Browsing by Author "Emhemed, Mohamed"

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    Cardiac sarcoidosis defined by cardiovascular magnetic resonance: patient characteristics and outcomes
    (2022) Emhemed, Mohamed; Ntusi, Ntobeko A B
    Introduction: Sarcoidosis is an inflammatory disorder that affects multiple systems. On histologic examination, sarcoidosis is defined by the production of non-caseating granulomas. Cardiac sarcoidosis (CS) is common, occurring in 20% or more of patients with systemic sarcoidosis, but because many people with CS may have nonspecific clinical manifestations or subclinical disease, the real extent of the disease prevalence is uncertain and possibly underestimated. Methods: Medical records of patients with CS diagnosed by cardiovascular magnetic resonance (CMR) were selected for inclusion into this study. We identified patients with a diagnosis of CS by CMR between March 2005 and January 2018 at Groote Schuur Hospital, Cape Town, South Africa and included into the South African Cardiovascular Magnetic Resonance (SA-CMR) registry. The demographics, clinical profile, and outcomes of patients diagnosed with CS via CMR were summarised utilising proportions, medians with interquartile ranges (IQRs), and means with standard deviations (SDs), as appropriate. Fisher's exact test was utilised to compare proportions, while T tests and Mann-Whitney U-tests were utilised to compare means and medians, respectively. Statistical Package for Social Sciences (version 26) program was used to analyse the data. Results: Medical records of 35 patients with a confirmed diagnosis of CS using CMR during the study period were identified. There were 21 (60%) males, and a male: female ratio of 1.5:1. The mean age of study participants was 50.3 ± 11 years. Most patients (84%) were overweight and obese, and comorbidities included hypertension (9%) and diabetes mellitus (3%). Nearly a quarter (23%) of patients presented with complete heart block and a third (31%) had ventricular tachycardia (VT) as the initial presentation. Half (54%) of patients had a permanent pacemaker or implantable cardioverter defibrillator implanted. A third (34%) of patients had evidence of acute myocardial oedema on T2-weighted imaging and T2 mapping, and 91% of subjects had evidence of focal fibrosis/infiltration on late gadolinium enhancement (LGE). Most patients (80%) had normal pericardial thickness and small pericardial effusions (< 1 cm) were noted in 49%. Extra-cardiac findings of sarcoidosis were characterised by hilar lymphadenopathy and pulmonary interstitial involvement (49%) and pleural effusions (11%). There were no deaths during the study period and median follow-up of 7 years. Conclusions: Sarcoidosis is a granulomatous systemic multiorgan condition that is a challenge to diagnose and manage in many settings. The availability of CMR has made it possible to diagnose CS noninvasively. We show that in our setting CS is characterised by oedema in a third of patients and evidence of LGE in almost all patients. Heart block and VT are common presentations; however, the prognosis is good with modern device therapies once the diagnosis has been made.
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    Difficulties and challenges in implementing screening for lung cancer in high-risk group patients in the respiratory clinic at Groote Schuur Hospital
    (2025) Emhemed, Mohamed; Van Zyl-Smit, Richard
    Introduction: Lung cancer is the leading cause of cancer related deaths in South Africa. The high prevalence of cigarette smoking in our population continues to contribute to the high burden of lung cancer. Screening high risk groups with annual low dose computed tomography (LDCT) has demonstrated the potential benefit of being able to identify individuals with early-stage disease and offer potential curative therapy from this deadly disease. Objective: To determine the barriers and challenges of implementing lung cancer screening in a group of high-risk patients with underling Chronic Obstructive Pulmonary Disease (COPD). Methods: We retrospectively analysed patient records of COPD patients attending the respiratory clinic at Groote Schuur Hospital, Cape Town in the year 2022. Eligibility for lung cancer screening included formal diagnosis of COPD, age 55-74 years, at least 30 pack year history of smoking or stopped smoking within the past 15 years, no history of lung cancer, good general health, fitness for surgery and patients' willingness to undergo further invasive investigations and treatment. Fitness for surgery was objectively determined by a modified Medical Research Council (mMRC) score less than 3 and FEV1 greater than one litre. Results: 116 patients with COPD were screened for eligibility for lung cancer screening. The mean (SD) age was 62.84(10.4) years and 56.1% were male. 44 (37.9%) patients were current smokers, 68 (58.6) were ex-smokers and 4 (3.5%) never smoked. Hypertension (46.6%) was the most common medical comorbidity, followed by previous tuberculosis (19.0%) and diabetes (7.8%). 16 (13.8%) patients were potentially eligible for lung cancer screening. 47 patients had a FEV1 < 1L, 54 participants had a mMRC of 3 and above and 38 patients were excluded because of age. Conclusion: Common clinical factors which made patients ineligible for lung cancer screening in our study are age and poor surgical candidates based on mMRC class and low FEV1. Tertiary service severe/multimorbid COPD clinics provide few patients for lung cancer screening, community-based service may provide a better yield of patients for active lung cancer screening.