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Jordan A, Näslund-Koch C, Vedel-Krogh S, Egil Bojesen S, Skov L. Alcohol consumption and risk of psoriasis: Results from observational and genetic analyses in more than 100,000 individuals from the Danish general population. JAAD Int 2024; 15:197-205. [PMID: 38707928 PMCID: PMC11066682 DOI: 10.1016/j.jdin.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 05/07/2024] Open
Abstract
Background Psoriasis is associated with high alcohol consumption, but the causality of this relationship is unclear. Objective We aimed to use a Mendelian randomization approach to investigate the causal effects of alcohol on incident psoriasis. Methods We included 102,655 adults from the prospective Copenhagen studies. All participants filled out a questionnaire on alcohol consumption, were physically examined, and had blood drawn for biochemical and genetic analyses. We created a genetic instrument based on the number of fast-metabolizing alleles in alcohol dehydrogenase 1B and alcohol dehydrogenase 1C, known to be associated with alcohol consumption, to test whether alcohol consumption was causally associated with psoriasis. Results Observationally, we found an increased risk of incident psoriasis among individuals with high alcohol consumption compared to those with low alcohol consumption with a hazard ratio of 1.30 (95% confidence interval 1.05-1.60) in the fully adjusted model. Using genetic data to predict alcohol consumption to avoid confounding and reverse causation, we found no association between number of fast-metabolizing alleles and risk of psoriasis. Limitations Alcohol consumption was self-reported and psoriasis was defined using the International Classification of Diseases 10th revision and 8th revision codes. Conclusion Alcohol consumption is observationally but not causally associated with incident psoriasis.
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Affiliation(s)
- Alexander Jordan
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Charlotte Näslund-Koch
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Signe Vedel-Krogh
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Stig Egil Bojesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Copenhagen City Heart Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Aguilar G, Lopez G, Sued O, Medina N, Caceres DH, Pereira J, Jordan A, Lezcano V, Vicenti C, Benitez G, Samudio T, Perez F. Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay. BMC Infect Dis 2024; 24:406. [PMID: 38627642 PMCID: PMC11020460 DOI: 10.1186/s12879-024-09257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Opportunistic infections (OIs) are common causes of mortality among people living with HIV (PLHIV). We determined prevalence and 30-day mortality due to histoplasmosis, cryptococcosis, and TB in PLHIV with advanced HIV disease (AHD). METHODS PLHIV 18 years and older, with a CD4 + T-cell count of less than 350 cells/mm3 newly diagnosed with HIV infection or re-engaged in care after being without ART for more than 90 days (Group A). The second group included symptomatic PLHIV regardless of ART status or CD4 + T-cell count (Group B); all followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was done by enzyme immunoassay (EIA), Cryptococcus antigen (CrAg) was detected in serum and cerebrospinal fluid (CSF) specimens by lateral flow assay (LFA), and lipoarabinomannan (LAM) detection in urine was by LFA (TB LAM) and in sputum by GeneXpert for diagnosis of Mycobacterium infections. RESULTS From August 2021 to June 2022, 491 PLHIV were enrolled; 482 (98%) had a CD4 + T-cell result, and 381 patients (79%) were classified with AHD according to CD4 + T-cell count (< 200 CD4/mm3). Frequency of an OI was 38% (n = 145/381). Antigen test positivity rate was 16% (72/467) for TB-LAM, 9% (43/464) for HisAg, and 11% (51/484) for CrAg. Twenty-one of 34 (62%) patients receiving CSF CrAg tests were positive, confirming meningitis. Significant differences in 30-day mortality were observed in patients with an OI (16%) vs. no OI (7%) (p = 0.002). Mortality was highest in patients with histoplasmosis (25%), co-infection (22%), cryptococcosis (18% overall; 19% for cryptococcal meningitis), and TB (10%). CONCLUSIONS TB and fungal OIs, including co-infection, were common in PLHIV in Paraguay and had high associated mortality. Laboratories and health facilities need access to CD4 + T-cell testing and rapid diagnostic assays.
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Affiliation(s)
- Gloria Aguilar
- National HIV Program, Asunción, Paraguay
- Facultad de Ciencias de la Salud, Universidad Sudamericana, Amambay, Paraguay
| | | | - Omar Sued
- Communicable Diseases Prevention, Control, and Elimination and Environmental Determinants of Health Department, Pan American Health Organization, 525 23rd St. NW, 20037, Washington, DC, USA
| | - Narda Medina
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), ASRT, Inc., Centers for Disease Control and Prevention, 30333, Atlanta, GA, USA
| | - Diego H Caceres
- IMMY, Inc., 73069, Norman, OK, USA
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Jose Pereira
- Centro de Especialidades Dermatológicas, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - Alexander Jordan
- Mycotic Diseases Branch-Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | | | | | | | - Freddy Perez
- Communicable Diseases Prevention, Control, and Elimination and Environmental Determinants of Health Department, Pan American Health Organization, 525 23rd St. NW, 20037, Washington, DC, USA.
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
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Rastoder E, Kamstrup P, Hedsund C, Jordan A, Sivapalan P, Rømer V, Falkvist F, Hamidi S, Bendstrup E, Sperling S, Dons M, Biering-Sørensen T, Falster C, Laursen CB, Carlsen J, Jensen JUS. Thrombelastography and Conventional Coagulation Markers in Chronic Obstructive Pulmonary Disease: A Prospective Paired-Measurements Study Comparing Exacerbation and Stable Phases. Int J Mol Sci 2024; 25:2051. [PMID: 38396728 PMCID: PMC10889576 DOI: 10.3390/ijms25042051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) exacerbation is known for its substantial impact on morbidity and mortality among affected patients, creating a significant healthcare burden worldwide. Coagulation abnormalities have emerged as potential contributors to exacerbation pathogenesis, raising concerns about increased thrombotic events during exacerbation. The aim of this study was to explore the differences in thrombelastography (TEG) parameters and coagulation markers in COPD patients during admission with exacerbation and at a follow-up after discharge. This was a multi-center cohort study. COPD patients were enrolled within 72 h of hospitalization. The baseline assessments were Kaolin-TEG and blood samples. Statistical analysis involved using descriptive statistics; the main analysis was a paired t-test comparing coagulation parameters between exacerbation and follow-up. One hundred patients participated, 66% of whom were female, with a median age of 78.5 years and comorbidities including atrial fibrillation (18%) and essential arterial hypertension (45%), and sixty-five individuals completed a follow-up after discharge. No significant variations were observed in Kaolin-TEG or conventional coagulation markers between exacerbation and follow-up. The Activated Partial Thromboplastin Clotting Time (APTT) results were near-significant, with p = 0.08. In conclusion, TEG parameters displayed no significant alterations between exacerbation and follow-up.
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Affiliation(s)
- Ema Rastoder
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Caroline Hedsund
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Alexander Jordan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Valdemar Rømer
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Frederikke Falkvist
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Sadaf Hamidi
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (S.S.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Søren Sperling
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (S.S.)
| | - Maria Dons
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark (T.B.-S.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2900 Hellerup, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark (T.B.-S.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2900 Hellerup, Denmark
| | - Casper Falster
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of South Denmark, 5000 Odense, Denmark; (C.F.); (C.B.L.)
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Christian B. Laursen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of South Denmark, 5000 Odense, Denmark; (C.F.); (C.B.L.)
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Jørn Carlsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
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Pedersen K, van Schalkwyk J, Brewerton M, Jordan A, Cooke P. Penicillin cross-sensitivity in patients with confirmed peri-operative allergic hypersensitivity reactions to cefazolin: a retrospective observational study. Anaesthesia 2024; 79:208-210. [PMID: 37989486 DOI: 10.1111/anae.16185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Affiliation(s)
- K Pedersen
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - J van Schalkwyk
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - M Brewerton
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - A Jordan
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - P Cooke
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
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Shteinberg M, Sibila O, Stein N, Faner R, Jordan A, Olvera N, Sivapalan P, Jensen JUS, Crichton M, Marrades P, Chalmers JD, Meyer CN, Saliba W. Risk of SARS-CoV-2 Infection and Disease Severity Among People With Bronchiectasis: Analysis of Three Population Registries. Chest 2024; 165:79-83. [PMID: 37574165 DOI: 10.1016/j.chest.2023.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/17/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Michal Shteinberg
- Pulmonary Institute and CF Center, Carmel Medical Center, Haifa, Israel; B. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel.
| | - Oriol Sibila
- Respiratory Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Rosa Faner
- Respiratory Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Alexander Jordan
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nuria Olvera
- Respiratory Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pradeesh Sivapalan
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Ulrik S Jensen
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Megan Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, England
| | - Pau Marrades
- Respiratory Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, England
| | - Christian N Meyer
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Medicine, Respiratory Unit, SUH-Roskilde, Copenhagen, Denmark
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel; B. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
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Pedersen K, van Schalkwyk J, Brewerton M, Jordan A, Cooke P. Retrospective observational study of the incidence of peri-operative allergic hypersensitivity reactions to cefazolin. Anaesthesia 2023; 78:1502-1504. [PMID: 37451258 DOI: 10.1111/anae.16101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Affiliation(s)
- K Pedersen
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - J van Schalkwyk
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - M Brewerton
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - A Jordan
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
| | - P Cooke
- Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand
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7
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Rajasingham R, Medina N, Mousquer GT, Caceres DH, Jordan A, Nacher M, Falci DR, Sebro A, Pasqualotto AC, Sued O, Chiller T, Perez F. Cost-effectiveness evaluation of routine histoplasmosis screening among people living with advanced HIV disease in Latin America and the Caribbean. PLOS Glob Public Health 2023; 3:e0001861. [PMID: 37582115 PMCID: PMC10427011 DOI: 10.1371/journal.pgph.0001861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/03/2023] [Indexed: 08/17/2023]
Abstract
Histoplasma antigen can be detected in people with advanced HIV disease (AHD), allowing for early and accurate diagnosis of histoplasmosis. The aim of this analysis was to assess the cost-effectiveness of routine histoplasmosis screening using antigen detection, among people with AHD. We developed a decision analytic model to evaluate Histoplasma antigen screening among people with AHD. The model estimated the costs, effectiveness, and cost-effectiveness of routine screening for Histoplasma antigen compared to the current practice of no routine Histoplasma antigen screening. The model includes stratification by symptoms of histoplasmosis, severity of presentation, and estimates of 30-day mortality. Data sources were taken from the Pan American Health Organization (PAHO) Strategic Fund databases on public purchases of medicines, and published literature on treatment outcomes. Outcome measures are life years saved (LYS), costs (US dollars), and incremental cost-effectiveness ratios (ICERs). Routine Histoplasma antigen screening avoids an estimated 17% of deaths in persons with advanced HIV disease, and is cost-effective compared to no histoplasmosis screening, with an ICER of $26/LYS. In sensitivity analysis assuming treatment for histoplasmosis with liposomal amphotericin, Histoplasma antigen screening remains cost-effective with an ICER of $607/LYS. Histoplasma antigen screening among people with AHD is a cost-effective strategy and could potentially avert 17% of AIDS-related deaths. Prospective evaluation of histoplasmosis screening is warranted to determine effectiveness and treatment outcomes with this strategy.
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Affiliation(s)
- Radha Rajasingham
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Narda Medina
- ASRT, Inc., Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gabriel T. Mousquer
- Graduate Program in Biosciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Diego H. Caceres
- Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Alexander Jordan
- Mycotic Diseases Branch -Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mathieu Nacher
- Center for Clinical Investigation Antilles-Guyane, Inserm 1424, Cayenne Hospital, Cayenne, French Guiana, France
| | - Diego R. Falci
- Infectious Diseases Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ayanna Sebro
- National AIDS Coordinating Committee Secretariat, Port of Spain, Trinidad & Tobago
| | - Alessandro C. Pasqualotto
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Omar Sued
- Communicable Diseases Prevention, Control, and Elimination Department, Pan American Health Organization, District of Colombia, United States of America
| | - Tom Chiller
- Mycotic Diseases Branch -Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Freddy Perez
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Communicable Diseases Prevention, Control, and Elimination Department, Pan American Health Organization, District of Colombia, United States of America
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Smith DJ, Gold JAW, Benedict K, Wu K, Lyman M, Jordan A, Medina N, Lockhart SR, Sexton DJ, Chow NA, Jackson BR, Litvintseva AP, Toda M, Chiller T. Public Health Research Priorities for Fungal Diseases: A Multidisciplinary Approach to Save Lives. J Fungi (Basel) 2023; 9:820. [PMID: 37623591 PMCID: PMC10455901 DOI: 10.3390/jof9080820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Fungal infections can cause severe disease and death and impose a substantial economic burden on healthcare systems. Public health research requires a multidisciplinary approach and is essential to help save lives and prevent disability from fungal diseases. In this manuscript, we outline the main public health research priorities for fungal diseases, including the measurement of the fungal disease burden and distribution and the need for improved diagnostics, therapeutics, and vaccines. Characterizing the public health, economic, health system, and individual burden caused by fungal diseases can provide critical insights to promote better prevention and treatment. The development and validation of fungal diagnostic tests that are rapid, accurate, and cost-effective can improve testing practices. Understanding best practices for antifungal prophylaxis can optimize prevention in at-risk populations, while research on antifungal resistance can improve patient outcomes. Investment in vaccines may eliminate certain fungal diseases or lower incidence and mortality. Public health research priorities and approaches may vary by fungal pathogen.
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Affiliation(s)
- Dallas J. Smith
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.W.G.); (K.B.); (K.W.); (M.L.); (A.J.); (N.M.); (S.R.L.); (D.J.S.); (N.A.C.); (B.R.J.); (A.P.L.); (M.T.)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tom Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.W.G.); (K.B.); (K.W.); (M.L.); (A.J.); (N.M.); (S.R.L.); (D.J.S.); (N.A.C.); (B.R.J.); (A.P.L.); (M.T.)
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Jordan A, Toennesen LL, Eklöf J, Sivapalan P, Meteran H, Bønnelykke K, Ulrik CS, Stæhr Jensen JU. Psychiatric Adverse Effects of Montelukast-A Nationwide Cohort Study. J Allergy Clin Immunol Pract 2023; 11:2096-2103.e1. [PMID: 36948487 DOI: 10.1016/j.jaip.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/13/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Recent observational studies suggest that the leukotriene receptor antagonist montelukast may have neuropsychiatric adverse effects; however, results are conflicting. OBJECTIVE To assess whether montelukast exposure in adults with asthma is associated with onset of neuropsychiatric adverse events using data from the Danish nationwide health registers. METHODS Individuals 18 years old or older with either 1 or more prescription redemption of inhaled corticosteroids or with at least 1 hospital contact with asthma as the main diagnosis between January 1, 2011, and December 31, 2018, were included. Montelukast exposure was assessed as a time-dependent variable. The 2 outcomes of interest were use of neuropsychiatric medicine including antidepressants, antipsychotics, anxiolytics, lithium, and medication used for attention-deficit/hyperactivity disorder (outcome 1), and hospital contacts with a neuropsychiatric diagnosis (outcome 2), within 90 days of exposure to montelukast. RESULTS Initiation of montelukast was significantly associated with outcome 1: use of neuropsychiatric medicine (hazard ratio [95% confidence interval]) 1.14 [1.08-1.20]; P < .0001). In the assessment of outcome 2: hospital contacts with a neuropsychiatric diagnosis, a significant risk associated with montelukast initiation was found only in the youngest age groups (hazard ratio [95% confidence interval] 1.28 [1.12-1.47], P < .001 and 1.16 [1.02-1.31]; P < .05, for age group 18-29 y and 30-44 y, respectively). Age-stratified analyses showed that the risk of both outcomes increased with decreasing age, with the highest risk seen in patients aged 18 to 29 years. CONCLUSIONS Among younger individuals, montelukast use was significantly associated with an increased risk of neuropsychiatric events such as use of neuropsychiatric medicine and hospital treatment. Clinicians should increase awareness of such adverse effects when prescribing montelukast.
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Affiliation(s)
- Alexander Jordan
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Louise Lindhardt Toennesen
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark; Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark.
| | - Josefin Eklöf
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark; Department of Respiratory Medicine, Zealand University Hospital-Roskilde, Copenhagen, Denmark
| | - Howraman Meteran
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark; Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
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Jordan A, Sivapalan P, Rømer V, Jensen JU. Time-Updated Phenotypic Guidance of Corticosteroids and Antibiotics in COPD: Rationale, Perspective and a Proposed Method. Biomedicines 2023; 11:biomedicines11051395. [PMID: 37239067 DOI: 10.3390/biomedicines11051395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with distinct phenotypes, each having distinct treatment needs. Eosinophilic airway inflammation is present in a subset of COPD patients in whom it can act as a driver of exacerbations. Blood eosinophil counts are a reliable way to identify patients with an eosinophilic phenotype, and these measurements have proven to be successful in guiding the use of corticosteroids in moderate and severe COPD exacerbations. Antibiotic use in COPD patients induces a risk of Clostridium difficile infection, diarrhea, and antibiotic resistance. Procalcitonin could possibly guide antibiotic treatment in patients admitted with AECOPD. Current studies in COPD patients were successful in reducing exposure to antibiotics with no changes in mortality or length of stay. Daily monitoring of blood eosinophils is a safe and effective way to reduce oral corticosteroid exposure and side effects for acute exacerbations. No evidence on time-updated treatment guidance for stable COPD exists yet, but a current trial is testing an eosinophil-guided approach on inhaled corticosteroid use. Procalcitonin-guided antibiotic treatment in AECOPD shows promising results in safely and substantially reducing antibiotic exposure both in time-independent and time-updated algorithms.
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Affiliation(s)
- Alexander Jordan
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark
| | - Valdemar Rømer
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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11
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Jordan A, Wilson AD. A comprehensive overview by region of condoms, natural family planning, and spermicide as a contraceptive method among men aged 13-54 years attending contraceptive services in England. Public Health 2023; 219:110-116. [PMID: 37163786 DOI: 10.1016/j.puhe.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/20/2023] [Accepted: 03/27/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES This study aimed to (1) provide a comprehensive overview of contraceptive methods self-reported by men in England, over 5 years, focusing on condoms in comparison to any male method; and (2) explore condom as a contraceptive method by region and ethnicity. STUDY DESIGN Data were from the Sexual and Reproductive Health Services (Contraception) England census data set from 2014/15 to 2018/19. Once missing data were removed, this left a total of 365,292 men. Two binomial logistic regression models were performed. Model 1 examined ethnicity, region, and time on condom as a method of contraception; and Model 2 examined ethnicity, region, and time by any male contraceptive. Descriptive statistics were run for natural family planning and spermicide. RESULTS Model 1 revealed a significant model, χ2 (15) = 30,976, P < 0.001, and predicted that condoms as a method decreased in London with a greater decrease in Midlands. London saw the lowest rate of decline among the non-White ethnic group, whereas North and South regions increased probability over time. The North started at a higher probability and the South at the lowest. Model 2 also revealed a significant model, χ2 (15) = 32,472, P < 0.001, with a similar pattern to Model 1. Contingency tables showed natural family planning and spermicide were the least reported methods and decreased over time. CONCLUSIONS As any male contraceptive method appears to be decreasing in both models, reproductive health promotion is required. This study has implications for commissioning funds and for identifying regional areas of further investigation.
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Affiliation(s)
- A Jordan
- Psychology, De Montfort University, UK
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12
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Rajasingham R, Govender NP, Jordan A, Loyse A, Shroufi A, Denning DW, Meya DB, Chiller TM, Boulware DR. The global burden of HIV-associated cryptococcal infection in adults in 2020: a modelling analysis. Lancet Infect Dis 2022; 22:1748-1755. [PMID: 36049486 PMCID: PMC9701154 DOI: 10.1016/s1473-3099(22)00499-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Cryptococcal meningitis is the most common cause of meningitis in adults living with HIV in sub-Saharan Africa. The estimates of national, regional, and global burden of cryptococcal meningitis are essential to guide prevention strategies and determine needs for diagnostic tests and treatments. We present a 2020 estimate of the global burden of HIV-associated cryptococcal infection (antigenaemia), cryptococcal meningitis, and cryptococcal-associated deaths. METHODS We defined advanced HIV disease as adults with a CD4 count of less than 200 cells/μL, as this group is at highest risk for cryptococcosis. We used UNAIDS estimates (2019-20) and population-based HIV impact assessment surveys (2016-18) to estimate the number of adults with CD4 counts of less than 200 cells/μL at risk for cryptococcosis, by country and region. Secondly, we summarised cryptococcal antigenaemia prevalence in those with a CD4 count of less than 200 cells/μL by reviewing published literature. Thereafter, we calculated the number of cryptococcal antigen (CrAg)-positive people in each country and region by multiplying the number with advanced HIV disease at risk for cryptococcal infection by the cryptococcal antigenaemia prevalence of the respective country or region. We estimated progression from cryptococcal antigenaemia to meningitis or death based on estimates from the published literature. FINDINGS We estimated that there were 4·3 million (IQR 3·0-4·8) adults with HIV and CD4 counts of less than 200 cells/μL globally in 2020. We calculated a mean global cryptococcal antigenaemia prevalence of 4·4% (95% CI 1·6-7·4) among HIV-positive people with CD4 counts of less than 200 cells/μL, corresponding to 179 000 cases (IQR 133 000-219 000) of cryptococcal antigenaemia globally in 2020. Annually, we estimated that there are 152 000 cases (111 000-185 000) of cryptococcal meningitis, resulting in 112 000 cryptococcal-related deaths (79 000-134 000). Globally, cryptococcal disease accounts for 19% (13-24) of AIDS-related mortality. INTERPRETATION Despite a reduction in the estimated absolute global burden of HIV-associated cryptococcal meningitis compared with 2014, likely to be due to antiretroviral therapy expansion, cryptococcal disease still accounts for 19% of AIDS-related deaths, similar to 2014 estimates. To end cryptococcal meningitis deaths by 2030, cryptococcal diagnostics, meningitis treatments, and implementation of preventive screening are urgently needed. FUNDING None.
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Affiliation(s)
- Radha Rajasingham
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Nelesh P Govender
- National Institute for Communicable Diseases, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander Jordan
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Angela Loyse
- Centre for Global Health, Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - David W Denning
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - David B Meya
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Tom M Chiller
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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13
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Jordan A, James AE, Gold JAW, Wu K, Glowicz J, Wolfe F, Vyas K, Litvintseva A, Gade L, Liverett H, Alverson M, Burgess M, Wilson A, Li R, Benowitz I, Gulley T, Patil N, Chakravorty R, Chu W, Kothari A, Jackson BR, Garner K, Toda M. Investigation of a Prolonged and Large Outbreak of Healthcare-Associated Mucormycosis Cases in an Acute Care Hospital-Arkansas, June 2019-May 2021. Open Forum Infect Dis 2022; 9:ofac510. [PMID: 36320193 PMCID: PMC9605704 DOI: 10.1093/ofid/ofac510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Background Outbreaks of healthcare-associated mucormycosis (HCM), a life-threatening fungal infection, have been attributed to multiple sources, including contaminated healthcare linens. In 2020, staff at Hospital A in Arkansas alerted public health officials of a potential HCM outbreak. Methods We collected data on patients at Hospital A who had invasive mucormycosis during January 2017-June 2021 and calculated annual incidence of HCM (defined as mucormycosis diagnosed within ≥7 days after hospital admission). We performed targeted environmental assessments, including linen sampling at the hospital, to identify potential sources of infection. Results During the outbreak period (June 2019-June 2021), 16 patients had HCM; clinical features were similar between HCM patients and non-HCM patients. Hospital-wide HCM incidence (per 100 000 patient-days) increased from 0 in 2018 to 3 in 2019 and 6 in 2020. For the 16 HCM patients, the most common underlying medical conditions were hematologic malignancy (56%) and recent traumatic injury (38%); 38% of HCM patients died in-hospital. Healthcare-associated mucormycosis cases were not epidemiologically linked by common procedures, products, units, or rooms. At Hospital A and its contracted offsite laundry provider, suboptimal handling of laundered linens and inadequate environmental controls to prevent mucormycete contamination were observed. We detected Rhizopus on 9 (9%) of 98 linens sampled at the hospital, including on linens that had just arrived from the laundry facility. Conclusions We describe the largest, single-center, HCM outbreak reported to date. Our findings underscore the importance of hospital-based monitoring for HCM and increased attention to the safe handling of laundered linens.
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Affiliation(s)
- Alexander Jordan
- Correspondence: Alexander Jordan, MPH, 1600 Clifton Road NE, Atlanta, GA 30329, USA ()
| | - Allison E James
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Wu
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Glowicz
- Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Frankie Wolfe
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Keyur Vyas
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anastasia Litvintseva
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lalitha Gade
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hazel Liverett
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary Alverson
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary Burgess
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amy Wilson
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ruoran Li
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isaac Benowitz
- Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trent Gulley
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | | | - Winston Chu
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Brendan R Jackson
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
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14
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Glowicz J, Benowitz I, Arduino MJ, Li R, Wu K, Jordan A, Toda M, Garner K, Gold JAW. Keeping health care linens clean: Underrecognized hazards and critical control points to avoid contamination of laundered health care textiles. Am J Infect Control 2022; 50:1178-1181. [PMID: 35868458 PMCID: PMC9628009 DOI: 10.1016/j.ajic.2022.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 01/25/2023]
Abstract
Outbreaks of health care-associated infections, particularly invasive mold infections, have been linked to environmental contamination of laundered health care textiles. Contamination may occur at the laundry or health care facility. This report highlights underrecognized hazards, control points, and actions that infection preventionists can take to help decrease the potential for patient exposure to contaminated health care textiles. Infection preventionists can use the checklists included in this report to assess laundry and health care facility management of laundered health care textiles.
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Affiliation(s)
- Janet Glowicz
- Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Isaac Benowitz
- Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Matthew J Arduino
- Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ruoran Li
- Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen Wu
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alexander Jordan
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mitsuru Toda
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Jeremy A W Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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15
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Samudio T, Aguilar G, Sued O, López G, Jordan A, Cáceres DH, Ovelar P, Cardozo M, Vicenti C, Lezcano V, Pereira J, Rios-Gonzalez C, Munoz S, Figueredo J, Taboada A, Chiller T, Benítez G. P258 Incidence of Histoplasmosis, Cryptococcosis, and TB Among People Living with HIV in Paraguay-Preliminary Report. Med Mycol 2022. [PMCID: PMC9509961 DOI: 10.1093/mmy/myac072.p258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Endemic fungal infections such as Histoplasmosis and Cryptococcosis as well as tuberculosis (TB) are important causes of mortality among people living with HIV (PLHIV) in Latin America. Rapid diagnostic assays (RDAs) could decrease the time to diagnosis and treatment of these infections, resulting in a reduction in mortality. The objectives of this study were to determine the incidence of Histoplasmosis, Cryptococcosis, and TB using RDAs in PLHIV with advanced HIV disease (AHD) and calculate 30-day mortality. Methods PLHIV 18 years and older, treated at the Institute of Tropical Medicine hospital in Asuncion, Paraguay, not receiving ART and presenting CD4 count ≤ 200 cells/μL or clinical symptoms suggestive of WHO stage 3 or 4 diseases were enrolled and followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was performed by enzyme immunoassay (EIA), Cryptococcus Ag (CrAg) detection in serum and cerebrospinal fluid specimens by lateral flow assay (LFA), and liparabinomannan (LAM) detection in urine by LFA (TB LAM) (limited to those patients with CD4 counts ≤ 100 cells/μL) and by GeneXpert (limited to patients with respiratory symptoms). Results From August 2021 to 25 March 2022, a total of 335 PLHIV were enrolled. Patient median age was 37 years [Interquartile Range (IQR) 16 years], median CD4 count at enrollment was 91 cells/μL (IQR 147 cell/μL). A total of 80% (n = 269) of patients were symptomatic for one or more of the three diseases being screened for. Ag positivity rate was 20% (40/196) for TB-LAM, 10% (32/314) for HisAg, and 11% (35/329) for CrAg (15 diagnosed with cryptococcal meningitis). GeneXpert testing showed a positivity of 14% (15/108), and six of these patients with positive GeneXpert also tested positive for TB-LAM. In total, 100/335 (30%) of patients tested had a positive result and coinfections were observed among 14/335 (4.2%) patients (Table 1). Histoplasmosis + TB was the most frequent co-infection observed 12/335 (3.6%). Mortality among those who completed 30-day follow-up was 12.6% (32/254) and 11% among those with an OI (11/102) Conclusions Preliminary results show that TB and fungal opportunistic infections, including co-infection were common in people with advanced HIV. Longitudinal follow-up will help to evaluate the feasibility and cost of implementing RDAs for the early detection of opportunistic infections in PLHIV with AHD in Paraguay. Early diagnosis could impact mortality reduction.
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Affiliation(s)
- Tania Samudio
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Gloria Aguilar
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Omar Sued
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Gladys López
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Alexander Jordan
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Diego H. Cáceres
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Patricia Ovelar
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Miguel Cardozo
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Cristina Vicenti
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Virgilio Lezcano
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - José Pereira
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Carlos Rios-Gonzalez
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Sergio Munoz
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Juan Figueredo
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Aurelia Taboada
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Tom Chiller
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
| | - Gustavo Benítez
- Advisor Research Communicable Diseases Freddy Perez, Panamerican Health Organization , Washington DC , United States
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Adashek JJ, Jordan A, Redwine LS, Tyson DM, Thompson Z, Pabbathi S. Pan-cancer analysis of fear of cancer recurrence among cancer survivors. ESMO Open 2022; 7:100528. [PMID: 35780591 PMCID: PMC9463169 DOI: 10.1016/j.esmoop.2022.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/19/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Fear of cancer recurrence (FCR) is a phenomenon estimated to affect a large portion of cancer survivors. This study sought to determine whether patients from a National Cancer Institute-designated institution had their clinical needs met relating to FCR. Patients and methods Patients referred to the survivorship clinic completed The Clinical Needs Assessment Tool for Cancer Survivors (CNAT-CS). Correlations between responses were calculated and univariable and multivariable logistic regression was used to identify predictors of met or unmet needs related to FCR. Results Of 647 patients, 241 (37.2%) reported they did not have clinical needs related to FCR and 386 (59.7%) reported they had clinical needs related to FCR but that the needs had been met. Only 20 (3.09%) reported that clinical needs relating to FCR were unmet. According to univariate logistic regression, sex had no impact on FCR (P = 0.8427), nor did years since diagnosis (P = 0.1014). Results of multivariable regression indicate that the odds ratio of reported FCR as an unmet need (versus not a need) is 0.939; the odds decreased by 6% (P = 0.0023) for every year increase in age. For each unit increase in distress score, the odds of reporting FCR as an unmet need increased by 32% (P = 0.0007). Conclusions This study is unique in not only examining the presence of FCR but also whether patients reported that their needs were met for FCR. The study found that most patients had clinical needs for FCR, but the needs were met at the time of the survey. Patients who report higher distress scores are more likely to report FCR as an unmet need. Therefore, cancer survivors reporting high distress scores in clinic visits should be evaluated for FCR. FCR is common among cancer survivors; it can be seen as a met or unmet need by each patient. Identifying factors that influence fear of cancer recurrence as a need met or not include age and distress score. Recognizing FCR as an unmet need is paramount to develop clinics and mitigation strategies to ameliorate this need.
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Affiliation(s)
- J J Adashek
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - A Jordan
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - L S Redwine
- Department of Family Medicine and Community Health, University of Miami, Miami, USA
| | - D Martinez Tyson
- College of Public Health, University of South Florida, Tampa, USA
| | - Z Thompson
- Departments of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | - S Pabbathi
- Individualized Cancer Management, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA.
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Larson B, Shroufi A, Muthoga C, Oladele R, Rajasingham R, Jordan A, Jarvis JN, Chiller TM, Govender NP. Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs. Wellcome Open Res 2022; 6:140. [PMID: 35706922 PMCID: PMC9184925 DOI: 10.12688/wellcomeopenres.16776.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Access to and the cost of induction treatment for cryptococcal meningitis (CM) is rapidly changing. The newly-announced price for flucytosine ($0.75 per 500 mg pill) and possibly lower prices for liposomal amphotericin B (AmB-L) create opportunities to reduce CM treatment costs compared to the current standard treatment in low- and middle-income countries. Methods: We developed an Excel-based cost model to estimate health system treatment costs for CM over a two-week induction phase for multiple treatment combinations, newly feasible with improved access to flucytosine and AmB-L. CM treatment costs include medications, laboratory tests and other hospital-based costs (bed-day costs and healthcare worker time). We report results from applying the model using country-specific information for South Africa, Uganda, Nigeria, and Botswana. Results: A 14-day induction-phase of seven days of inpatient AmB-D with flucytosine, followed by seven days of high-dose fluconazole as an outpatient, will cost health systems less than a 14-day hospital stay with AmB-D and fluconazole. If daily AmB-L replaces AmB-D for those with baseline renal dysfunction, with a cost of $50 or less per 50 mg vial, incremental costs would still be less than the AmB-D with fluconazole regimen. Simple oral combinations (e.g., seven days of flucytosine with fluconazole as an inpatient) are practical when AmB-D is not available, and treatment costs would remain less than the current standard treatment. Conclusions: Improved access to and lower prices for flucytosine and AmB-L create opportunities for improving CM treatment regimens. An induction regimen of flucytosine and AmB-D for seven days is less costly than standard care in the settings studied here. As this regimen has also been shown to be more effective than current standard care, countries should prioritize scaling up flucytosine access. The cost of AmB-L based regimens is highly dependent on the price of AmB-L, which currently remains unclear.
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Affiliation(s)
- Bruce Larson
- Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Charles Muthoga
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Rita Oladele
- College of Medicine, Univerity of Lagos, Lagos, Nigeria
| | - Radha Rajasingham
- Division of Infectious Diseases & International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alexander Jordan
- Mycotic Diseases Branch, Centers for Disease Controls and Prevention, Atlanta, Georgia, USA
| | - Joseph N. Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom M. Chiller
- Mycotic Diseases Branch, Centers for Disease Controls and Prevention, Atlanta, Georgia, USA
| | - Nelesh P. Govender
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- University of Witwatersrand, Johannesburg, South Africa
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Chapman S, Jordan A, Tillett W. POS1574-PARE PATIENTS REPORT HIGH LEVELS OF CONCERNS ABOUT MEDICATION FOR PSORIATIC AND RHEUMATOID ARTHRITIS: UNMET NEEDS REVEALED BY A UK PILOT WEB SURVEY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are often nonadherent to prescribed symptom-modifying drugs. [1] Concerns about the potential negative effects of medication have been implicated in medication nonadherence. Few evidence-based interventions to address concerns about medication and support medication-taking are available in the UK context.ObjectivesTo inform the development of intervention to support people with RA and PsA to manage medication we conducted a survey of unmet needs relating to perceptions of arthritis and arthritis medication, medication-taking behaviour and experience of side effects.MethodsWe recruited people with arthritis via local and national patient groups for participation in an online survey. The survey included clinical and demographic questions, validated measures of treatment (Beliefs about Medication Questionnaire; BMQ) and illness perceptions (brief Illness Perception Questionnaire; bIPQ), medication adherence (Compliance Questionnaire Rheumatology; CQR), and patient-reported side effects. Participants were asked about consequences of taking and not taking their arthritis medication as free text to contextualize scores.ResultsQuestionnaire responses from 98 participants (42 with PsA, 56 with RA, 89.8% female) indicated participants typically viewed arthritis negatively with ratings on the bIPQ indicating high emotional impacts, symptoms and affects on everyday life, and doubts about their ability to control their arthritis. Analysis of the BMQ indicated ambivalence about RA/PsA medications; while few people expressed doubts about their personal need for medication, concerns about RA/PsA medications were common, see Figure 1). Most, 85.7% (n=84), reported a side effect in the last month, with a mean of 10 ‘moderately severe’ or ‘very severe’ side effects (m=10.02, sd = 5.98). Just over a quarter (26.0%, n=25) were classed as low adherers using the CQR with 54.6% reporting they had missed some of their arthritis medication over the last year. Free text responses indicated that some participants had additional concerns about medication (e.g. worries about impact on life expectancy) not addressed in the questionnaire measures.ConclusionIn this pilot survey, many participants reported concerns about medication, doubts about whether medication controls arthritis symptoms, severe side effects and medication nonadherence. Although our small sample is unlikely to be generalizable to all arthritis patients, these findings suggest potential targets for intervention and indicate that some patients have needs for support with medication that are not currently being addressed.References[1]Van Den Bemt BJ, Zwikker HE, Van Den Ende CH. Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Expert review of clinical immunology. 2012 May 1;8(4):337-51.AcknowledgementsWe acknowledge the financial assistance of Bath Institute of Rheumatic Diseases, the people who volunteered their time to respond to this survey and the efforts of Elena Mut and Kishwar Khanum in assisting with data collection.Disclosure of InterestsSarah Chapman: None declared, Abbie Jordan: None declared, William Tillett Speakers bureau: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Pfizer and UCB, Consultant of: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Pfizer and UCB, Grant/research support from: Abbvie, Celgene, Eli-Lilly, Janssen, and UCB
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Joachim A, Schwerd T, Hölz H, Sokollik C, Konrad LA, Jordan A, Lanzersdorfer R, Schmidt-Choudhury A, Hünseler C, Adam R. [Fecal Microbiota Transfer (FMT) in Children and Adolescents - Review and statement by the GPGE microbiome working group]. Z Gastroenterol 2022; 60:963-969. [PMID: 35533688 DOI: 10.1055/a-1801-0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The human microbiome and especially the gastrointestinal microbiota are associated with health and disease. Disturbance in the composition or function of fecal microbiota (dysbiosis) plays a role in the development of pediatric gastrointestinal diseases. Fecal microbiota transfer (FMT) is a special intervention, where microbiota are transferred from a healthy donor.In this review we describe the current state of knowledge for FMT in pediatric patients. There is satisfactory evidence concerning FMT in patients with recurrent C. difficile infection. For inflammatory bowel disease, few studies show a potential benefit.Adverse events occurred frequently in clinical studies, but were mostly mild and transient. There are hardly any data on long-term side effects of FMT, which are particularly significant for pediatrics. In practice, there is uncertainty as to which application route, dosage or frequency should be used. Legally, donor stool is considered a drug in German-speaking countries, for which no marketing authorization exists.In conclusion, knowledge about physiology, efficacy and side effects of FMT is insufficient and legal concerns complicate its implementation. More studies on this topic are needed urgently.
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Affiliation(s)
| | - Tobias Schwerd
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universtität München, LMU München, München, Germany
| | - Hannes Hölz
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universtität München, LMU München, München, Germany
| | - Christiane Sokollik
- Abteilung Pädiatrische Gastroenterologie, Hepatologie und Ernährung, Universitätsklinik für Kinderheilkunde, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Lukas Alfons Konrad
- Klinik für Neonatologie und allgemeine Pädiatrie, Gesundheit Nordhessen, Klinikum Kassel, Kassel, Germany
| | - Alexander Jordan
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim, Mannheim, Germany
| | | | - Anjona Schmidt-Choudhury
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | | | - Rüdiger Adam
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim, Mannheim, Germany
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Jordan A, Sherazi A, Flewelling AJ, Northrup V, Naseemuddin A, Shea JL. Identification of cannabinoids in post-mortem blood samples from the province of New Brunswick before and after recreational cannabis legalization. International Journal of Drug Policy 2022; 103:103629. [DOI: 10.1016/j.drugpo.2022.103629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
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Gold JAW, Revis A, Thomas S, Perry L, Blakney RA, Chambers T, Bentz ML, Berkow EL, Lockhart SR, Lysen C, Nunnally NS, Jordan A, Kelly HC, Montero AJ, Farley MM, Oliver NT, Pouch SM, Webster AS, Jackson BR, Beer KD. Clinical Characteristics, Healthcare Utilization, and Outcomes among Patients in a Pilot Surveillance System for Invasive Mold Disease—Georgia, United States, 2017–2019. Open Forum Infect Dis 2022; 9:ofac215. [DOI: 10.1093/ofid/ofac215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Invasive mold diseases (IMD) cause severe illness, but public health surveillance data are lacking. We describe data collected from a laboratory-based, pilot IMD surveillance system.
Methods
During 2017–2019, the Emerging Infections Program conducted active IMD surveillance at three Atlanta-area hospitals. We ascertained potential cases by reviewing histopathology, culture, and Aspergillus galactomannan results and classified patients as having an IMD case (based on European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [MSG] criteria) or a non-MSG IMD case (based on the treating clinician’s diagnosis and use of mold-active antifungal therapy). We described patient features and compared patients with MSG versus non-MSG IMD cases.
Results
Among 304 patients with potential IMD, 104 (34.2%) met an IMD case definition (41 MSG, 63 non-MSG). The most common IMD types were invasive aspergillosis (n = 66, 63.5%), mucormycosis (n = 8, 7.7%), and fusariosis (n = 4, 3.8%); the most frequently affected body sites were pulmonary (n = 66, 63.5%), otorhinolaryngologic (n = 17, 16.3%), and cutaneous/deep tissue (n = 9, 8.7%). Forty-five (43.3%) IMD patients received intensive care unit-level care, and 90-day all-cause mortality was 32.7%; these outcomes did not differ significantly between MSG and non-MSG IMD patients.
Conclusions
IMD patients had high mortality rates and a variety of clinical presentations. Comprehensive IMD surveillance is needed to assess emerging trends, and strict application of MSG criteria for surveillance might exclude > one-half of clinically significant IMD cases.
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Affiliation(s)
| | - Andrew Revis
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Stepy Thomas
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lewis Perry
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Rebekah A. Blakney
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Taylor Chambers
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | - Monica M. Farley
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nora T. Oliver
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephanie M. Pouch
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew S. Webster
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Larson B, Shroufi A, Muthoga C, Oladele R, Rajasingham R, Jordan A, Jarvis JN, Chiller TM, Govender NP. Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs. Wellcome Open Res 2022; 6:140. [PMID: 35706922 PMCID: PMC9184925 DOI: 10.12688/wellcomeopenres.16776.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Access to and the cost of induction treatment for cryptococcal meningitis (CM) is rapidly changing. The newly-announced price for flucytosine ($0.75 per 500 mg pill) and possibly lower prices for liposomal amphotericin B (AmB-L) create opportunities to reduce CM treatment costs compared to the current standard treatment in low- and middle-income countries. Methods: We developed an Excel-based cost model to estimate health system treatment costs for CM over a two-week induction phase for multiple treatment combinations, newly feasible with improved access to flucytosine and AmB-L. CM treatment costs include medications, laboratory tests and other hospital-based costs (bed-day costs and healthcare worker time). We report results from applying the model using country-specific information for South Africa, Uganda, Nigeria, and Botswana. Results: A 14-day induction-phase of seven days of inpatient AmB-D with flucytosine, followed by seven days of high-dose fluconazole as an outpatient, will cost health systems less than a 14-day hospital stay with AmB-D and fluconazole. If daily AmB-L replaces AmB-D for those with baseline renal dysfunction, with a cost of $50 or less per 50 mg vial, incremental costs would still be less than the AmB-D with fluconazole regimen. Simple oral combinations (e.g., seven days of flucytosine with fluconazole as an inpatient) are practical when AmB-D is not available, and treatment costs would remain less than the current standard treatment. Conclusions: Improved access to, and lower prices for flucytosine and AmB-L create opportunities for improving CM treatment regimens. An induction regimen of flucytosine and AmB-D for seven days is less costly than standard care in the settings studied here. As this regimen has also been shown to be more effective than current standard care, countries should prioritize scaling up flucytosine access. The cost of AmB-L based regimens is highly dependent on the price of AmB-L, which currently remains unclear.
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Affiliation(s)
- Bruce Larson
- Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Charles Muthoga
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Rita Oladele
- College of Medicine, Univerity of Lagos, Lagos, Nigeria
| | - Radha Rajasingham
- Division of Infectious Diseases & International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alexander Jordan
- Mycotic Diseases Branch, Centers for Disease Controls and Prevention, Atlanta, Georgia, USA
| | - Joseph N. Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom M. Chiller
- Mycotic Diseases Branch, Centers for Disease Controls and Prevention, Atlanta, Georgia, USA
| | - Nelesh P. Govender
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- University of Witwatersrand, Johannesburg, South Africa
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Sivapalan P, Ulrik CS, Lapperre TS, Bojesen RD, Eklöf J, Browatzki A, Wilcke JT, Gottlieb V, Håkansson KEJ, Tidemandsen C, Tupper O, Meteran H, Bergsøe C, Brøndum E, Bødtger U, Bech Rasmussen D, Graff Jensen S, Pedersen L, Jordan A, Priemé H, Søborg C, Steffensen IE, Høgsberg D, Klausen TW, Frydland MS, Lange P, Sverrild A, Ghanizada M, Knop FK, Biering-Sørensen T, Lundgren JD, Jensen JUS. Azithromycin and hydroxychloroquine in hospitalised patients with confirmed COVID-19: a randomised double-blinded placebo-controlled trial. Eur Respir J 2022; 59:2100752. [PMID: 34083403 PMCID: PMC8186006 DOI: 10.1183/13993003.00752-2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Combining the antibiotic azithromycin and hydroxychloroquine induces airway immunomodulatory effects, with the latter also having in vitro antiviral properties. This may improve outcomes in patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS Placebo-controlled double-blind randomised multicentre trial. Patients aged ≥18 years, admitted to hospital for ≤48 h (not intensive care) with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription PCR test were recruited. The intervention was 500 mg daily azithromycin for 3 days followed by 250 mg daily azithromycin for 12 days combined with 200 mg twice-daily hydroxychloroquine for all 15 days. The control group received placebo/placebo. The primary outcome was days alive and discharged from hospital within 14 days (DAOH14). RESULTS After randomisation of 117 patients, at the first planned interim analysis, the data and safety monitoring board recommended stopping enrolment due to futility, based on pre-specified criteria. Consequently, the trial was terminated on 1 February 2021. 61 patients received the combined intervention and 56 patients received placebo. In the intervention group, patients had a median (interquartile range) 9.0 (3-11) DAOH14 versus 9.0 (7-10) DAOH14 in the placebo group (p=0.90). The primary safety outcome, death from all causes on day 30, occurred for one patient in the intervention group versus two patients receiving placebo (p=0.52), and readmittance or death within 30 days occurred for nine patients in the intervention group versus six patients receiving placebo (p=0.57). CONCLUSIONS The combination of azithromycin and hydroxychloroquine did not improve survival or length of hospitalisation in patients with COVID-19.
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Affiliation(s)
- Pradeesh Sivapalan
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Charlotte Suppli Ulrik
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | | | - Rasmus Dahlin Bojesen
- Dept of Surgery, Slagelse Hospital, Slagelse, Denmark
- Dept of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Josefin Eklöf
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Andrea Browatzki
- Dept of Respiratory and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Jon Torgny Wilcke
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Vibeke Gottlieb
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Kjell Erik Julius Håkansson
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Casper Tidemandsen
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Oliver Tupper
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Howraman Meteran
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Christina Bergsøe
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Eva Brøndum
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Uffe Bødtger
- Dept of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Sidse Graff Jensen
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Lars Pedersen
- Dept of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Alexander Jordan
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Helene Priemé
- Dept of Medicine, Section of Respiratory Medicine, Herlev Hospital, Herlev, Denmark
| | - Christian Søborg
- Dept of Medicine, Section of Respiratory Medicine, Herlev Hospital, Herlev, Denmark
| | - Ida E. Steffensen
- Dept of Medicine, Section of Respiratory Medicine, Herlev Hospital, Herlev, Denmark
| | - Dorthe Høgsberg
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | | | - Martin Steen Frydland
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Peter Lange
- Dept of Medicine, Section of Respiratory Medicine, Herlev Hospital, Herlev, Denmark
- Institute of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Asger Sverrild
- Dept of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Muhzda Ghanizada
- Dept of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Filip K. Knop
- Center for Clinical Metabolic Research, Gentofte University Hospital, Hellerup, Denmark
- Dept of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jens D. Lundgren
- Dept of Infectious Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
- Dept of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Mejía-Santos H, Montoya S, Chacón-Fuentes R, Zielinski-Gutierrez E, Lopez B, Ning MF, Farach N, García-Coto F, Rodríguez-Araujo DS, Rosales-Pavón K, Urbina G, Rivera AC, Peña R, Tovar A, Paz MC, Lopez R, Pardo-Cruz F, Mendez C, Flores A, Varela M, Chiller T, Jackson BR, Jordan A, Lyman M, Toda M, Caceres DH, Gold JAW. Notes from the Field: Mucormycosis Cases During the COVID-19 Pandemic - Honduras, May-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1747-1749. [PMID: 34914675 PMCID: PMC8675660 DOI: 10.15585/mmwr.mm7050a2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Tenforde MW, Muthoga C, Ponatshego P, Ngidi J, Mine M, Greene G, Jordan A, Chiller T, Larson BA, Jarvis JN. Cost-effectiveness of cryptococcal antigen screening at CD4 counts of 101-200 cells/µL in Botswana. Wellcome Open Res 2021; 6:55. [PMID: 35087954 PMCID: PMC8767426 DOI: 10.12688/wellcomeopenres.16624.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Cryptococcal antigen (CrAg) screening in individuals with advanced HIV reduces cryptococcal meningitis (CM) cases and deaths. The World Health Organization recently recommended increasing screening thresholds from CD4 ≤100 cells/µL to ≤200 cells/µL. CrAg screening at CD4 ≤100 cells/µL is cost-effective; however, the cost-effectiveness of screening patients with CD4 101-200 cells/µL requires evaluation. Methods: Using a decision analytic model with Botswana-specific cost and clinical estimates, we evaluated CrAg screening and treatment among individuals with CD4 counts of 101-200 cells/µL. We estimated the number of CM cases and deaths nationally and treatment costs without screening. For screening we modeled the number of CrAg tests performed, number of CrAg-positive patients identified, proportion started on pre-emptive fluconazole, CM cases and deaths. Screening and treatment costs were estimated and cost per death averted or disability-adjusted life year (DALY) saved compared with no screening. Results: Without screening, we estimated 142 CM cases and 85 deaths annually among individuals with CD4 101-200 cells/µL, with treatment costs of $368,982. With CrAg screening, an estimated 33,036 CrAg tests are performed, and 48 deaths avoided (1,017 DALYs saved). While CrAg screening costs an additional $155,601, overall treatment costs fall by $39,600 (preemptive and hospital-based CM treatment), yielding a net increase of $116,001. Compared to no screening, high coverage of CrAg screening and pre-emptive treatment for CrAg-positive individuals in this population avoids one death for $2440 and $114 per DALY saved. In sensitivity analyses assuming a higher proportion of antiretroviral therapy (ART)-naïve patients (75% versus 15%), cost per death averted was $1472; $69 per DALY saved. Conclusions: CrAg screening for individuals with CD4 101-200 cells/µL was estimated to have a modest impact, involve additional costs, and be less cost-effective than screening populations with CD4 counts ≤100 cells/µL. Additional CrAg screening costs must be considered against other health system priorities.
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Affiliation(s)
- Mark W. Tenforde
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, 98195, USA
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Charles Muthoga
- Botswana-UPenn Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Julia Ngidi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- National Health Laboratory, Gaborone, Botswana
| | - Madisa Mine
- National Health Laboratory, Gaborone, Botswana
| | - Greg Greene
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Alexander Jordan
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Tom Chiller
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Bruce A. Larson
- Department of Global Health, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Joseph N. Jarvis
- Botswana-UPenn Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- London School of Hygiene & Tropical Medicine, London, UK
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Flood E, Browne L, Kurian S, Lynch C, Doyle M, Jordan A, Varghese R, Mello S. 132 GERIATRIC REHABILITATION IN THE COVID-19 ERA: SERVICE INNOVATION AND PATIENT OUTCOMES. Age Ageing 2021. [PMCID: PMC8689995 DOI: 10.1093/ageing/afab219.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- E Flood
- Peamount Healthcare, Dublin, Ireland
| | - L Browne
- Peamount Healthcare, Dublin, Ireland
| | - S Kurian
- Peamount Healthcare, Dublin, Ireland
| | - C Lynch
- Peamount Healthcare, Dublin, Ireland
| | - M Doyle
- Peamount Healthcare, Dublin, Ireland
| | - A Jordan
- Peamount Healthcare, Dublin, Ireland
| | | | - S Mello
- Peamount Healthcare, Dublin, Ireland,Tallaght University Hospital, Dublin, Ireland
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Jordan A, Sherazi A, Stevens A, Quondam Franks C, Sturgeon K, Northrup V, Shea JL. Evaluation of BD Barricor™ and PST™ blood collection tubes compared to serum for testing 11 therapeutic drugs on a Roche Cobas® 8000 platform. Clin Biochem 2021; 100:60-66. [PMID: 34788637 DOI: 10.1016/j.clinbiochem.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The type of blood collection tube used when obtaining samples for therapeutic drug monitoring (TDM) has important implications on the accuracy of results. Serum tubes without a gel separator are currently considered best practice. We sought to evaluate the performance of Barricor™, a novel plasma tube that utilizes an inert mechanical separator, as well as a gel-based tube (PST™) for testing acetaminophen, digoxin, gentamicin, methotrexate, phenobarbital, phenytoin, salicylate, vancomycin, valproic acid, carbamazepine, and theophylline on a Roche Cobas® 8000 platform. METHODS Paired patient samples were collected from individuals taking at least one of the medications evaluated. These were supplemented with spiked specimens to ensure a minimum of 40 paired samples per drug. All drugs were measured within two hours of collection on Roche e602 or c502 instruments. Deming regression was used to assess bias between Barricor™ vs serum and PST™ vs serum. Seven-day refrigerated stability was also assessed in Barricor™, PST™, and serum tubes in a subset of samples (n = 10) for each drug. RESULTS Drug concentrations in Barricor™ were similar to serum for each drug assessed. In contrast, a negative bias was observed in PST™ compared to serum tubes for carbamazepine (-7.6%) and phenytoin (-6.8%) although this did not surpass our total allowable error goal of 10%. All drugs recovered within ±10% of baseline value when samples were stored refrigerated for 7 days except for carbamazepine, phenytoin, and phenobarbital where significant analyte loss was observed within the first day in PST™ tubes. CONCLUSION Barricor™ tubes are a suitable alternative to serum for TDM on the Roche Cobas® 8000 platform.
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Affiliation(s)
- Alexander Jordan
- Dalhousie Medicine New Brunswick, Dalhousie Medical School, Saint John, NB, Canada
| | - Ali Sherazi
- Department of Research Services, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Ashley Stevens
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Christina Quondam Franks
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Kayla Sturgeon
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Victoria Northrup
- Department of Research Services, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Jennifer L Shea
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Pathology, Dalhousie University, Halifax, NS, Canada.
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Jordan A, Sivapalan P, Eklöf J, Vestergaard JB, Meteran H, Saeed MI, Biering-Sørensen T, Løkke A, Seersholm N, Jensen JUS. The Association between Use of ICS and Psychiatric Symptoms in Patients with COPD-A Nationwide Cohort Study of 49,500 Patients. Biomedicines 2021; 9:biomedicines9101492. [PMID: 34680609 PMCID: PMC8533368 DOI: 10.3390/biomedicines9101492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Psychiatric side effects are well known from treatment with systemic corticosteroids. It is, however, unclear whether inhaled corticosteroids (ICS) have psychiatric side effects in patients with COPD. We conducted a nationwide cohort study in all Danish COPD outpatients who had respiratory medicine specialist-verified COPD, age ≥40 years, and no previous cancer. Prescription fillings of antidepressants and risk of admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder were assessed by Cox proportional hazards models. We observed a dose-dependent increase in the risk of antidepressant-use with ICS cumulated dose (HR 1.05, 95% CI 1.03–1.07, p = 0.0472 with low ICS exposure, HR 1.10, 95% CI 1.08–1.12, p < 0.0001 with medium exposure, HR 1.15, 95% CI 1.11–1.15, p < 0.0001 with high exposure) as compared to no ICS exposure. We found a discrete increased risk of admission to psychiatric hospitals in the medium and high dose group (HR 1.00, 95% CI 0.98–1.03, p = 0.77 with low ICS exposure, HR 1.07, 95% CI 1.05–1.10, p < 0.0001 with medium exposure, HR 1.13, 95% CI 1.10–1.15, p < 0.0001 with high exposure). The association persisted when stratifying for prior antidepressant use. Thus, exposure to ICS was associated with a small to moderate increase in antidepressant-use and psychiatric admissions.
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Affiliation(s)
- Alexander Jordan
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
- Correspondence:
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Josefin Eklöf
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Jakob B. Vestergaard
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Howraman Meteran
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Mohamad Isam Saeed
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Tor Biering-Sørensen
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Anders Løkke
- Department of Medicine, Hospital Lillebælt, 7100 Vejle, Denmark;
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Niels Seersholm
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Jens Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Jordan A, Sivapalan P, Ëklof J, Vestergaard J, Meteran H, Saeed MI, Biering-Sørensen T, Løkke A, Knop FK, Seersholm N, Jensen JUS. Use of inhaled corticosteroids and the risk of depressive symptoms in patients with chronic obstructive pulmonary disease. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.pa2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Larson B, Shroufi A, Muthoga C, Oladele R, Rajasingham R, Jordan A, Jarvis JN, Chiller TM, Govender NP. Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs. Wellcome Open Res 2021; 6:140. [PMID: 35706922 PMCID: PMC9184925 DOI: 10.12688/wellcomeopenres.16776.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Access to and the cost of induction treatment for cryptococcal meningitis (CM) is rapidly changing. The newly-announced price for flucytosine ($0.75 per 500 mg pill) and possibly lower prices for liposomal amphotericin B (AmB-L) create opportunities to reduce CM treatment costs compared to the current standard treatment in low- and middle-income countries. Methods: We developed an Excel-based cost model to estimate health system treatment costs for CM over a two-week induction phase for multiple treatment combinations, newly feasible with improved access to flucytosine and AmB-L. CM treatment costs include medications, laboratory tests and other hospital-based costs (bed-day costs and healthcare worker time). We report results from applying the model using country-specific information for South Africa, Uganda, Nigeria, and Botswana. Results: A 14-day induction-phase of seven days of inpatient AmB-D with flucytosine, followed by seven days of high-dose fluconazole as an outpatient, will cost health systems less than a 14-day hospital stay with AmB-D and fluconazole. If daily AmB-L replaces AmB-D for those with baseline renal dysfunction, with a cost of $50 or less per 50 mg vial, incremental costs would still be less than the AmB-D with fluconazole regimen. Simple oral combinations (e.g., seven days of flucytosine with fluconazole as an inpatient) are practical when AmB-D is not available, and treatment costs would remain less than the current standard treatment. Conclusions: Improved access to, and lower prices for flucytosine and AmB-L create opportunities for improving CM treatment regimens. An induction regimen of flucytosine and AmB-D for seven days is less costly than standard care in the settings studied here. As this regimen has also been shown to be more effective than current standard care, countries should prioritize scaling up flucytosine access. The cost of AmB-L based regimens is highly dependent on the price of AmB-L, which currently remains unclear.
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Affiliation(s)
- Bruce Larson
- Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Charles Muthoga
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Rita Oladele
- College of Medicine, Univerity of Lagos, Lagos, Nigeria
| | - Radha Rajasingham
- Division of Infectious Diseases & International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alexander Jordan
- Mycotic Diseases Branch, Centers for Disease Controls and Prevention, Atlanta, Georgia, USA
| | - Joseph N. Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom M. Chiller
- Mycotic Diseases Branch, Centers for Disease Controls and Prevention, Atlanta, Georgia, USA
| | - Nelesh P. Govender
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- University of Witwatersrand, Johannesburg, South Africa
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Tenforde MW, Milton T, Rulaganyang I, Muthoga C, Tawe L, Chiller T, Greene G, Jordan A, Williams CG, Owen L, Leeme TB, Boose A, Ngidi J, Mine M, Jarvis JN. Outcomes of Reflex Cryptococcal Antigen (CrAg) Screening in Human Immunodeficiency Virus (HIV)-Positive Patients With CD4 Counts of 100-200 Cells/µL in Botswana. Clin Infect Dis 2021; 72:1635-1638. [PMID: 32604411 DOI: 10.1093/cid/ciaa899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/24/2020] [Indexed: 01/20/2023] Open
Abstract
Increasing the CD4-count threshold for cryptococcal antigen (CrAg) screening from ≤100 to ≤200 cells/µL resulted in a 3-fold increase in numbers screened. CrAg-prevalence was 3.5% at CD4 101-200 and 6.2% ≤100 cells/µL. Six-month mortality was 21.4% (9/42) in CrAg-positive CD4 ≤100 cells/µL and 3.2% (1/31) in CrAg-positive CD4 101-200 cells/µL.
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Affiliation(s)
- Mark W Tenforde
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA.,Botswana-UPenn Partnership, Gaborone, Botswana
| | | | | | - Charles Muthoga
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Tom Chiller
- Mycotics Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gregory Greene
- Mycotics Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexander Jordan
- Mycotics Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Leah Owen
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Tshepo B Leeme
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Amber Boose
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Julia Ngidi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Madisa Mine
- Botswana National Health Laboratory, Gaborone, Botswana
| | - Joseph N Jarvis
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ameratunga R, Jordan A, Cavadino A, Ameratunga S, Hills T, Steele R, Hurst M, McGettigan B, Chua I, Brewerton M, Kennedy N, Koopmans W, Ahn Y, Barker R, Allan C, Storey P, Slade C, Baker A, Huang L, Woon ST. Bronchiectasis is associated with delayed diagnosis and adverse outcomes in the New Zealand Common Variable Immunodeficiency Disorders cohort study. Clin Exp Immunol 2021; 204:352-360. [PMID: 33755987 DOI: 10.1111/cei.13595] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/19/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023] Open
Abstract
Common variable immunodeficiency disorders (CVID) are multi-system disorders where target organ damage is mediated by infective, autoimmune and inflammatory processes. Bronchiectasis is probably the most common disabling complication of CVID. The risk factors for bronchiectasis in CVID patients are incompletely understood. The New Zealand CVID study (NZCS) is a nationwide longitudinal observational study of adults, which commenced in 2006. In this analysis, the prevalence and risk factors for bronchiectasis were examined in the NZCS. After informed consent, clinical and demographic data were obtained with an interviewer-assisted questionnaire. Linked electronic clinical records and laboratory results were also reviewed. Statistical methods were applied to determine if variables such as early-onset disease, delay in diagnosis and increased numbers of infections were associated with greater risk of bronchiectasis. One hundred and seven adult patients with a diagnosis of CVID are currently enrolled in the NZCS, comprising approximately 70% of patients known to have CVID in New Zealand. Fifty patients (46·7%) had radiologically proven bronchiectasis. This study has shown that patients with compared to those without bronchiectasis have an increased mortality at a younger age. CVID patients with bronchiectasis had a greater number of severe infections consequent to early-onset disease and delayed diagnosis. Indigenous Māori have a high prevalence of CVID and a much greater burden of bronchiectasis compared to New Zealand Europeans. Diagnostic latency has not improved during the study period. Exposure to large numbers of infections because of early-onset disease and delayed diagnosis was associated with an increased risk of bronchiectasis. Earlier diagnosis and treatment of CVID may reduce the risk of bronchiectasis and premature death in some patients.
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Affiliation(s)
- R Ameratunga
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand.,Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - A Jordan
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - A Cavadino
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - S Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand.,Population Health Directorate, Counties Manukau Health, Auckland, New Zealand
| | - T Hills
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - R Steele
- Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand
| | - M Hurst
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - B McGettigan
- Department of Clinical Immunology, Fiona Stanley Hospital, Perth, WA, Australia
| | - I Chua
- Department of Clinical Immunology, Christchurch Hospital, Christchurch, New Zealand
| | - M Brewerton
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - N Kennedy
- Department of Respiratory Medicine, Wellington Hospital, Wellington, New Zealand
| | - W Koopmans
- Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand
| | - Y Ahn
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand.,Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand
| | - R Barker
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - C Allan
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - P Storey
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - C Slade
- Walter and Eliza Hall Institute, Melbourne, VIC, Australia
| | - A Baker
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - L Huang
- Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand
| | - S-T Woon
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
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Knott NA, Williams J, Harasti D, Malcolm HA, Coleman MA, Kelaher BP, Rees MJ, Schultz A, Jordan A. A coherent, representative, and bioregional marine reserve network shows consistent change in rocky reef fish assemblages. Ecosphere 2021. [DOI: 10.1002/ecs2.3447] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N. A. Knott
- Fisheries Research NSW Department of Primary Industries Huskisson New South Wales2540Australia
| | - J. Williams
- New South Wales Department of Primary Industries Port Stephens Fisheries Institute Taylors Beach Road Taylors Beach New South Wales2316Australia
| | - D. Harasti
- New South Wales Department of Primary Industries Port Stephens Fisheries Institute Taylors Beach Road Taylors Beach New South Wales2316Australia
| | - H. A. Malcolm
- Fisheries Research NSW Department of Primary Industries Coffs Harbour New South Wales2800Australia
| | - M. A. Coleman
- Fisheries Research NSW Department of Primary Industries Coffs Harbour New South Wales2800Australia
| | - B. P. Kelaher
- National Marine Science Centre and Marine Ecology Research Centre Southern Cross University Coffs Harbour New South Wales2450Australia
| | - M. J. Rees
- Fisheries Research NSW Department of Primary Industries Huskisson New South Wales2540Australia
| | - A. Schultz
- Fisheries Research NSW Department of Primary Industries Coffs Harbour New South Wales2800Australia
| | - A. Jordan
- New South Wales Department of Primary Industries Port Stephens Fisheries Institute Taylors Beach Road Taylors Beach New South Wales2316Australia
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Williams M, Jordan A, Scott J, Jones M. Pharmacy professionals’ views regarding the future of NHS patient medicines helpline services: A multimethod qualitative study. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab015.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Patient medicines helpline services (PMHS) have been established at some National Health Service (NHS) hospitals in England, to provide medicines-related support to recently discharged hospital patients and carers. However, findings suggest that, due to a lack of resources, considerable variation exists in the operation of PMHS, and that their access, availability, and promotion do not meet national standards regarding helpline provision (1, 2). To develop recommendations for service improvement, this qualitative study sought to examine pharmacy professionals’ views regarding the future of PMHS.
Aim
To examine pharmacy professionals’ perceptions of the future of PMHS, and develop recommendations for service improvement.
Methods
University ethics and Health Research Authority approval were obtained before commencement. Participants comprised pharmacy professionals from acute, mental health, specialist, and community NHS Trusts that provided a PMHS. Invitations to participate in an online qualitative survey and subsequent semi-structured telephone interview were sent via email to pharmacy services at all Trusts that provided a PMHS. Within the survey and the interview schedule was one question “How do you see patient medicines helplines at NHS Trusts developing in the future?” and only the data generated from this open-ended question were analysed for this study. Survey data were collected via SurveyMonkey (n=100). Individuals interested in participating in an interview contacted the research team, resulting in 34 interviews. Interviews were conducted from May-October 2018, and ranged from 16 to 53 minutes. Braun and Clarke’s inductive reflexive thematic analysis was used to analyse the data. Guidelines for enhancing the validity and trustworthiness of qualitative research were used.
Results
Two themes were generated from the survey and interviews. Enhancing value for service users identifies suggestions for improving the value of PMHS for service users. These include providing access methods beyond the telephone, and providing patients/carers with post-discharge follow-up calls from a pharmacist. Improving efficiency identifies that, in the future, and in line with NHS plans for efficiency and shared resources, PMHS may become centralised or provided by community pharmacies. Centralised services were considered to likely have more resources available to provide a patient medicines information service compared to hospital pharmacies. Participants often referred to the Carter report and sustainability and transformation plans, which promote the sharing of resources within regions. However, such a change was perceived to only increase efficiency if patient information can be shared between relevant healthcare settings.
Conclusion
PMHS are perceived by pharmacy professionals as likely to become centralised in the future (i.e., provided regionally or nationally) or provided by community pharmacies. This is dependent upon patients’ information being shared between hospitals and the centralised PMHS or pharmacies. To enhance the value of PMHS for service users, providers could establish other methods of access, such as email and video consultation. A limitation of this study is that it did not seek the perspectives of pharmacy professionals who do not provide a PMHS, other healthcare professionals, nor patients and carers. Considering the uncertainty around the future of PMHS, research should establish the best way to support all patients and carers regarding medicines following hospital discharge.
References
1. Williams MJ, Jones MD, Jordan AL, Scott JA. Operating a patient medicines helpline. A survey study exploring current practice in England using the RE-AIM evaluation framework. BMC Health Serv Res. 2018; doi:10.1186/s12913-018-3690-9
2. Williams M, Jordan A, Scott J, Jones MD. Pharmacy professionals’ experiences and perceptions of providing NHS patient medicines helpline services: a qualitative study. BMC Health Serv Res. 2020; doi.org/10.1186/s12913-020-05182-w.
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Affiliation(s)
- M Williams
- Department of Pharmacy & Pharmacology, University of Bath, Bath, United Kingdom
| | - A Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - J Scott
- Department of Pharmacy & Pharmacology, University of Bath, Bath, United Kingdom
| | - M Jones
- Department of Pharmacy & Pharmacology, University of Bath, Bath, United Kingdom
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Tenforde MW, Muthoga C, Ponatshego P, Ngidi J, Mine M, Greene G, Jordan A, Chiller T, Larson BA, Jarvis JN. Cost-effectiveness of cryptococcal antigen screening at CD4 counts of 101-200 cells/µL in Botswana. Wellcome Open Res 2021; 6:55. [PMID: 35087954 PMCID: PMC8767426 DOI: 10.12688/wellcomeopenres.16624.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 04/06/2024] Open
Abstract
Background: Cryptococcal antigen (CrAg) screening in individuals with advanced HIV reduces cryptococcal meningitis (CM) cases and deaths. The World Health Organization recently recommended increasing screening thresholds from CD4 ≤100 cells/µL to ≤200 cells/µL. CrAg screening at CD4 ≤100 cells/µL is cost-effective; however, the cost-effectiveness of screening patients with CD4 101-200 cells/µL requires evaluation. Methods: Using a decision analytic model with Botswana-specific cost and clinical estimates, we evaluated CrAg screening and treatment among individuals with CD4 counts of 101-200 cells/µL. We estimated the number of CM cases and deaths nationally and treatment costs without screening. For screening we modeled the number of CrAg tests performed, number of CrAg-positive patients identified, proportion started on pre-emptive fluconazole, CM cases and deaths. Screening and treatment costs were estimated and cost per death averted or disability-adjusted life year (DALY) saved compared with no screening. Results: Without screening, we estimated 142 CM cases and 85 deaths annually among individuals with CD4 101-200 cells/µL, with treatment costs of $368,982. With CrAg screening, an estimated 33,036 CrAg tests are performed, and 48 deaths avoided (1,017 DALYs saved). While CrAg screening costs an additional $155,601, overall treatment costs fall by $39,600 (preemptive and hospital-based CM treatment), yielding a net increase of $116,001. Compared to no screening, high coverage of CrAg screening and pre-emptive treatment for CrAg-positive individuals in this population avoids one death for $2440 and $114 per DALY saved. In sensitivity analyses assuming a higher proportion of antiretroviral therapy (ART)-naïve patients (75% versus 15%), cost per death averted was $1472; $69 per DALY saved. Conclusions: CrAg screening for individuals with CD4 101-200 cells/µL was estimated to have a modest impact, involve additional costs, and be less cost-effective than screening populations with CD4 counts ≤100 cells/µL. Additional CrAg screening costs must be considered against other health system priorities.
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Affiliation(s)
- Mark W. Tenforde
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, 98195, USA
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Charles Muthoga
- Botswana-UPenn Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Julia Ngidi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- National Health Laboratory, Gaborone, Botswana
| | - Madisa Mine
- National Health Laboratory, Gaborone, Botswana
| | - Greg Greene
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Alexander Jordan
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Tom Chiller
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Bruce A. Larson
- Department of Global Health, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Joseph N. Jarvis
- Botswana-UPenn Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- London School of Hygiene & Tropical Medicine, London, UK
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Jordan A, Sivapalan P, Jensen JU. Does inhaled corticosteroid use affect the risk of
COVID-19-related death? Breathe (Sheff) 2021; 17:200275. [PMID: 34295392 PMCID: PMC8291911 DOI: 10.1183/20734735.0275-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
ICS does not seem to protect against COVID-19-related mortality, but more data is needed to determine whether it is harmful. Due to its known and important benefits ICS should be prescribed as usual for both asthma and COPD. https://bit.ly/3pWVimX.
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Affiliation(s)
- Alexander Jordan
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Jordan A, Dougherty M, Mukherjee M, Timmerman M, Woscyna G, Hanson C. The Use of an Eye-Tracking Technology Tool in Analyzing and Assessing the Nutrition Focused Physical Exam Performance between Novice Nutrition Students and Expert Registered Dietitians. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Oladele RO, Jordan A, Akande P, Akanmu SA, Akase IE, Aliyu S, Denning DW, Chiller T. Tackling cryptococcal meningitis in Nigeria, one-step at a time; the impact of training. PLoS One 2020; 15:e0235577. [PMID: 32628714 PMCID: PMC7337344 DOI: 10.1371/journal.pone.0235577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/17/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Nigeria is estimated to have 25,000 cases of cryptococcal antigenemia (CrAg) annually. CrAg screening with pre-emptive fluconazole treatment is recommended but not yet implemented in Nigeria. Trainings were conducted to improve health-care provider (HCP) awareness and clinical skills in the management and prevention of cryptococcal meningitis (CM). METHODS HCPs providing care for people living with HIV were targeted for training at 13 sites from April to November 2018 Course content was adapted from CDC Cryptococcal Screening Program Training Manual and LIFE-website. "Hands-on" training on CrAg testing and lumbar puncture was included. A 14-point pre and post-test assessment instrument was designed to capture the impact of the training and focus group discussions (FGDs) were conducted. RESULTS A total of 761 HCPs were trained. 519 HCPs completed the pre-test evaluation while 470 (90.6%) took part in the post-test evaluation. Post-training, HCPs were significantly more likely to respond correctly to all 14 assessment items, with the mean percentage score rising to 91.0% from a pre-training value of 60.0%. FGDs revealed that many of the HCPs were not aware of the CrAg screening and pre-emptive treatment recommendations in Nigerian guidelines, and reported not having seen or managed a case of CM. Also, they highlighted challenges with routine CrAg screening due to a lack of access to CD4 testing, CrAg test kits, antifungal drugs, as well as the need for similar trainings across all tiers of care in Nigeria. CONCLUSION Training significantly improved HCPs' understanding of Nigerian policy on CrAg screening, CM diagnosis and best management practices. This training could be included in routine capacity building efforts for HCPs involved in HIV care in Nigeria.
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Affiliation(s)
- Rita O Oladele
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Alexander Jordan
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | | | | | - Iorhen E Akase
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sani Aliyu
- National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - David W Denning
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Tenforde MW, Muthoga C, Callaghan A, Ponatshego P, Ngidi J, Mine M, Jordan A, Chiller T, Larson BA, Jarvis JN. Cost-effectiveness of reflex laboratory-based cryptococcal antigen screening for the prevention and treatment of cryptococcal meningitis in Botswana. Wellcome Open Res 2020; 4:144. [PMID: 31803848 PMCID: PMC6871359 DOI: 10.12688/wellcomeopenres.15464.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 01/26/2023] Open
Abstract
Background: Cryptococcal antigen (CrAg) screening for antiretroviral therapy (ART)-naïve adults with advanced HIV/AIDS can reduce the incidence of cryptococcal meningitis (CM) and all-cause mortality. We modeled the cost-effectiveness of laboratory-based "reflex" CrAg screening for ART-naïve CrAg-positive patients with CD4<100 cells/µL (those currently targeted in guidelines) and ART-experienced CrAg-positive patients with CD4<100 cells/µL (who make up an increasingly large proportion of individuals with advanced HIV/AIDS). Methods: A decision analytic model was developed to evaluate CrAg screening and treatment based on local CD4 count and CrAg prevalence data, and realistic assumptions regarding programmatic implementation of the CrAg screening intervention. We modeled the number of CrAg tests performed, the number of CrAg positives stratified by prior ART experience, the proportion of patients started on pre-emptive antifungal treatment, and the number of incident CM cases and CM-related deaths. Screening and treatment costs were evaluated, and cost per death or disability-adjusted life year (DALY) averted estimated. Results: We estimated that of 650,000 samples undergoing CD4 testing annually in Botswana, 16,364 would have a CD4<100 cells/µL and receive a CrAg test, with 70% of patients ART-experienced at the time of screening. Under base model assumptions, CrAg screening and pre-emptive treatment restricted to ART-naïve patients with a CD4<100 cells/µL prevented 20% (39/196) of CM-related deaths in patients undergoing CD4 testing at a cost of US$2 per DALY averted. Expansion of preemptive treatment to include ART-experienced patients with a CD4<100 cells/µL resulted in 55 additional deaths averted (a total of 48% [94/196]) and was cost-saving compared to no screening. Findings were robust across a range of model assumptions. Conclusions: Reflex laboratory-based CrAg screening for patients with CD4<100 cells/µL is a cost-effective strategy in Botswana, even in the context of a relatively low proportion of advanced HIV/AIDS in the overall HIV-infected population, the majority of whom are ART-experienced.
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Affiliation(s)
- Mark W. Tenforde
- University of Washington School of Medicine, Seattle, Washington, 98195, USA
- University of Washington School of Public Health, Seattle, WA, 98195, USA
| | - Charles Muthoga
- Botswana-UPenn Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Julia Ngidi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- National Health Laboratory, Gaborone, Botswana
| | - Madisa Mine
- National Health Laboratory, Gaborone, Botswana
| | - Alexander Jordan
- Centers for Disease Controls and Prevention, Atlanta, Georgia, 30329-4018, USA
| | - Tom Chiller
- Centers for Disease Controls and Prevention, Atlanta, Georgia, 30329-4018, USA
| | - Bruce A. Larson
- Boston University School of Public Health, Boston, MA, 02118, USA
| | - Joseph N. Jarvis
- Botswana-UPenn Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- London School of Hygiene & Tropical Medicine, London, UK
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Bongomin F, Govender NP, Chakrabarti A, Robert-Gangneux F, Boulware DR, Zafar A, Oladele RO, Richardson MD, Gangneux JP, Alastruey-Izquierdo A, Bazira J, Boyles TH, Sarcarlal J, Nacher M, Obayashi T, Worodria W, Pasqualotto AC, Meya DB, Cheng B, Sriruttan C, Muzoora C, Kambugu A, Rodriguez Tudela JL, Jordan A, Chiller TM, Denning DW. Essential in vitro diagnostics for advanced HIV and serious fungal diseases: international experts' consensus recommendations. Eur J Clin Microbiol Infect Dis 2019; 38:1581-1584. [PMID: 31175479 DOI: 10.1007/s10096-019-03600-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Felix Bongomin
- Global Action Fund for Fungal Infections, Rue Le Corbusier 12, 1208, Geneva, Switzerland.,Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda
| | - Nelesh P Govender
- National Institute for Communicable Diseases (Centers for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), Johannesburg, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | - Malcolm D Richardson
- The University of Manchester, Manchester, UK.,Mycology Reference Centre, Manchester, UK
| | | | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Joel Bazira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tom H Boyles
- University of the Witwatersrand, Johannesburg, South Africa
| | - Jahit Sarcarlal
- Department of Microbiology, Faculty of Medicine , University Eduardo Mondlane, Maputo, Mozambique
| | | | | | - William Worodria
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - David B Meya
- College of Health Sciences, Makerere University, Kampala, Uganda.,Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Ben Cheng
- Global Health Impact Group, Atlanta, USA
| | - Charlotte Sriruttan
- National Institute for Communicable Diseases (Centers for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), Johannesburg, South Africa
| | - Conrad Muzoora
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew Kambugu
- College of Health Sciences, Makerere University, Kampala, Uganda.,Infectious Disease Institute, Makerere University, Kampala, Uganda
| | | | | | - Tom M Chiller
- Centers for Disease Control and Prevention, Atlanta, USA
| | - David W Denning
- Global Action Fund for Fungal Infections, Rue Le Corbusier 12, 1208, Geneva, Switzerland. .,The University of Manchester, Manchester, UK.
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Tolson J, Barnes M, Bartlett D, Rochford P, Jordan A, Trinder J, Jackson M. CPAP usage is increased after a psychoeducation program at 1 month, but not at 4 months. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Tenforde MW, Muthoga C, Callaghan A, Ponatshego P, Ngidi J, Mine M, Jordan A, Chiller T, Larson BA, Jarvis JN. Cost-effectiveness of reflex laboratory-based cryptococcal antigen screening for the prevention and treatment of cryptococcal meningitis in Botswana. Wellcome Open Res 2019; 4:144. [PMID: 31803848 PMCID: PMC6871359 DOI: 10.12688/wellcomeopenres.15464.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 01/06/2023] Open
Abstract
Background: Cryptococcal antigen (CrAg) screening for antiretroviral therapy (ART)-naïve adults with advanced HIV/AIDS can reduce the incidence of cryptococcal meningitis (CM) and all-cause mortality. We modeled the cost-effectiveness of laboratory-based "reflex" CrAg screening for ART-naïve CrAg-positive patients with CD4<100 cells/µL (those currently targeted in guidelines) and ART-experienced CrAg-positive patients with CD4<100 cells/µL (who make up an increasingly large proportion of individuals with advanced HIV/AIDS). Methods: A decision analytic model was developed to evaluate CrAg screening and treatment based on local CD4 count and CrAg prevalence data, and realistic assumptions regarding programmatic implementation of the CrAg screening intervention. We modeled the number of CrAg tests performed, the number of CrAg positives stratified by prior ART experience, the proportion of patients started on pre-emptive antifungal treatment, and the number of incident CM cases and CM-related deaths. Screening and treatment costs were evaluated, and cost per death or disability-adjusted life year (DALY) averted estimated. Results: We estimated that of 650,000 samples undergoing CD4 testing annually in Botswana, 16,364 would have a CD4<100 cells/µL and receive a CrAg test, with 70% of patients ART-experienced at the time of screening. Under base model assumptions, CrAg screening and pre-emptive treatment restricted to ART-naïve patients with a CD4<100 cells/µL prevented 20% (39/196) of CM-related deaths in patients undergoing CD4 testing at a cost of US$2 per DALY averted. Expansion of preemptive treatment to include ART-experienced patients with a CD4<100 cells/µL resulted in 55 additional deaths averted (a total of 48% [94/196]) and was cost-saving compared to no screening. Findings were robust across a range of model assumptions. Conclusions: Reflex laboratory-based CrAg screening for patients with CD4<100 cells/µL is a cost-effective strategy in Botswana, even in the context of a relatively low proportion of advanced HIV/AIDS in the overall HIV-infected population, the majority of whom are ART-experienced.
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Affiliation(s)
- Mark W. Tenforde
- University of Washington School of Medicine, Seattle, Washington, 98195, USA
- University of Washington School of Public Health, Seattle, WA, 98195, USA
| | - Charles Muthoga
- Botswana-UPenn Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Julia Ngidi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- National Health Laboratory, Gaborone, Botswana
| | - Madisa Mine
- National Health Laboratory, Gaborone, Botswana
| | - Alexander Jordan
- Centers for Disease Controls and Prevention, Atlanta, Georgia, 30329-4018, USA
| | - Tom Chiller
- Centers for Disease Controls and Prevention, Atlanta, Georgia, 30329-4018, USA
| | - Bruce A. Larson
- Boston University School of Public Health, Boston, MA, 02118, USA
| | - Joseph N. Jarvis
- Botswana-UPenn Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- London School of Hygiene & Tropical Medicine, London, UK
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Rajasingham R, Meya DB, Greene GS, Jordan A, Nakawuka M, Chiller TM, Boulware DR, Larson BA. Evaluation of a national cryptococcal antigen screening program for HIV-infected patients in Uganda: A cost-effectiveness modeling analysis. PLoS One 2019; 14:e0210105. [PMID: 30629619 PMCID: PMC6328136 DOI: 10.1371/journal.pone.0210105] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/16/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cryptococcal meningitis accounts for 15% of AIDS-related mortality. Cryptococcal antigen (CrAg) is detected in blood weeks before onset of meningitis, and CrAg positivity is an independent predictor of meningitis and death. CrAg screening for patients with advanced HIV and preemptive treatment is recommended by the World Health Organization, though implementation remains limited. Our objective was to evaluate costs and mortality reduction (lives saved) from a national CrAg screening program across Uganda. METHODS We created a decision analytic model to evaluate CrAg screening. CrAg screening was considered for those with a CD4<100 cells/μL per national and international guidelines, and in the context of a national HIV test-and-treat program where CD4 testing was not available. Costs (2016 USD) were estimated for screening, preemptive therapy, hospitalization, and maintenance therapy. Parameter assumptions were based on large prospective CrAg screening studies in Uganda, and clinical trials from sub Saharan Africa. CrAg positive (CrAg+) persons could be: (a) asymptomatic and thus eligible for preemptive treatment with fluconazole; or (b) symptomatic with meningitis with hospitalization. RESULTS In the base case model for 1 million persons with a CD4 test annually, 128,000 with a CD4<100 cells/μL were screened, and 8,233 were asymptomatic CrAg+ and received preemptive therapy. Compared to no screening and treatment, CrAg screening and treatment in the base case cost $3,356,724 compared to doing nothing, and saved 7,320 lives, for a cost of $459 per life saved, with the $3.3 million in cost savings derived from fewer patients developing fulminant meningitis. In the scenario of a national HIV test-and-treat program, of 1 million HIV-infected persons, 800,000 persons were screened, of whom 640,000 returned to clinic, and 8,233 were incident CrAg positive (CrAg prevalence 1.4%). The total cost of a CrAg screening and treatment program was $4.16 million dollars, with 2,180 known deaths. Conversely, without CrAg screening, the cost of treating meningitis was $3.09 million dollars with 3,806 deaths. Thus, despite the very low CrAg prevalence of 1.4% in the general HIV-infected population, and inadequate retention-in-care, CrAg screening averted 43% of deaths from cryptococcal meningitis at a cost of $662 per death averted. CONCLUSION CrAg screening and treatment programs are cost-saving and lifesaving, assuming preemptive treatment is 77% effective in preventing death, and could be adopted and implemented by ministries of health to reduce mortality in those with advanced HIV disease. Even within HIV test-and-treat programs where CD4 testing is not performed, and CrAg prevalence is only 1.4%, CrAg screening is cost-effective.
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Affiliation(s)
- Radha Rajasingham
- Division of Infectious Diseases & International Medicine, University of Minnesota, Minnesota, United States of America
- * E-mail:
| | - David B. Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Gregory S. Greene
- Mycotic Diseases Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Alexander Jordan
- Mycotic Diseases Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Mina Nakawuka
- AIDS Control Program, Ministry of Health, Kampala, Uganda
| | - Tom M. Chiller
- Mycotic Diseases Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - David R. Boulware
- Division of Infectious Diseases & International Medicine, University of Minnesota, Minnesota, United States of America
| | - Bruce A. Larson
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Morgul MH, Raschzok N, Schwartlander R, Vondran F, Michel R, Stelter L, Pinkernelle J, Jordan A, Teichgraber U, Sauer IM. Tracking of Primary Human Hepatocytes with Clinical MRI: Initial Results with Tat-Peptide Modified Superparamagnetic Iron Oxide Particles. Int J Artif Organs 2018; 31:252-7. [DOI: 10.1177/039139880803100309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The transplantation of primary human hepatocytes is a promising approach in the treatment of specific liver diseases. However, little is known about the fate of the cells following application. Magnetic resonance imaging (MRI) could enable real-time tracking and long-term detection of transplanted hepatocytes. The use of superparamagnetic iron oxide particles as cellular contrast agents should allow for the non-invasive detection of labelled cells on high-resolution magnetic resonance images. Experiments were performed on primary human hepatocytes to transfer the method of detecting labelled cells via clinical MRI into human hepatocyte transplantation. For labelling, Tat-peptide modified nano-sized superparamagnetic MagForce particles were used. Cells were investigated via a clinical MR scanner at 3.0 Tesla and the particle uptake within single hepatocytes was estimated using microscopic examinations. The labelled primary human hepatocytes were clearly detectable by MRI, proving the feasibility of this new concept. Therefore, this method is a useful tool to investigate the effects of human hepatocyte transplantation and to improve safety aspects of this method.
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Affiliation(s)
- M. H. Morgul
- Department of General, Visceral, and Transplantation Surgery, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
- Istanbul Faculty of Medicine, Istanbul University, Istanbul - Turkey
| | - N. Raschzok
- Department of General, Visceral, and Transplantation Surgery, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
| | - R. Schwartlander
- Department of General, Visceral, and Transplantation Surgery, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
| | - F.W. Vondran
- Department of General, Visceral, and Transplantation Surgery, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
| | - R. Michel
- Department of Radiology, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
| | - L. Stelter
- Department of Radiology, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
| | - J. Pinkernelle
- Department of Radiology, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
| | - A. Jordan
- Department of Radiology, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
| | - U. Teichgraber
- Department of Radiology, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
| | - I. M. Sauer
- Department of General, Visceral, and Transplantation Surgery, Chiarité - Campus Virchow, Universitätsmedizin Berlin - Germany
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Fry MM, Yao B, Ríos C, Wong C, Mann S, McArt JAA, Nydam DV, Leal Yepes FA, Viesselmann L, Geick A, Goldin K, Jordan A, Behling-Kelly E. Diagnostic performance of cytology for assessment of hepatic lipid content in dairy cattle. J Dairy Sci 2017; 101:1379-1387. [PMID: 29248218 DOI: 10.3168/jds.2017-12897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 10/10/2017] [Indexed: 12/26/2022]
Abstract
The objective of our study was to characterize the diagnostic performance of cytology for assessing hepatic lipid content (HLC) in dairy cows by comparing microscopic evaluation of lipid vacuolation in touch imprint slide preparations of liver biopsies with quantitative measurement of triglyceride concentration ([TG]; mg/mg of wet weight) in paired biopsy samples. Our study also sought to compare the diagnostic performance of liver cytology, plasma nonesterified fatty acid concentration ([NEFA]), and plasma β-hydroxybutyrate concentration ([BHB]) derived from a measurement performed on whole blood, for assessing HLC. Chemical extraction of TG from liver tissue remains the gold standard for quantifying HLC, largely because available blood tests, although useful for detecting some types of pathology, such as increased lipid mobilization, ketosis, or hepatocellular injury, are nonspecific as to etiology. Veterinary practitioners can sample bovine liver for cytological evaluation in a fast, minimally invasive, and inexpensive manner. Thus, if highly predictive of HLC, cytology would be a practical diagnostic tool for dairy veterinarians. In our study, liver biopsy samples from Holstein cows (219 samples from 105 cows: 52 from cows 2 to 20 d prepartum, 105 from cows 0 to 10 d in milk, 62 from cows 18 to 25 d in milk) were used to prepare cytology slides and to quantify [TG] using the Folch extraction method followed by the Hantzch condensation reaction and spectrophotometric measurement. An ordinal scale (0-4) based on amount of hepatocellular cytoplasm occupied by discrete clear vacuoles was used by 3 blinded, independent observers to rank HLC in Wright-Giemsa-stained slides. Interobserver agreement in cytology scoring was good. Corresponding plasma [NEFA] and [BHB] measurements were available for 187 and 195 of the 219 samples, respectively. Liver [TG] correlated more strongly with cytology score than with NEFA or BHB, and receiver operating characteristic curve analysis showed that cytology had better diagnostic performance than either NEFA or BHB for correctly categorizing [TG] at thresholds of 5, 10, and 15%. Hepatic lipidosis in high-producing dairy cows is of major clinical and economic importance, and this study demonstrates that cytology is an accurate means of assessing HLC. Additional work is indicated to evaluate the diagnostic utility of liver cytology.
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Affiliation(s)
- M M Fry
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville 37996
| | - B Yao
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - C Ríos
- Dirección Académica, Universidad Santo Tomás, Mendoza 120, Los Ángeles, Chile
| | - C Wong
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - S Mann
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - J A A McArt
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - D V Nydam
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - F A Leal Yepes
- Department of Animal Science, Cornell University, Ithaca NY 14853
| | - L Viesselmann
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville 37996
| | - A Geick
- College of Veterinary Medicine, University of Tennessee, Knoxville 37996
| | - K Goldin
- College of Veterinary Medicine, University of Tennessee, Knoxville 37996
| | - A Jordan
- College of Veterinary Medicine, University of Tennessee, Knoxville 37996
| | - E Behling-Kelly
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853.
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Cori J, Rochford P, O'Donoghue F, Trinder J, Jordan A. Hypocapnia has minimal influence on genioglossus muscle afterdischarge elicited by arousal from sleep in healthy individuals. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O'Connell A, Tummon A, Coleman K, Jordan A, McCormack J, Kelly ME. Antenatal Pertussis Vaccination: Why are General Practitioners Reluctant? A Mixed Methods StudySetting. Ir Med J 2017; 110:634. [PMID: 29372949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pertussis has a disproportionately higher morbidity and mortality in infants less than 3 months of age. International and national guidelines recommend pertussis vaccination during pregnancy, as a safe and effective way to protect these infants. Antenatal pertussis vaccination uptake rates remain suboptimal, with many health care professionals (HCPs) still not recommending it. The reasons underlying this reluctance on behalf of HCPs have not been fully established. This study aims to evaluate the current practice and attitudes of General Practitioners (GPs) with regard to antenatal pertussis vaccination. An embedded mixed method design was used. The response rate was 41% (n=109). 54% of GPs who responded (n=59) routinely recommend antenatal pertussis vaccination. Safety concerns and a sense of isolation emerged as the major qualitative themes. More safety data, adequate funding from the Health Service Executive (HSE) and support from secondary care may help to increase the GP recommendation rate and enhance vaccination uptake in pregnancy.
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Affiliation(s)
- A O'Connell
- GP Registrar, Western Training Programme in General Practice, Galway University Hospital, Galway, Ireland
| | - A Tummon
- GP Registrar, Western Training Programme in General Practice, Galway University Hospital, Galway, Ireland
| | - K Coleman
- GP Registrar, Western Training Programme in General Practice, Galway University Hospital, Galway, Ireland
| | - A Jordan
- GP Registrar, Western Training Programme in General Practice, Galway University Hospital, Galway, Ireland
| | - J McCormack
- Assistant Programme Director, Western Training Programme in General Practice, Galway University Hospital, Galway, Ireland
| | - M E Kelly
- Assistant Programme Director, Western Training Programme in General Practice, Galway University Hospital, Galway, Ireland
- Lecturer in the Discipline of General Practice, Medical School, National University of Ireland, Galway
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Sachdev N, Maxwell S, Jordan A, Prates R, Konstantinidis M, Licciardi F. Determining the odds of pregnancy in brca positive women undergoing combined pre-implantation genetic diagnosis (PGD) and screening. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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