Digital medicine is already well established in respiratory medicine through remote monitoring digital devices which are used in the day-to-day care of patients with asthma, COPD and sleep disorders. Image recognition software, deployed in thoracic radiology for many applications including lung cancer screening, is another application of digital medicine. Used as clinical decision support, this software will soon become part of day-to-day practice once concerns regarding generalisability have been addressed. Embodied in the electronic health record, digital medicine also plays a substantial role in the day-to-day clinical practice of respiratory medicine. Given the considerable work the electronic health record demands from clinicians, the next tangible impact of digital medicine may be artificial intelligence that aids administration, makes record keeping easier and facilitates better digital communication with patients. Future promises of digital medicine are based on their potential to analyse and characterise the large amounts of digital clinical data that are collected in routine care. Offering the potential to predict outcomes and personalise therapy, there is much to be excited by in this new epoch of innovation. However, these digital tools are by no means a silver bullet. It remains uncertain whether, let alone when, the promises of better models of personalisation and prediction will translate into clinically meaningful and cost-effective products for clinicians.

"Immunosuppressed Pets as a Conduit for Zoonotic Tuberculosis." American Journal of Respiratory and Critical Care Medicine, 208(6), pp. 732–733

Background: Multi-drug resistant Tuberculosis (MDR TB) represents approximately 5.7% of TB Worldwide. Prior to the advent of Bedaquiline in 2019, iv aminoglycosides were a mainstay of treatment for MDR TB. Methods: This study is a 15 year retrospective cohort study of all patients treated with IV aminoglycosides for MDR TB analysed the effect of these aminoglycosides on hearing loss and renal function in a National TB Referral Centre. Results: Over this time period, 26 patients were treated with IV amikacin for MDR TB. All patients had pre-and post-treatment audiology performed. 17 of these patients had subjective hearing loss, with 18 patients having confirmed objective hearing loss on audiology, and 19 patients reported tinnitus. A higher risk of developing objective hearing loss was seen in patients who were treated for longer durations with IV amikacin. Over half of all patients showed an increase in their creatinine of more than 10% above their pre-treatment baseline. While there was an association between duration of amikacin treatment and objective hearing loss, this was not statistically significant, once adjusted for confounders including age and gender. Conclusion: This study illustrates the high prevalence of hearing loss in patients with MDR TB prior to the advent of Bedaquiline, with both hearing loss and tinnitus causing significant burden of patient symptoms. Current, entirely oral based, MDR TB regimens are not associated with this risk.

Introduction/Aims: This study investigated whether the Covid-19 pandemic affected lung cancer presentation, in particular whether patients presented with later stage disease at diagnosis. Methods: This retrospective cohort study analysed new primary lung cancers staged at Lung Cancer multi-disciplinary meeting in a tertiary referral centre. We compared cancer stage in a 6-month period before the Covid-19 pandemic (Apr‘19-Sept‘19, Group 1) to a similar period following the start of the pandemic (Sept’20-Feb’21, Group 2). Comparison of patient demographics, tumour staging and treatment referrals were made. Results: In Group 1, 91 new lung cancers were staged at the Lung Cancer MDT, with a median age of 68. 58% of patients were male. In Group 2, fewer patients (41) were staged, with a median age of 70, with the majority being female (56%). 39% of those in Group 2 were current smokers versus 29.6% in Group 1. Median tumour size at time of diagnosis was larger in Group 2 (5.6cm vs 4.1cm), reflecting overall upgrading from T3 to T4. Group 2 presented with higher stage nodal disease, where 36.5% of patients presented with N3 disease, versus 20.9% in Group 1. Both groups saw approximately 30% of patients with metastatic disease (M-stage) at time of presentation. Conclusion: This study suggests patients are presenting with more advanced disease following the pandemic, with larger tumours, and higher burden of nodal disease. The cause for this is likely multifactorial, and may include patient reluctance to present to doctors for review. Further study is required to explore factors such as patient education and lung cancer screening that may prevent this trend towards later presenting disease.

Since its emergence in late 2019, COVID-19 (caused by the SARSCoV-2 virus) has affected over 100 million people worldwide to date. COVID-19 has been associated with a significant increase in thrombosis, particularly in patients requiring hospitalization, where it is estimated that up to 33% of patients have thrombotic events. The incidence is higher in those that are critically-ill with COVID-19 as per a recent JAMA paper which showed that in a US registry of patients with COVID-19, thrombotic complications occurred in 2.6% of 229 non-critically ill hospitalized patients and in 35.3% of 170 hospitalized critically ill patients. Intravascular coagulation resulting from endovascular disruption is a major contributor to patient mortality. As such, several studies, including the REMAP-CAP trial, ATTACC and ACTIV-4 trials are currently investigating the role for empiric therapeutic anti-coagulation in all patients with severe COVID-19 disease. However, therapeutic anti-coagulation is not without risk. This limited case series describes a single center, inpatient service experience of bleeding complications secondary to therapeutic anti-coagulation in the setting of COVID-19 infection, wherein 3 patients over a 6-week period suffered spontaneous bleeding into either rectus sheath or retroperitoneum.

Learning Point Point 1 - This case illustrates auto-antibody testing as an essential diagnostic tool in patients with idiopathic ILD. It is the first reported case of isolated anti-Ku-related ILD without clinical manifestation of CTD. This may represent an independent pathology or a diagnosis of ILD that precedes development of clinical manifestations of a CTD.

In January 2020, the WHO declared the SARS-CoV-2 outbreak a public health emergency; by March 11, a pandemic was declared. To date in Ireland, over 3300 patients have been admitted to acute hospitals as a result of infection with COVID-19. This article aims to describe the establishment of a COVID Recovery Service, a multidisciplinary service for comprehensive follow-up of patients with a hospital diagnosis of COVID-19 pneumonia. A hybrid model of virtual and in-person clinics was established, supported by a multidisciplinary team consisting of respiratory, critical care, infectious diseases, psychiatry, and psychology services. This model identifies patients who need enhanced follow-up following COVID-19 pneumonia and aims to support patients with complications of COVID-19 and those who require integrated community care. We describe a post-COVID-19 service structure together with detailed protocols for multidisciplinary follow-up. One hundred seventy-four patients were discharged from Beaumont Hospital after COVID-19 pneumonia. Sixty-seven percent were male with a median age (IQR) of 66.5 (51–97). Twenty-two percent were admitted to the ICU for mechanical ventilation, 11% had non-invasive ventilation or high flow oxygen, and 67% did not have specialist respiratory support. Early data suggests that 48% of these patients will require medium to long-term specialist follow-up. We demonstrate the implementation of an integrated multidisciplinary approach to patients with COVID-19, identifying those with increased physical and mental healthcare needs. Our initial experience suggests that significant physical, psychological, and cognitive impairments may persist despite clinical resolution of the infection.