentation is classically late following an MI but in some cases can present within 24 hours. There can be sudden overt clinical symptoms or it can present insidiously and therefore there must be a high index of suspicion. This report highlights the case of a gentleman with no prior history of ischaemic heart disease that presented with non-specific symptoms. A diagnosis of left ventricular (LV) free wall rupture near the atrial appendage, post MI was made and he was managed successfully. Clinical Presentation We present the case of a 75 year old gentleman who collapsed suddenly whilst riding his bicycle. According to an eye-witness he was unresponsive & confused for a few minutes after the episode. Paramedics attended and brought him to the Accident and Emergency department at a local hospital and he was subsequently transferred ...

Research paper thumbnail of P183 Impact of patient choice on survival in patients with chronic thromboembolic pulmonary hypertension offered pulmonary endarterectomy

Pulmonary vascular disease: monitoring and managing, 2017

Research paper thumbnail of Effective strategies in recruitment and clinical orientation programme to manage NHS junior doctor workforce shortfall: a district general hospital experience

Future Healthcare Journal, 2020

Research paper thumbnail of Long term outcome, aetiological factors and predictors of mortality in chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension occurs when blood clots in the lungs do not resolve... more Chronic thromboembolic pulmonary hypertension occurs when blood clots in the lungs do not resolve. This causes the pressure in the lungs to rise and without treatment it is a serious condition which reduces life expectancy. It occurs in approximately 1 in 20 patients who have had a lung clot (also known as a pulmonary embolism). The condition can be potentially cured by an operation called pulmonary endarterectomy where the chronic lung clots are removed. However, not all patients are suitable for the operation and some patients who are suitable for the operation decline surgery. This study identifies a number of tests that can be used to identify patients at highest risk of dying and shows that surgery provides very good long term results which are superior to those who decline surgery. The results of this study will help doctors and patients with CTEPH when discussing treatment options. The authors conclude that more work is required to ensure that patients are counselled and supp...