Umar Chaudhry

St George's, University of London

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Derek G. Cook

St George's, University of London

Tess Harris

St George's, University of London

Iain M. Carey

St George's, University of London

Stephen DeWilde

St George's, University of London

Thanos Athanasiou

Imperial College London

Julia Critchley

St George's, University of London

Elizabeth Limb

St George's, University of London

Leanne Harling

Imperial College London

Peter H. Whincup

St George's, University of London

Hutan Ashrafian

Imperial College London

Cooperative Institutions

Virginia Department of Environmental Quality

143

Accreditation Council for Graduate Medical Education

131

Pediatric Oncology Group

120

Society of Thoracic Surgeons

University College London

St George's, University of London

Valve (United States)

Emory University

Imperial College London

New York Proton Center

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A matched cohort study evaluating the risks of infections in people with type 1 diabetes and their associations with glycated haemoglobin

Diabetes Research and Clinical Practice (2023)

Umar Chaudhry Iain M. Carey Julia Critchley Stephen DeWilde Elizabeth Limb

AimsPeople with type 1 diabetes (T1D) have raised infection rates compared to those without, but how these risks vary by age, sex and ethnicity, or by glycated haemoglobin (HbA1c), remain uncertain.Methods33,829 patients with T1D in Clinical Practice Research Datalink on 01/01/2015 were age-sex-ethnicity matched to two non-diabetes patients. Infections were collated from primary care and linked hospitalisation records during 2015–2019, and incidence rate ratios (IRRs) were estimated versus non-diabetes. For 26,096 people with T1D, with ≥3 HbA1c measurements in 2012–2014, mean and coefficient of variation were estimated, and compared across percentiles.ResultsPeople with T1D had increased risk for infections presenting in primary care (IRR = 1.81, 95%CI 1.77–1.85) and hospitalisations (IRR = 3.37, 3.21–3.53) compared to non-diabetes, slightly attenuated after further adjustment. Younger ages and non-White ethnicities had greater relative risks, potentially explained by higher HbA1c mean and variability amongst people with T1D within these sub-groups. Both mean HbA1c and greater variability were strongly associated with infection risks, but the greatest associations were at the highest mean levels (hospitalisations IRR = 4.09, 3.64–4.59) for >97 versus ≤53 mmol/mol.ConclusionsInfections are a significant health burden in T1D. Improved glycaemic control may reduce infection risks, while prompter infection treatments may reduce hospital admissions.

Glycated haemoglobin

Rate ratio

10.1016/j.diabres.2023.111023

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Risk factors for excess all-cause mortality during the first wave of the COVID-19 pandemic in England: A retrospective cohort study of primary care data

DOAJ (DOAJ: Directory of Open Access Journals) (2021)

Iain M. Carey Derek G. Cook Tess Harris Stephen DeWilde Umar Chaudhry

Pandemic

Excess mortality

2019-20 coronavirus outbreak

Third wave

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Prevalence and incidence of neuromuscular conditions in the UK between 2000 and 2019: A retrospective study using primary care data

DOAJ (DOAJ: Directory of Open Access Journals) (2021)

Iain M. Carey Emma Banchoff Niranjanan Nirmalananthan Tess Harris Stephen DeWilde

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Modern management of systolic anterior motion of the mitral valve

European Journal of Cardio-Thoracic Surgery (2012)

Michael Ibrahim Christopher Rao Hutan Ashrafian Umar Chaudhry Ara Darzi

Systolic anterior motion (SAM) of the mitral valve (MV) can be a life-threatening condition. The SAM can result in severe left ventricular outflow tract obstruction and/or mitral regurgitation and is associated with an up to 20% risk of sudden death (which is substantially lower in hypertrophic cardiomyopathy (HCM)). The mechanisms of SAM are complex and depend on the functional status of the ventricle. The SAM can occur in the normal population, but is typically observed in patients with HCM or following MV repair. Echocardiography (2D, 3D and stress) has a central diagnostic role as the application of echocardiographic SAM predictors allows the incorporation of prevention techniques during surgery and post-operative SAM assessment. Cardiac magnetic resonance imaging has a special role in understanding the dynamic nature of SAM, especially in anatomically atypical hearts (including HCM). This article describes what the clinician needs to know about SAM ranging from pathophysiological mechanisms and imaging modalities to conservative (medical) and surgical approaches and their respective outcomes. A stepwise approach is advocated consisting of medical therapy, followed by aggressive volume loading and beta-adrenoceptor blockade. Surgery is the final option. The correct choice of surgical technique requires an understanding of the anatomical substrate of SAM.

Mitral valve replacement

10.1093/ejcts/ezr232

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Citations (109)

Myasthenia Gravis-Like Syndrome Resulting From Immune Checkpoint Inhibitors in a Patient With Urothelial Carcinoma

Cureus (2024)

Alvaro J Vivas Umar Chaudhry Naveen Punchayil Narayanankutty Ramón López Jorge Lamarche

The widespread use of immune checkpoint inhibitors (ICIs) for the treatment of various types of cancer has led to increasing reports of associated adverse effects. The use of the ipilimumab/nivolumab/sacituzumab combination is currently under study in patients with metastatic urothelial carcinoma, given their potential synergism for immunogenic cell death. Information regarding the toxicity spectrum of this combination is lacking. Here, we describe a patient with urothelial carcinoma who had a severe multisystem autoimmune-like toxicity and myasthenia gravis-like syndrome in response to the ipilimumab/nivolumab/sacituzumab combination therapy. We also briefly describe the literature regarding the association between combined immunotherapy use and systemic and neurological autoimmunity.

Immune checkpoint

Thymic carcinoma

10.7759/cureus.60003

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Evaluating ethnic variations in the risk of infections in people with prediabetes and type 2 diabetes: a matched cohort study

Iain M. Carey Julia Critchley Umar Chaudhry Stephen DeWilde Elizabeth Limb

<p> </p> <h3>Objective</h3> <p>People living with type 2 diabetes (T2DM) are at higher infection risk, but it is unknown how this risk varies by ethnicity, or whether the risk is similarly observed in people with non-diabetic hyperglycaemia (“prediabetes”).</p> <h3>Research Design and Methods</h3> <p>We included 527,151 patients in England with T2DM and 273,216 with prediabetes, aged 18-90 and alive on 1st January 2015 on the Clinical Practice Research Datalink. Each were matched to 2 patients without diabetes or prediabetes on age, sex and ethnic group. Infections during 2015-9 were collated from primary care and linked hospitalisation records. Infection incidence rate ratios (IRR) for prediabetes or T2DM were estimated, unadjusted and adjusted for confounders.</p> <h3>Results</h3> <p>People with T2DM had increased risk for infections presenting in primary care (IRR=1.51, 95%CI 1.51-1.52) and hospitalisations (IRR=1.91, 1.90-1.93). This was broadly consistent overall within each ethnic group, though younger White T2DM patients (age <50) experienced a greater relative risk. Adjustment for socio-economic deprivation, smoking and co-morbidity attenuated associations, but IRRs remained similar by ethnicity. For prediabetes, a significant but smaller risk was observed (primary care IRR=1.35 1.34-1.36, hospitalisation IRR=1.33, 1.31-1.35); these were similar within each ethnicity for primary care infections, but less consistent for infection related hospitalisations.</p> <h3>Conclusions</h3> <p>The elevated infection risk for people with T2DM appears similar for different ethnic groups and is also seen in people with prediabetes. Infections are a substantial cause of ill-health and health service use for people with prediabetes and T2DM. This has public health implications with rising prediabetes and diabetes prevalence. </p>

Prediabetes

Rate ratio

10.2337/figshare.22266118.v1

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Contribution of infection to mortality in people with type 2 diabetes: a population-based cohort study using electronic records

The Lancet Regional Health - Europe (2024)

Iain M. Carey Julia Critchley Umar Chaudhry Stephen DeWilde Elizabeth Limb

Health records

10.1016/j.lanepe.2024.101147

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Citations (2)

OP06 Incident cardiovascular events before and after tuberculosis diagnosis: results from two large electronic health databases

SSM Annual Scientific Meeting (2024)

Elizabeth Limb Anjali Khakharia Iain M. Carey Stephen De Wilde Tess Harris

10.1136/jech-2024-ssmabstracts.6

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What are the perceptions and concerns of people living with diabetes and National Health Service staff around the potential implementation of AI-assisted screening for diabetic eye disease? Development and validation of a survey for use in a secondary care screening setting

BMJ Open (2023)

Kathryn Willis Umar Chaudhry Lakshmi Chandrasekaran Charlotte Wahlich Abraham Olvera‐Barrios

Introduction The English National Health Service (NHS) Diabetic Eye Screening Programme (DESP) performs around 2.3 million eye screening appointments annually, generating approximately 13 million retinal images that are graded by humans for the presence or severity of diabetic retinopathy. Previous research has shown that automated retinal image analysis systems, including artificial intelligence (AI), can identify images with no disease from those with diabetic retinopathy as safely and effectively as human graders, and could significantly reduce the workload for human graders. Some algorithms can also determine the level of severity of the retinopathy with similar performance to humans. There is a need to examine perceptions and concerns surrounding AI-assisted eye-screening among people living with diabetes and NHS staff, if AI was to be introduced into the DESP, to identify factors that may influence acceptance of this technology. Methods and analysis People living with diabetes and staff from the North East London (NEL) NHS DESP were invited to participate in two respective focus groups to codesign two online surveys exploring their perceptions and concerns around the potential introduction of AI-assisted screening. Focus group participants were representative of the local population in terms of ages and ethnicity. Participants’ feedback was taken into consideration to update surveys which were circulated for further feedback. Surveys will be piloted at the NEL DESP and followed by semistructured interviews to assess accessibility, usability and to validate the surveys. Validated surveys will be distributed by other NHS DESP sites, and also via patient groups on social media, relevant charities and the British Association of Retinal Screeners. Post-survey evaluative interviews will be undertaken among those who consent to participate in further research. Ethics and dissemination Ethical approval has been obtained by the NHS Research Ethics Committee (IRAS ID: 316631). Survey results will be shared and discussed with focus groups to facilitate preparation of findings for publication and to inform codesign of outreach activities to address concerns and perceptions identified.

10.1136/bmjopen-2023-075558

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Citations (1)

Your Subjective Age Is More Important Than Your Actual Age, Study Finds

Science Trends (2018)

Umar Chaudhry

10.31988/scitrends.23081

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