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Prior C, Swales H, Sharman M, Reed N, Bommer N, Kent A, Glanemann B, Clarke K, Kortum A, Kelly D, Lea C, Roberts E, Rutherford L, Tamborini A, Murphy K, Batchelor DJ, Calleja S, Burrow R, Jamieson P, Best M, Borgonovi S, Calvo-Saiz I, Elgueta I, Piazza C, Gil Morales C, Hrovat A, Keane M, Kennils J, Lopez E, Spence S, Izaguirre E, Hernandez-Perello M, Lau N, Paul A, Ridyard A, Shales C, Shelton E, Farges A, Specchia G, Espada L, Fowlie SJ, Tappin S, Van den Steen N, Sparks TH, Allerton F. Diagnostic findings in sinonasal aspergillosis in dogs in the United Kingdom: 475 cases (2011-2021). J Small Anim Pract 2024. [PMID: 38679786 DOI: 10.1111/jsap.13736] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/28/2024] [Accepted: 03/31/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES To describe the diagnostic tests used and their comparative performance in dogs diagnosed with sinonasal aspergillosis in the United Kingdom. A secondary objective was to describe the signalment, clinical findings and common clinicopathologic abnormalities in sinonasal aspergillosis. MATERIALS AND METHODS A multi-centre retrospective survey was performed involving 23 referral centres in the United Kingdom to identify dogs diagnosed with sinonasal aspergillosis from January 2011 to December 2021. Dogs were included if fungal plaques were seen during rhinoscopy or if ancillary testing (via histopathology, culture, cytology, serology or PCR) was positive and other differential diagnoses were excluded. RESULTS A total of 662 cases were entered into the database across the 23 referral centres. Four hundred and seventy-five cases met the study inclusion criteria. Of these, 419 dogs had fungal plaques and compatible clinical signs. Fungal plaques were not seen in 56 dogs with turbinate destruction that had compatible clinical signs and a positive ancillary test result. Ancillary diagnostics were performed in 312 of 419 (74%) dogs with observed fungal plaques permitting calculation of sensitivity of cytology as 67%, fungal culture 59%, histopathology 47% and PCR 71%. CLINICAL SIGNIFICANCE The sensitivities of ancillary diagnostics in this study were lower than previously reported challenging the clinical utility of such tests in sinonasal aspergillosis. Treatment and management decisions should be based on a combination of diagnostics including imaging findings, visual inspection, and ancillary testing, rather than ancillary tests alone.
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Affiliation(s)
- C Prior
- Willows Veterinary Centre and Referral Service, Part of Linnaeus Veterinary Limited, Solihull, UK
| | - H Swales
- Moorview Referrals, Cramlington, UK
| | | | - N Reed
- Veterinary Specialists Scotland, Livingston, UK
| | - N Bommer
- Veterinary Specialists Scotland, Livingston, UK
| | - A Kent
- Blaise Veterinary Referral Hospital, Birmingham, UK
| | | | - K Clarke
- Davies Veterinary Specialists, Hitchin, UK
| | - A Kortum
- Cambridge Veterinary School, Cambridge, UK
| | - D Kelly
- Southern Counties Veterinary Specialists, Ringwood, UK
| | - C Lea
- Southern Counties Veterinary Specialists, Ringwood, UK
| | - E Roberts
- Bristol Veterinary Specialists, Bristol, UK
| | | | | | - K Murphy
- Rowe Veterinary Referrals, Bristol, UK
| | - D J Batchelor
- School of Veterinary Science, University of Liverpool, Neston, UK
| | - S Calleja
- Lumbry Park Veterinary Specialists, Hampshire, UK
| | - R Burrow
- Northwest Veterinary Specialists, Runcorn, UK
| | - P Jamieson
- VetsNow 24/7 Emergency & Specialty Hospital, Glasgow, UK
| | - M Best
- Eastcott Veterinary Referrals, Swindon, UK
| | | | | | - I Elgueta
- VetsNow 24/7 Emergency & Specialty Hospital, Glasgow, UK
| | - C Piazza
- Scarsdale Vets Pride Veterinary Centre, Derby, UK
| | | | - A Hrovat
- Scarsdale Vets Pride Veterinary Centre, Derby, UK
| | - M Keane
- School of Veterinary Science, University of Liverpool, Neston, UK
| | - J Kennils
- Langford Veterinary Services Ltd, Langford, UK
| | - E Lopez
- Langford Veterinary Services Ltd, Langford, UK
| | - S Spence
- North Downs Specialist Referrals, Surrey, UK
| | - E Izaguirre
- North Downs Specialist Referrals, Surrey, UK
| | | | - N Lau
- Davies Veterinary Specialists, Hitchin, UK
| | - A Paul
- Anderson Moores Veterinary Specialists, Hampshire, UK
| | - A Ridyard
- University of Glasgow Small Animal Hospital, Glasgow, UK
| | - C Shales
- Willows Veterinary Centre and Referral Service, Part of Linnaeus Veterinary Limited, Solihull, UK
| | - E Shelton
- The Royal Veterinary College, London, UK
| | - A Farges
- University of Glasgow Small Animal Hospital, Glasgow, UK
| | - G Specchia
- Scarsdale Vets Pride Veterinary Centre, Derby, UK
| | - L Espada
- University of Glasgow Small Animal Hospital, Glasgow, UK
| | - S J Fowlie
- Southfields Veterinary Specialists, Essex, UK
| | - S Tappin
- Dick White Referrals, Cambridge, UK
| | | | - T H Sparks
- Waltham Petcare Science Institute, Leicestershire, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Part of Linnaeus Veterinary Limited, Solihull, UK
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Coates LC, Bukhari M, Chan A, Choy E, Galloway J, Gullick N, Kent A, Savage L, Siebert S, Tillett W, Wood N, Conaghan PG. Enhancing current guidance for psoriatic arthritis and its comorbidities: recommendations from an expert consensus panel. Rheumatology (Oxford) 2024:keae172. [PMID: 38490262 DOI: 10.1093/rheumatology/keae172] [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: 12/08/2023] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Existing guidelines for psoriatic arthritis (PsA) cover many aspects of management. Some gaps remain relating to routine practice application. An expert group aimed to enhance current guidance and develop recommendations for clinical practice that are complementary to existing guidelines. METHODS A steering committee comprising experienced, research-active clinicians in rheumatology, dermatology and primary care agreed on themes and relevant questions. A targeted literature review of PubMed and Embase following a PICO framework was conducted. At a second meeting, recommendations were drafted and subsequently an extended faculty comprising rheumatologists, dermatologists, primary care clinicians, specialist nurses, allied health professionals, non-clinical academic participants and members of the Brit-PACT patient group, was recruited. Consensus was achieved via an online voting platform when 75% of respondents agreed in the range of 7-9 on a 9-point scale. RESULTS The guidance comprised 34 statements covering four PsA themes. Diagnosis focused on strategies to identify PsA early and refer appropriately, assessment of diagnostic indicators, use of screening tools and use of imaging. Disease assessment centred on holistic consideration of disease activity, physical functioning and impact from a patient perspective, and on how to implement shared decision-making. For comorbidities, recommendations included specific guidance for high-impact conditions such as depression and obesity. Management statements (which excluded extant guidance on pharmacological therapies) covered multidisciplinary team working, implementation of lifestyle modifications and treat-to-target strategies. Minimising corticosteroid use was recommended where feasible. CONCLUSION The consensus group have made evidence-based best practice recommendations for the management of PsA to enhance the existing guidelines.
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Affiliation(s)
- Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Marwan Bukhari
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster, United Kingdom
| | - Antoni Chan
- University Department of Rheumatology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Ernest Choy
- Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre, Cardiff University, Cardiff, United Kingdom
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Nicola Gullick
- Rheumatology Department, University Hospitals of Coventry & Warwickshire, Coventry, United Kingdom
| | - Alison Kent
- Department of Rheumatology, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - Laura Savage
- Department of Dermatology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | - William Tillett
- Rheumatology Department, Royal National Hospital for Rheumatic Disease, Bath, United Kingdom
| | - Natasha Wood
- The Wooda Surgery, Bideford, Devon, United Kingdom
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
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Sepriano A, van Dijk B, Ramiro S, van der Helm-van Mil A, Combe B, van Schaardenburg D, de Wit M, Kent A, Mateus E, Landewé R. Distinction and prognosis of early arthritis phenotypes: an analysis in three European cohorts. RMD Open 2023; 9:e003611. [PMID: 37914180 PMCID: PMC10626756 DOI: 10.1136/rmdopen-2023-003611] [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: 08/14/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES The objective of this study is to evaluate whether there are differences in the long-term prognosis across various phenotypes of early arthritis (EA). METHODS Three EA cohorts (Reade, Etude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) and Early Arthritis Clinic (EAC)) were analysed. Clinical data were collected up to 24 years. Hands and feet radiographs were scored according to the Sharp van der Heijde (SvdH) method. Latent class analysis was applied to determine the EA phenotypes at baseline. Each class received a label reflecting its most prominent features. Prognostic outcomes included Health Assessment Questionnaire (HAQ), Short Form 36 (SF36) and SvdH score. The association between class membership and outcomes over time was tested in multivariable models. RESULTS In total, 390 (Reade), 798 (ESPOIR) and 3991 (EAC) patients were analysed separately. Two classes with symmetrical polyarthritis emerged; one of these labelled as autoimmune inflammatory polyarthritis (AIPA), had high likelihood of acute phase reactants (APR) elevation and autoantibody positivity, while the other (mild-inflammatory polyarthritis; MIPA) had not. A third class had oligoarthritis of upper limbs (OAUL) and could be subdivided into autoimmune OAUL and mild-inflammatory OAUL. A fifth class had oligoarthritis of lower limbs. The SvdH scores were worse in patients with APR/autoantibodies (AIPA) than in those without (MIPA). No clinically meaningful differences across classes in HAQ or SF36 over time were found. CONCLUSION Radiographic progression over time primarily occurs in EA patients with APR/autoantibodies. The absence of these markers, however, does not necessarily translate into better long-term function and quality of life. Clinicians should not only aim at preventing joint damage, but look beyond structural progression in order to further improve the lives of people with EA.
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Affiliation(s)
- Alexandre Sepriano
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | | | | | | | - Maarten de Wit
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Alison Kent
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Elsa Mateus
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Robert Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands
- Rheumatology, Zuyderland Medical Centre, Heerlen, Netherlands
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McCormick NE, Earle M, Kent A, Ha C, Hakes L, Anderson L, Stoddart AK, Langille MGI, Gagnon GA. Betaproteobacteria are a key component of surface water biofilters that maintain sustained manganese removal in response to fluctuations in influent water temperature. Water Res 2023; 244:120515. [PMID: 37634461 DOI: 10.1016/j.watres.2023.120515] [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: 03/15/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
The health risks associated with manganese (Mn) in drinking water, and an improved understanding of Mn accumulation within, and subsequent release from, distribution systems, have increased the need for robust, sustainable treatment options to minimize Mn concentrations in finished water. Biofiltration is an established and effective method to remove Mn in groundwater however, Mn removal in surface water biofilters is an emerging treatment process that has not been extensively studied. Seasonal variations in water temperature can present an operational challenge for surface water biofilters which may see reduced Mn removal under colder conditions. This study examined the microbiomes of surface water biofilters at three utilities (ACWD WTP, WTP B, and WTP D) which all experienced similar seasonal fluctuations in influent water temperature. High Mn removal was observed at the ACWD WTP for much of the year, but Mn removal decreased with a concurrent decrease in the influent water temperature (58% ± 22%). In contrast, both WTP B and WTP D achieved year-round Mn removal (84% ± 5% and 93% ± 8% respectively). Marker gene (16S rRNA) sequencing analysis of the biofilter microbiomes identified a high abundance of Betaproteobacteria in WTP B and WTP D (37% ± 12% and 21% ± 3% respectively), but a low abundance of Betaproteobacteria in the ACWD WTP (2% ± 2%). The microbiomes of new bench-scale biofilters, in operation at the ACWD WTP, were also investigated. The abundance of Betaproteobacteria was significantly greater (p < 0.05) after the biofilters had acclimated than before acclimation, and differential abundance analysis identified 6 genera within the Betaproteobacteria class were enriched in the acclimated microbiome. Additionally, the acclimated biofilters were able to maintain high Mn removal performance (87% ± 10%) when the influent water temperature decreased to 10 °C or less. Further analysis of previously published studies found the abundance of Betaproteobacteria was also significantly greater (p < 0.001) in biofilters with sustained Mn removal than in biofilters which did not treat for Mn as a contaminant, despite differences in design scale, source water, and media type. Microbiome network analysis identified multiple co-occurrence relationships between Betaproteobacteria and Mn oxidizing bacteria in the WTP B and WTP D biofilters, suggesting indirect contributions by Betaproteobacteria to biological Mn oxidation. These co-occurrence relationships were not present in the full-scale ACWD WTP microbiome. Whether the role of Betaproteobacteria in biological Mn oxidation is direct, indirect, or a combination of both, they are consistently present at a high abundance in both groundwater and surface water biofilters with sustained Mn removal, and their absence may contribute to the seasonal fluctuations in Mn removal observed at the ACWD WTP. This new insight to Betaproteobacteria and their role in Mn biofiltration could contribute to water innovation and design that would improve the reliability of Mn removal.
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Affiliation(s)
- N E McCormick
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada.
| | - M Earle
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada
| | - A Kent
- Arcadis US, Inc., Austin, TX, USA
| | - C Ha
- Alameda County Water District, Freemont, CA, USA
| | - L Hakes
- Alameda County Water District, Freemont, CA, USA
| | - L Anderson
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada
| | - A K Stoddart
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada
| | - M G I Langille
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - G A Gagnon
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada
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Healy J, Longbottom K, Kent A, Whittaker E, Parks T. On the lookout for post-streptococcal complications in the UK. Arch Dis Child 2023:archdischild-2023-326198. [PMID: 37775145 DOI: 10.1136/archdischild-2023-326198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Justin Healy
- Department of Infectious Disease, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Katherine Longbottom
- Department of Microbiology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Alison Kent
- Department of Paediatrics, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Tom Parks
- Department of Infectious Disease, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
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Work M, Scudder C, Bergum Hjellegjerde K, Dunning M, Gajanayake I, Kent A, Tintle L, Sparks T, Allerton F. A survey on Shar Pei autoinflammatory disease in the United Kingdom. J Small Anim Pract 2023; 64:401-408. [PMID: 36978210 DOI: 10.1111/jsap.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/03/2022] [Accepted: 01/16/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES To characterise the fever episodes attributed to Shar Pei autoinflammatory disease and to identify common diagnostic and management strategies in the United Kingdom. A secondary objective was to determine risk factors associated with Shar Pei autoinflammatory disease fever episodes. METHODS A retrospective survey was performed to characterise episodes of Shar Pei autoinflammatory disease fever and to identify commonly used treatments in affected dogs. Clinical data were collected from owners and veterinarians. Frequencies of previously proposed risk factors (skin thickness and folding, muzzle conformation) and comorbid conditions were compared between dogs that had exhibited fever episodes consistent with Shar Pei autoinflammatory disease and those who had not. RESULTS At least one episode of fever attributed to Shar Pei autoinflammatory disease was reported in 52 of 106 (49%) Shar Pei. Nine other dogs had fever episodes consistent with Shar Pei autoinflammatory disease reported by their owners but not by veterinarians. Median rectal temperature at presentation for Shar Pei autoinflammatory disease fever was 40.1°C [104.2°F] (39.9 to 41.3°C [103.8 to 106.3°F]) and owners reported associated hyporexia (n=33, 63%) and vomiting (n=8, 15%) more frequently than veterinary records (n=22, 42% and n=0, 0%, respectively). The median number of veterinary appointments for Shar Pei autoinflammatory disease was two per dog (1 to 15) while owners reported a median of four episodes per dog per year. None of the assessed phenotypic variants or comorbidities were significantly associated with exhibiting Shar Pei autoinflammatory disease fever episodes. CLINICAL SIGNIFICANCE Episodes of Shar Pei autoinflammatory disease fever were reported approximately twice as frequently by owners compared to veterinary records, suggesting the burden of this condition may be underestimated by veterinarians. Specific risk factors for Shar Pei autoinflammatory disease fever were not identified.
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Affiliation(s)
- M Work
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - C Scudder
- Southfields Veterinary Specialists, Essex, UK
- Royal Veterinary College, Potters Bar, Hertfordshire, UK
| | | | - M Dunning
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - I Gajanayake
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - A Kent
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - L Tintle
- Wurtsboro Veterinary Clinic, Wurtsboro, New York, USA
| | - T Sparks
- Waltham Petcare Science Institute, Leicestershire, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Solihull, UK
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Ravicini S, Kent A, Dunning M, Baines S, Clarke S, Allerton F. Description and outcome of dogs with primary immune-mediated polyarthritis: 73 cases (2012-2017). J Small Anim Pract 2023; 64:142-148. [PMID: 36321528 DOI: 10.1111/jsap.13565] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/18/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To provide a description of primary idiopathic immune-mediated polyarthritis, including long-term outcome and relapse rates, for dogs starting treatment with corticosteroids alone or corticosteroids with a second immunosuppressant. MATERIALS AND METHODS Medical records were reviewed between January 2012 and December 2017 to identify dogs diagnosed with primary immune-mediated polyarthritis. Data including signalment, clinicopathological findings, type and duration of treatment, relapse and outcome were recorded. RESULTS Seventy-three dogs were included. Fifty-four dogs were started on corticosteroid monotherapy (an additional immunosuppressant was introduced later in 27/54 dogs) and 19 dogs were treated with multi-modal immunosuppression from the outset. Ninety-five percent (69/73) of dogs responded favourably to therapy although death was attributed to immune-mediated polyarthritis in 19% (14/73) of dogs. Relapse of clinical signs was reported in 53% (39/73) dogs (31/39 while on treatment), with multiple relapses observed in 17 dogs. Complete cure (permanent withdrawal of immunosuppressive medication) was achieved in 46 dogs (63%). Overall, 81% of dogs had a well-managed disease for an extended timeframe (≥1131 days). Fourteen of 19 (74%) dogs that started treatment with multi-modal immunosuppression and 32 of 54 (59%) started on corticosteroids alone achieved a complete cure. CLINICAL SIGNIFICANCE This study provides extended follow-up information for a large cohort of dogs with primary immune-mediated polyarthritis. Immunosuppressive therapy was discontinued in the majority of dogs but disease-associated mortality remains high.
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Affiliation(s)
- S Ravicini
- Washington State University, College of Veterinary Medicine, Pullman, WA, USA
| | - A Kent
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - M Dunning
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK.,School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - S Baines
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - S Clarke
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
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Xu JH, Bariciak E, Harrison MA, Broom M, Lemyre B, Webster RJ, Weiler G, Dahlstrom JE, Kent A. Normative values of renin and aldosterone in clinically stable preterm neonates. Pediatr Nephrol 2022; 38:1877-1886. [PMID: 36409371 PMCID: PMC10154272 DOI: 10.1007/s00467-022-05807-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of literature on the normative levels of plasma renin concentration (PRC) and serum aldosterone (SA) in premature neonates. This study aims to provide normative data on PRC and SA levels in preterm neonates in the first 2 weeks after birth and explore associations with maternal, perinatal, or postnatal factors. METHODS Neonates born at 26- to 34-week gestation were recruited from two neonatal intensive care units in Canada and Australia. The direct renin assay PRC and SA were analyzed on day 1 and days 14-21 after birth to compare across categorical variables and to produce normative values. RESULTS A total of 262 subjects were enrolled from the Canadian (29%) and Australian (71%) sites. The mean gestational age was 30 weeks, with a mean birth weight of 1457 g. The normative values of PRC and SA for neonates born between 26 + 0 and 29 + 6 weeks and 30 + 0 and 34 + 0 weeks of gestation were produced for day 1 and day 14-21 after birth. Both PRC and SA increased from day 1 to day 14-21. The more premature neonates reached a higher PRC on days 14-21 after birth but exhibited lower SA levels on day 1 after birth. When comparing gender, birth weight, and maternal risk factor categories, no statistical differences in PRC or SA were found. A small but significant decrease in PRC, but not SA, was noted for neonates with placental pathology. CONCLUSIONS This study produced normative values of PRA and SA in clinically stable preterm neonates that can be referenced for use in clinical practice. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- James Haiyang Xu
- Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Erika Bariciak
- Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital General Campus, Ottawa, Canada
| | - Mary-Ann Harrison
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Margaret Broom
- Dept of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, ACT Australia, SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, ACT, Canberra, Australia
| | - Brigitte Lemyre
- Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital General Campus, Ottawa, Canada
| | - Richard J Webster
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Gabrielle Weiler
- Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jane E Dahlstrom
- Dept of Anatomical Pathology, Canberra Hospital, ACT Australia, Australian National University, Canberra, ACT, Australia
| | - Alison Kent
- Department of Pediatrics, University of Rochester, Rochester, NY, USA. .,Australian National University, Canberra, ACT, Australia.
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Chmielewski J, Chaudhry PM, Harer MW, Menon S, South AM, Chappell A, Griffin R, Askenazi D, Jetton J, Starr MC, Selewski DT, Sarkar S, Kent A, Fletcher J, Abitbol CL, DeFreitas M, Duara S, Charlton JR, Swanson JR, Guillet R, D’Angio C, Mian A, Rademacher E, Mhanna MJ, Raina R, Kumar D, Jetton JG, Brophy PD, Colaizy TT, Klein JM, Arikan AA, Rhee CJ, Goldstein SL, Nathan AT, Kupferman JC, Bhutada A, Rastogi S, Bonachea E, Ingraham S, Mahan J, Nada A, Cole FS, Davis TK, Dower J, Milner L, Smith A, Fuloria M, Reidy K, Kaskel FJ, Soranno DE, Gien J, Gist KM, Chishti AS, Hanna MH, Hingorani S, Juul S, Wong CS, Joseph C, DuPont T, Ohls R, Staples A, Rohatgi S, Sethi SK, Wazir S, Khokhar S, Perazzo S, Ray PE, Revenis M, Mammen C, Synnes A, Wintermark P, Zappitelli M, Woroniecki R, Sridhar S. Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation. J Perinatol 2022; 42:930-936. [PMID: 35676535 PMCID: PMC9280854 DOI: 10.1038/s41372-022-01424-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/29/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate whether NICU discharge summaries documented neonatal AKI and estimate if nephrology consultation mediated this association. STUDY DESIGN Secondary analysis of AWAKEN multicenter retrospective cohort. EXPOSURES AKI severity and diagnostic criteria. OUTCOME AKI documentation on NICU discharge summaries using multivariable logistic regression to estimate associations and test for causal mediation. RESULTS Among 605 neonates with AKI, 13% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5% vs. 51%, p < 0.001) and SCr-only AKI (76.9% vs. 50.1%, p = 0.04). Nephrology consultation mediated 78.0% (95% CL 46.5-109.4%) of the total effect of AKI severity and 82.8% (95% CL 70.3-95.3%) of the total effect of AKI diagnostic criteria on documentation. CONCLUSION We report a low prevalence of AKI documentation at NICU discharge. AKI severity and SCr-only AKI increased odds of AKI documentation. Nephrology consultation mediated the associations of AKI severity and diagnostic criteria with documentation.
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Affiliation(s)
- Jennifer Chmielewski
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Paulomi M. Chaudhry
- Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew W. Harer
- Department of Pediatrics, Division of Neonatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shina Menon
- Division of Nephrology, University of Washington and Seattle Children’s Hospital, Seattle, WA, USA
| | - Andrew M. South
- Department of Pediatrics, Section of Nephrology, Brenner Children’s, Wake Forest School of Medicine, Winston Salem, NC, USA.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Ashley Chappell
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Russell Griffin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Askenazi
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Jetton
- Division of Nephrology, Dialysis and Transplantation, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Michelle C. Starr
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA.,Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,Correspondence and requests for materials should be addressed to Michelle C. Starr.
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10
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Dejaco C, Machado PM, Carubbi F, Bosch P, Terslev L, Tamborrini G, Sconfienza LM, Scirè CA, Ruetten S, van Rompay J, Proft F, Pitzalis C, Obradov M, Moe RH, Mascarenhas VV, Malattia C, Klauser AS, Kent A, Jans L, Hartung W, Hammer HB, Duftner C, Balint PV, Alunno A, Baraliakos X. EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2022; 81:760-767. [PMID: 34893469 DOI: 10.1136/annrheumdis-2021-221261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/28/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To develop evidence-based Points to Consider (PtC) for the use of imaging modalities to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). METHODS European Alliance of Associations for Rheumatology (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound (US), fluoroscopy, MRI, CT and fusion imaging to guide interventional procedures. Based on evidence and expert opinion, the task force (25 participants consisting of physicians, healthcare professionals and patients from 11 countries) developed PtC, with consensus obtained through voting. The final level of agreement was provided anonymously. RESULTS A total of three overarching principles and six specific PtC were formulated. The task force recommends preference of imaging over palpation to guide targeted interventional procedures at peripheral joints, periarticular musculoskeletal structures, nerves and the spine. While US is the favoured imaging technique for peripheral joints and nerves, the choice of the imaging method for the spine and sacroiliac joints has to be individualised according to the target, procedure, expertise, availability and radiation exposure. All imaging guided interventions should be performed by a trained specialist using appropriate operational procedures, settings and assistance by technical personnel. CONCLUSION These are the first EULAR PtC to provide guidance on the role of imaging to guide interventional procedures in patients with RMDs.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria
- Department of Rheumatology (ASAA-SABES), Brunico Hospital, Brunico, Italy
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
- Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Philipp Bosch
- Department of Rheumatology, Medical University of Graz, Graz, Austria
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Giorgio Tamborrini
- UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Universita degli Studi di Milano, Milano, Italy
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Carlo Alberto Scirè
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Epidemiology Research Unit, Italian Society of Rheumatology, Milano, Italy
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology, St. Anna Hospital, Herne, Germany
| | - Jef van Rompay
- Patient Research Partners, Patient Research, Antwerpen, Belgium
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Marina Obradov
- Radiology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Rikke Helene Moe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Vasco V Mascarenhas
- UIME (Unidade de Imagem Musculo-esquelética), Hospital da Luz Imaging Center, Lisbon, Portugal
- Rheumatic Diseases Lab, CEDOC, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Genova, Italy
| | - Andrea Sabine Klauser
- Radiology II, Medical University Innsbruck Department of Radiology, Innsbruck, Austria
| | - Alison Kent
- Salisbury Hospital NHS Foundation Trust, Salisbury, UK
| | - Lennart Jans
- Radiology, Ghent University Hospital Radiology Department, Gent, Belgium
| | - Wolfgang Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Bad Abbach, Germany
| | - Hilde Berner Hammer
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute for Rheumatology and Physiotherapy, Budapest, Hungary
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
| | - Xenofon Baraliakos
- Rheumatology, Ruhr-University Bochum, Rheumazentrum Ruhrgebiet Herne, Herne, Germany
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11
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Mc Gowan S, Goumalatsou C, Kent A. Fantastic niches and where to find them: the current diagnosis and management of uterine niche. Facts Views Vis Obgyn 2022; 14:37-47. [PMID: 35373546 PMCID: PMC9612856 DOI: 10.52054/fvvo.14.1.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Caesarean section (CS) scar niche is a well recognised complication of caesarean delivery and is defined as an indentation at the site of the CS scar with a depth of at least 2mm. Objectives To review systematically the medical literature regarding the current diagnosis and management of uterine niche Materials and methods We carried out a systematic review using MeSH terms ‘niche’ OR ‘sacculation’ OR ‘caesarean scar defect’ OR ‘caesarean section scar’ OR ‘uterine defect’ OR ‘isthmocele.’ Articles included were peer-reviewed and in English language. Main outcome measures Prevalence, symptoms, diagnosis, pathophysiology and management of uterine niche. Results CS scar niche is common and, in a subgroup, produces a range of symptoms including post-menstrual bleeding, dyspareunia and subfertility. It may be linked to use of locked sutures during CS closure. Niche repair can be achieved laparoscopically or hysteroscopically and appears to improve symptoms, although solid conclusions regarding fertility outcomes cannot be drawn. Conclusions CS scar niche is associated with a range of symptoms. Repair may aid subfertile patients and those with post-menstrual spotting. The presence of a niche is probably irrelevant in the absence of symptoms. What is new? LNG-IUS and surgical repair appear to improve symptoms in those with a niche.
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12
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Stevenson K, Brooks M, Hetherington L, Lench J, Kent A, Dunphy J, Lubitsh G, Ellis B. Employing a service user as a member of a musculoskeletal (MSK) service; How to start, support and scale this opportunity. Musculoskeletal Care 2021; 20:666-670. [PMID: 34825775 DOI: 10.1002/msc.1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Kay Stevenson
- Midlands Partnership NHS Foundation Trust, Stafford, UK.,Impact Accelerator Unit, The Medical School, Keele University, Keele, UK.,NHS England and NHS Improvement, Birmingham, UK
| | | | | | | | - Alison Kent
- Salisbury NHS Foundation Trust, Salisbury, UK
| | | | - Guy Lubitsh
- Hult Ashridge Executive Education, Berkhamsted, UK
| | - Benjamin Ellis
- Versus Arthritis, Chesterfield, UK.,Charing Cross Hospital, London, UK
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13
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Work M, Allerton F, Griffin S, Kent A. Percutaneous-endoscopic rendezvous cholangiography with biliary stent placement in a dog with extra-hepatic biliary duct obstruction. J Small Anim Pract 2021; 63:416-420. [PMID: 34658028 DOI: 10.1111/jsap.13442] [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] [Received: 05/05/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
A middle-aged male springer spaniel was presented for investigation of acute vomiting, lethargy and icterus. Marked distension of the gall bladder and common bile duct was evident at ultrasound due to obstruction by mineralised intraluminal material. After 48 hours of hospitalisation with intravenous fluid therapy, analgesia and antimicrobial therapy, intervention was deemed necessary to relieve the obstruction. A percutaneous-endoscopic rendezvous approach was used to achieve placement of a pigtail stent into the distal common bile duct, successfully relieving the obstruction. Serial biochemistry measurements postprocedure confirmed marked improvements in serum bilirubin. The patient remains clinically well 24 months postprocedure, and all hepatic enzyme activities have normalised. Based on the literature search performed, this is the first successful application of this technique in the management of canine extrahepatic biliary duct obstruction.
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Affiliation(s)
- M Work
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - S Griffin
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - A Kent
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
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14
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Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, van der Goes MC, Kent A, Bakkers M, Pchelnikova P, Blaas E, Senolt L, Szekanecz Z, Choy EH, Dougados M, Jacobs JW, Geenen R, Bijlsma JW, Zink A, Aletaha D, Schoneveld L, van Riel P, Dumas S, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, van der Heijde D, van Laar JM. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021; 81:20-33. [PMID: 34407926 PMCID: PMC8761998 DOI: 10.1136/annrheumdis-2021-220973] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [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: 06/12/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). METHODS An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. RESULTS Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). CONCLUSIONS These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.
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Affiliation(s)
- György Nagy
- Department of Rheumatology & Clinical Immunology, Semmelweis University, Budapest, Hungary .,Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Melinda Kedves
- Bács-Kiskun County Hospital, Rheumatology Department, Kecskemét, Hungary
| | - Attila Hamar
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Alison Kent
- Salisbury Foundation Trust NHS Hospital, Wiltshire, UK
| | - Margot Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Polina Pchelnikova
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Etienne Blaas
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ladislav Senolt
- Department of Rheumatology, 1st Faculty of Medicine, Charles University and Institute of Rheumatology, Prague, Czech Republic
| | - Zoltan Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maxime Dougados
- Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153) Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Johannes Wg Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Johannes Wj Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Leonard Schoneveld
- Department of Rheumatology, Bravis Hospital, Roosendaal, The Netherlands
| | - Piet van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sophie Dumas
- Department of Pharmacy, Marin Hospital, Asisstance Publique-Hopitaux de Paris, Hendaye, France
| | - Yeliz Prior
- School of Health and Society, Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital, London, UK
| | | | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Kimme L Hyrich
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Maya H Buch
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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15
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Kent A, Kecskes Z, Cochrane T. Magnesium sulfate for term infants following perinatal asphyxia. Hippokratia 2021. [DOI: 10.1002/14651858.cd004494.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alison Kent
- Department of Neonatology; The Canberra Hospital; Garran Australia
| | - Zsuzsoka Kecskes
- Centre for Newborn Care; The Canberra Hospital; Canberra Australia
| | - Tim Cochrane
- Department of Neonatology; Centenary Hospital for Women and Children, Canberra Hospital; Garran Australia
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16
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Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, van der Goes MC, Kent A, Bakkers M, Blaas E, Senolt L, Szekanecz Z, Choy E, Dougados M, Jacobs JWG, Geenen R, Bijlsma HWJ, Zink A, Aletaha D, Schoneveld L, van Riel P, Gutermann L, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, van der Heijde D, van Laar JM. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021; 80:31-35. [PMID: 33004335 PMCID: PMC7788062 DOI: 10.1136/annrheumdis-2020-217344] [Citation(s) in RCA: 191] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/27/2020] [Accepted: 08/06/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite treatment according to the current management recommendations, a significant proportion of patients with rheumatoid arthritis (RA) remain symptomatic. These patients can be considered to have 'difficult-to-treat RA'. However, uniform terminology and an appropriate definition are lacking. OBJECTIVE The Task Force in charge of the "Development of EULAR recommendations for the comprehensive management of difficult-to-treat rheumatoid arthritis" aims to create recommendations for this underserved patient group. Herein, we present the definition of difficult-to-treat RA, as the first step. METHODS The Steering Committee drafted a definition with suggested terminology based on an international survey among rheumatologists. This was discussed and amended by the Task Force, including rheumatologists, nurses, health professionals and patients, at a face-to-face meeting until sufficient agreement was reached (assessed through voting). RESULTS The following three criteria were agreed by all Task Force members as mandatory elements of the definition of difficult-to-treat RA: (1) Treatment according to European League Against Rheumatism (EULAR) recommendation and failure of ≥2 biological disease-modifying antirheumatic drugs (DMARDs)/targeted synthetic DMARDs (with different mechanisms of action) after failing conventional synthetic DMARD therapy (unless contraindicated); (2) presence of at least one of the following: at least moderate disease activity; signs and/or symptoms suggestive of active disease; inability to taper glucocorticoid treatment; rapid radiographic progression; RA symptoms that are causing a reduction in quality of life; and (3) the management of signs and/or symptoms is perceived as problematic by the rheumatologist and/or the patient. CONCLUSIONS The proposed EULAR definition for difficult-to-treat RA can be used in clinical practice, clinical trials and can form a basis for future research.
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Affiliation(s)
- György Nagy
- Department of Rheumatology, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary .,Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Nadia MT Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paco MJ Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Melinda Kedves
- Department of Rheumatology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Attila Hamar
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands,Department of Rheumatology, Meander Medical Center, Amersfoort, the Netherlands
| | - Alison Kent
- Salisbury Foundation Trust NHS Hospital, Wiltshire, UK
| | - Margot Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Etienne Blaas
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ladislav Senolt
- Department of Rheumatology, 1st Faculty of Medicine, Charles University and Institute of Rheumatology, Prague, Czech Republic
| | - Zoltan Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ernest Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maxime Dougados
- Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Johannes WG Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
| | - Hans WJ Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, and Rheumatology, Charité, University Medicine, Berlin, Germany
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Leonard Schoneveld
- Department of Rheumatology, Bravis Hospital, Roosendaal, the Netherlands
| | - Piet van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Loriane Gutermann
- Department of Pharmacy, Paris Descartes University, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Yeliz Prior
- School of Health and Society, Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
| | | | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Kimme L Hyrich
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Maya H Buch
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Maxwell A, Kent A, Tinkler M, Mathur S, Beale A. Pleural empyema secondary to xanthogranulomatous pyelonephritis. Thorax 2020; 76:740-741. [PMID: 33115938 DOI: 10.1136/thoraxjnl-2020-215786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Adam Maxwell
- Respiratory Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Alison Kent
- Respiratory Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Marianne Tinkler
- Respiratory Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Sunil Mathur
- Urology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Andy Beale
- Radiology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
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18
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Kent A, Makwana A, Sheppard CL, Collins S, Fry NK, Heath PT, Ramsay M, Ladhani SN. Invasive Pneumococcal Disease in UK Children <1 Year of Age in the Post-13-Valent Pneumococcal Conjugate Vaccine Era: What Are the Risks Now? Clin Infect Dis 2020; 69:84-90. [PMID: 30281069 DOI: 10.1093/cid/ciy842] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/03/2018] [Accepted: 09/28/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) has declined significantly since the introduction of pneumococcal conjugate vaccines (PCVs). It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed to describe the epidemiology, clinical characteristics, serotype distribution, and outcomes of IPD in infants, and to estimate the relative risk of PCV13-type, non-PCV13-type, and overall IPD in premature infants compared to term infants during a 4-year period after the PCV13 program was established. METHODS This was a prospective, enhanced national surveillance of laboratory-confirmed IPD in England in infants aged <1 year diagnosed during 2013-2016. RESULTS There were 517 cases of IPD (incidence: 19/100000 infants). Incidence was significantly higher in premature infants compared with those born at term (49/100000 vs 17/100000; incidence rate ratio [IRR], 2.87; P < .001), with infants born before 28 weeks' gestation having the highest incidence (150/100000; IRR, 8.8; P < .001). Of the 454 IPD cases with serotyped isolates, most were caused by non-PCV13 serotypes (369 cases, 71.4%), with 85 cases (16.4%) due to PCV13 serotypes. There were 31 deaths (case fatality rate [CFR], 6.2% [95% confidence interval, 4.3%-8.6%]). Premature infants did not have a higher CFR than term infants (P = .62). CONCLUSIONS IPD incidence in infants remains lower than rates reported prior to PCV7 introduction in England. The risk of IPD remains significantly higher in premature infants compared to infants born at term, for both PCV13 and non-PCV13 serotypes. Any changes to the infant PCV13 immunization schedule may disproportionally affect premature infants.
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Affiliation(s)
- Alison Kent
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St Georges, University of London
| | | | - Carmen L Sheppard
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England
| | - Sarah Collins
- Department of Immunisation, Hepatitis and Blood Safety
| | - Norman K Fry
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St Georges, University of London.,St George's University Hospitals National Health Service Trust, London, United Kingdom
| | - Mary Ramsay
- Department of Immunisation, Hepatitis and Blood Safety
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St Georges, University of London.,Department of Immunisation, Hepatitis and Blood Safety
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19
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Kvien TK, Balsa A, Betteridge N, Buch MH, Durez P, Favalli EG, Favier G, Gabay C, Geenen R, Gouni-Berthold I, van den Hoogen F, Kent A, Klareskog L, Ostergaard M, Pavelka K, Polido Pereira J, Semb AG, Sköld M, Dougados M. Considerations for improving quality of care of patients with rheumatoid arthritis and associated comorbidities. RMD Open 2020; 6:e001211. [PMID: 32683326 PMCID: PMC7722279 DOI: 10.1136/rmdopen-2020-001211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder with a global prevalence of approximately 0.5-1%. Patients with RA are at an increased risk of developing comorbidities (eg, cardiovascular disease, pulmonary disease, diabetes and depression). Despite this, there are limited recommendations for the management and implementation of associated comorbidities. This study aimed to identify good practice interventions in the care of RA and associated comorbidities. METHODS A combination of primary research (180+ interviews with specialists across 12 European rheumatology centres) and secondary research (literature review of existing publications and guidelines/recommendations) were used to identify challenges in management and corresponding good practice interventions. Findings were prioritised and reviewed by a group of 18 rheumatology experts including rheumatologists, comorbidity experts, a patient representative and a highly specialised nurse. RESULTS Challenges throughout the patient pathway (including delays in diagnosis and referral, shortage of rheumatologists, limited awareness of primary care professionals) and 18 good practice interventions were identified in the study. The expert group segmented and prioritised interventions according to three distinct stages of the disease: (1) suspected RA, (2) recent diagnosis of RA and (3) established RA. Examples of good practice interventions included enabling self-management (self-monitoring and disease management support, for example, lifestyle adaptations); early arthritis clinic; rapid access to care (online referral, triage, ultrasound-guided diagnosis); dedicated comorbidity specialists; enhanced communication with primary care (hotline, education sessions); and integrating patient registries into daily clinical practice. CONCLUSION Learning from implementation of good practice interventions in centres across Europe provides an opportunity to more widely improved care for patients with RA and associated comorbidities.
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Affiliation(s)
- Tore K Kvien
- Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester, Manchester, UK
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
| | - Patrick Durez
- Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | | | - Guillaume Favier
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
- Global Strategy Group, KPMG LLP, London, UK
| | - Cem Gabay
- Department of Internal Medicine Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Frank van den Hoogen
- Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
- Sint Maartenskliniek, Nijmegen, Netherlands
| | - Alison Kent
- Salisbury NHS Foundation Trust, Salisbury, UK
| | | | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Karel Pavelka
- Rheumatologic Clinic, Institute of Rheumatology, Prague, Czech Republic
| | | | | | - Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maxime Dougados
- Hôpital Cochin, Rheumatology, Université Paris Descartes, Paris, France
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Bukhari M, Kent A. How rheumatologists assess disability in the current era needs an overhaul: focus on the Health Assessment Questionnaire. Rheumatology (Oxford) 2020; 59:267-268. [PMID: 31586425 DOI: 10.1093/rheumatology/kez423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marwan Bukhari
- Rheumatology Department, University Hospitals of Morecambe Bay Foundation NHS Trust, Royal Lancaster Infirmary, Lancaster
| | - Alison Kent
- Rheumatology Department, Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, UK
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21
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Andrews N, Kent A, Amin-Chowdhury Z, Sheppard C, Fry N, Ramsay M, Ladhani SN. Effectiveness of the seven-valent and thirteen-valent pneumococcal conjugate vaccines in England: The indirect cohort design, 2006-2018. Vaccine 2019; 37:4491-4498. [PMID: 31272872 DOI: 10.1016/j.vaccine.2019.06.071] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 05/13/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the UK childhood immunisation programme in 2006 and replaced with a 13-valent vaccine (PCV13) in 2010. Both vaccines led to rapid declines in vaccine-serotype invasive pneumococcal disease (IPD). Here, we assessed the long-term vaccine-effectiveness (VE) of both vaccines in England. METHODS Public Health England conducts enhanced national surveillance of IPD in England. VE against IPD was estimated using vaccine-serotype IPD cases and non-vaccine serotype IPD controls among vaccine-eligible children from September 2006 to June 2018 (the Broome method). RESULTS Vaccine history was available for 3421 IPD cases, including 1299 due to the additional PCV13 serotypes and the PCV13-related serotype 6C, 274 PCV7 serotypes and 1848 non-PCV13 serotypes. For the complete 2 + 1 schedule, both PCV7 and PCV13 showed high effectiveness against PCV7 serotypes with a combined VE of 92.0% (95%CI, 81.7-96.7). For the 2 + 1 schedule, PCV13 VE against the additional PCV13 serotypes plus 6C was 73.7% (31.1-89.9) compared to 90.0% (75.3 - 96.0) for PCV7 against PCV7 serotypes, although PCV13 VE increased to 84.8% (58.7-94.4) if serotype 3 was excluded; all 36 eligible serotype 3 IPD cases were fully-vaccinated with PCV13. Case numbers were low in older ages but there was evidence of waning, which was significant for serotype 19A for which there were sufficient numbers of cases for analysis. CONCLUSIONS PCVs are highly effective in preventing vaccine-serotype IPD except for serotype 3 which has been increasing in incidence. Serotype 19A IPD has also persisted, likely due to a slightly lower VE and/or more rapid waning of protection.
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Affiliation(s)
- Nick Andrews
- Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Alison Kent
- Paediatric Infectious Diseases Research Group, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Carmen Sheppard
- Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, UK
| | - Norman Fry
- Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, UK
| | - Mary Ramsay
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK; Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
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Kent A, Beebeejaun K, Braccio S, Kadambari S, Clarke P, Heath PT, Ladhani S. Safety of meningococcal group B vaccination in hospitalised premature infants. Arch Dis Child Fetal Neonatal Ed 2019; 104:F171-F175. [PMID: 29636385 DOI: 10.1136/archdischild-2017-314152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/04/2018] [Accepted: 02/08/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the risk of significant adverse events in premature infants receiving the novel 4-component group B meningococcal vaccine (4CMenB) with their routine immunisations at 2 months of age. PARTICIPANTS, DESIGN AND SETTING In December 2015, Public Health England requested neonatal units across England to voluntarily participate in a national audit; 19 units agreed to participate. Anonymised questionnaires were completed for infants receiving 4CMenB alongside their routine immunisations. For comparison, a historical cohort of premature infants receiving their primary immunisations without 4CMenB or paracetamol prophylaxis was used. MAIN OUTCOME MEASURES Paracetamol use; temperature, cardiovascular, respiratory and neurological status before and after vaccination; and management and investigations postvaccination, including serum C reactive protein levels, infection screens and antibiotic use. RESULTS Complete questionnaires were returned for 133 premature infants (<35 weeks' gestation) who received their first dose of 4CMenB at 8 weeks of age, including 108 who received prophylactic paracetamol according to national recommendations. Overall, 7% (8/108) of infants receiving 4CMenB with paracetamol had fever (>38°C) after vaccination compared with 20% (5/25) of those receiving 4CMenB without paracetamol (P=0.06) and none of those in the historical cohort. There were no significant differences between cohorts in the proportion of infants with apnoea, bradycardia, desaturation and receiving respiratory support after vaccination. CONCLUSIONS 4CMenB does not increase the risk of serious adverse events in hospitalised premature infants. This audit supports the current national recommendations to offer 4CMenB with other routine vaccinations and prophylactic paracetamol to premature infants at their chronological age.
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Affiliation(s)
- Alison Kent
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, University of London, London, UK
| | - Kazim Beebeejaun
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Serena Braccio
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, University of London, London, UK.,Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | | | - Paul Clarke
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, University of London, London, UK.,Department of Paediatrics, St George's University Hospitals NHS Trust, London, UK
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, University of London, London, UK.,Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
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Orefice R, Kent A, Sethna F, Dahlstrom JE. Of pregnancies complicated by small for gestational age babies at term, what proportions have placental findings with implications for future pregnancies or neonatal outcomes? J Matern Fetal Neonatal Med 2019; 33:2990-2995. [PMID: 30646781 DOI: 10.1080/14767058.2019.1566899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Small for gestational age (SGA) is a term to define any baby born with birth weight <10th centile. SGA can be associated with a number of placental pathology findings, which may influence maternal outcomes, neonatal neurodevelopment, and future pregnancies.Aims: To identify the proportion of term pregnancies complicated by SGA with placental findings that may have implications for future pregnancies or neonatal outcomes.Method: A retrospective review between 2011 and 2015 of babies and placentas born at term with SGA histopathological findings were categorized as to whether they had a high recurrence rate and where the long-term neurodevelopmental outcome may affect the neonate.Results: Six hundred and ninety-eight babies were identified as SGA. Only 335 (47.8%) placentas were sent for histopathological assessment. Of these, 60 (17.9%) had histopathological findings associated with high recurrence rates and 68 (20.2%) had findings associated with potential adverse neonatal outcomes.Conclusions: Of those placentas sent for examination between 17.9% and 20.2% had findings associated with either high recurrence rates or findings that may benefit from neonatal follow-up. Under 50% of pregnancies complicated by SGA at term had a placental examination, resulting in a significant number of potential important clinical consequences being missed.
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Affiliation(s)
| | - Alison Kent
- Department of Neonatology, Canberra Hospital, Canberra, Australia
| | - Farah Sethna
- Fetal Medicine Unit, Canberra Hospital, Canberra, Australia
| | - Jane E Dahlstrom
- Department of Anatomical Pathology, Canberra Hospital, Canberra, Australia
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Ghai V, Jan H, Shakir F, Kent A. A Retrospective Cohort Study: Identifying Pre-Operative Factors Associated with Non-Responders in Women Undergoing Comprehensive Surgical Treatment for Endometriosis. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.092] [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: 10/28/2022]
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25
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Shakir F, Clemente G, Jan H, Jan T, Kent A. The Design and Validation of Observational Clinical Human Reliability Analysis (OCHRA) as a Competency Tool for Assessment in Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.137] [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: 11/29/2022]
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26
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Kent A, Hardcastle N, Kron T, Wheeler G, Hegi-Johnson F. P3.08-17 Paediatric Motion Management Solutions for Particle Therapy Based Thoracic Stereotactic Ablative Body Radiotherapy (SABR). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Allerton F, Swinbourne F, Barker L, Black V, Kathrani A, Tivers M, Henriques T, Kisielewicz C, Dunning M, Kent A. Gall bladder mucoceles in Border terriers. J Vet Intern Med 2018; 32:1618-1628. [PMID: 30079451 PMCID: PMC6189338 DOI: 10.1111/jvim.15249] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 12/27/2022] Open
Abstract
Background Gall bladder mucoceles (GBM) are a leading cause of biliary disease in dogs with several breeds, including the Shetland Sheepdog, American Cocker Spaniel, Chihuahua, Pomeranian, and Miniature Schnauzer apparently predisposed. Objective To determine risk factors, clinical features, and response to treatment of GBM in Border terriers (BT). Animals Medical records of 99 dogs (including 51 BT) with an ultrasonographic (±histopathologic) diagnosis of GBM from three referral centers in the United Kingdom were collected. A control group of 87 similar‐aged BT with no ultrasonographic evidence of gall bladder disease was selected for comparison. Method Retrospective case‐control study. Odds ratios were calculated to establish breed predisposition. Signalment, presence of endocrine disease, clinicopathologic results, and outcome were compared between the BT, other breeds, and control BTs. Results The odds of identifying a GBM in a BT in this hospital population was 85 times that of all other breeds (95% confidence interval 56.9‐126.8). BT had similar clinical signs and clinicopathologic changes to other breeds with GBM. There was no evidence that endocrinopathies were associated with GBM in BT. Clinical Significance A robust breed predisposition to GBM is established for the BT.
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Affiliation(s)
- F Allerton
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, The United Kingdom
| | - F Swinbourne
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, The United Kingdom
| | - L Barker
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, The United Kingdom
| | - V Black
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, The United Kingdom
| | - A Kathrani
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, The United Kingdom
| | - M Tivers
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, The United Kingdom
| | - T Henriques
- Pride Veterinary Centre, Riverside Road, Derby, DE24 8HX, The United Kingdom
| | - C Kisielewicz
- Pride Veterinary Centre, Riverside Road, Derby, DE24 8HX, The United Kingdom
| | - M Dunning
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Leicestershire, The United Kingdom
| | - A Kent
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, The United Kingdom
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Rebelo P, Green A, Aziz T, Kent A, Schafer D, Venkatesan L, Cheeran B. Thalamic Directional Deep Brain Stimulation for tremor: Spend less, get more. Brain Stimul 2018; 11:600-606. [DOI: 10.1016/j.brs.2017.12.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 11/26/2022] Open
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Kent A, Vinken PJ. The Center for International Biomedical Communications Research. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636285] [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: 10/17/2022]
Abstract
A joint center has been established by the University of Pittsburgh and the Excerpta Medica Foundation. The basic objective of the Center is to seek ways in which the health sciences community may achieve increasingly convenient and economical access to scientific findings. The research center will make use of facilities and resources of both participating institutions. Cooperating from the University of Pittsburgh will be the School of Medicine, the Computation and Data Processing Center, and the Knowledge Availability Systems (KAS) Center. The KAS Center is an interdisciplinary organization engaging in research, operations, and teaching in the information sciences.Excerpta Medica Foundation, which is the largest international medical abstracting service in the world, with offices in Amsterdam, New York, London, Milan, Tokyo and Buenos Aires, will draw on its permanent medical staff of 54 specialists in charge of the 35 abstracting journals and other reference works prepared and published by the Foundation, the 700 eminent clinicians and researchers represented on its International Editorial Boards, and the 6,000 physicians who participate in its abstracting programs throughout the world. Excerpta Medica will also make available to the Center its long experience in the field, as well as its extensive resources of medical information accumulated during the Foundation’s twenty years of existence. These consist of over 1,300,000 English-language _abstract of the world’s biomedical literature, indexes to its abstracting journals, and the microfilm library in which complete original texts of all the 3,000 primary biomedical journals, monitored by Excerpta Medica in Amsterdam are stored since 1960.The objectives of the program of the combined Center include: (1) establishing a firm base of user relevance data; (2) developing improved vocabulary control mechanisms; (3) developing means of determining confidence limits of vocabulary control mechanisms in terms of user relevance data; 4. developing and field testing of new or improved media for providing medical literature to users; 5. developing methods for determining the relationship between learning and relevance in medical information storage and retrieval systems’; and (6) exploring automatic methods for retrospective searching of the specialized indexes of Excerpta Medica.The priority projects to be undertaken by the Center are (1) the investigation of the information needs of medical scientists, and (2) the development of a highly detailed Master List of Biomedical Indexing Terms. Excerpta Medica has already been at work on the latter project for several years.
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Abstract
An experiment is described which attempts to derive quantitative indicators regarding the potential relevance predictability of the intermediate stimuli used to represent documents in information retrieval systems. In effect, since the decision to peruse an entire document is often predicated upon the examination of one »level of processing« of the document (e.g., the citation and/or abstract), it became interesting to analyze the properties of what constitutes »relevance«. However, prior to such an analysis, an even more elementary step had to be made, namely, to determine what portions of a document should be examined.An evaluation of the ability of intermediate response products (IRPs), functioning as cues to the information content of full documents, to predict the relevance determination that would be subsequently made on these documents by motivated users of information retrieval systems, was made under controlled experimental conditions. The hypothesis that there might be other intermediate response products (selected extracts from the document, i.e., first paragraph, last paragraph, and the combination of first and last paragraph), that would be as representative of the full document as the traditional IRPs (citation and abstract) was tested systematically. The results showed that:1. there is no significant difference among the several IRP treatment groups on the number of cue evaluations of relevancy which match the subsequent user relevancy decision on the document;2. first and last paragraph combinations have consistently predicted relevancy to a higher degree than the other IRPs;3. abstracts were undistinguished as predictors; and4. the apparent high predictability rating for citations was not substantive.Some of these results are quite different than would be expected from previous work with unmotivated subjects.
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Kent A. Digital Computer Use in Medical Bibliography. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636231] [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: 10/17/2022]
Abstract
A brief review has been provided with regard to some approaches to information retrieval that are now under development in the United States. These developments are discussed in terms of the unit operations of documentation: acquisition; analysis (abstracting, indexing, classifying, extracting); terminology control; recording of results of analysis on searchable medium; storage of source documents; question analysis and development of search strategy;conductingofsearch;anddelivery of search results.At the present time efforts in this field are largely uncoordinated, with decisions on depth of analysis of documents and philosophy of coding system left largely to the desires and opinions of individuals or separate organizations.Two programs in medjcal documentation at Western Reserve University are discussed: one in communicable diseases; and the other in diabetes. Both programs involve the analysis of the literature in considerable detail, using roles and links, and the control of the meaning of terminology using the technique , of semantic factoring.
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Affiliation(s)
- A Kent
- Genetic Alliance UK, London, UK
| | - J Spink
- Genetic Alliance UK, London, UK
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Nillsen A, Kent A. Sepsis and Neonatal Acute Kidney Injury. J PEDIAT INF DIS-GER 2016. [DOI: 10.1055/s-0036-1597299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Nillsen
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australia
| | - Alison Kent
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australia
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Kent A, Scorrer T, Pollard AJ, Snape MD, Clarke P, Few K, Menson E, Varghese AS, Hughes S, Ladhani SN, Heath PT. Lymphocyte subpopulations in premature infants: an observational study. Arch Dis Child Fetal Neonatal Ed 2016; 101:F546-F551. [PMID: 27075591 DOI: 10.1136/archdischild-2015-309246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 03/12/2016] [Accepted: 03/16/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES The infant's immune system evolves over the first months and years of life. Strong correlation exists between lymphocyte count, lymphocyte subpopulations and gestational age at birth. Associations with antenatal and postnatal steroid treatment, infection and chronic lung disease have also been described. Few published studies report the effect of increasing postnatal age (PNA) and comorbidities on lymphocyte subpopulations in premature infants beyond the first 4 months of life. This study aimed to describe changes in lymphocyte subpopulations in preterm infants up to 13 months PNA. METHODS Premature infants (23-34 weeks completed gestation) from five centres had lymphocyte subpopulations measured at 2, 5 or 7, 12 and 13 months PNA alongside their vaccine responses in a vaccination trial. RESULTS 393 blood samples from 151 babies were analysed. There was an increase in absolute numbers of total lymphocytes (median cell count 6.21×109/L at 13 months compared with 4.9×109/L at 2 months PNA) and CD3+, CD4+, CD8+, natural killer and B cells with increasing age. At 2 months PNA, there was a positive correlation between gestation and CD3+ and CD4+ counts (r=0.32 and 0.46, respectively) and proportions (r=0.22 and 0.41, respectively), and CD4+:CD8+ ratios (r=0.57), but a negative correlation with CD8+ proportions (r=-0.32). CONCLUSIONS This longitudinal study describes the distribution of lymphocyte subpopulations in premature infants and provides reference ranges for the major lymphocyte subsets to help guide clinicians when assessing premature infants for immunodeficiency in the first year of life. TRIAL REGISTRATION NUMBER EudraCT 2007-007535-23.
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Affiliation(s)
- Alison Kent
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, UK
| | - Tim Scorrer
- Neonatal Unit, Queen Alexandra Hospital, Portsmouth, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Matthew D Snape
- Oxford Vaccine Group, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Paul Clarke
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Karen Few
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Esse Menson
- Department of Paediatric Infectious Diseases, Evelina London Children's Hospital, London, UK
| | - Anu S Varghese
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, UK
| | - Stephen Hughes
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, UK
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, UK.,Immunisation, Hepatitis and Blood Safety Department, Public Health England, Colindale, London, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, UK
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Kent A, Kortsalioudaki C, Monahan IM, Bielicki J, Planche TD, Heath PT, Sharland M. Neonatal gram-negative infections, antibiotic susceptibility and clinical outcome: an observational study. Arch Dis Child Fetal Neonatal Ed 2016; 101:F507-F512. [PMID: 26951742 DOI: 10.1136/archdischild-2015-309554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Neonatal gram-negative (GN) infections are associated with high mortality and morbidity. Early appropriate antibiotic treatment is vital and gentamicin is the most frequently used antibiotic on neonatal units (NNUs). Antimicrobial breakpoints are predominantly based on adult data and the relationship between minimum inhibitory concentrations (MICs) and outcome in neonates is unclear. We aimed to determine the MIC of GN pathogens causing neonatal infections and relate this to clinical outcomes. METHODS MICs for eight antibiotics plus extended spectrum β-lactamase (ESBL) production were determined for invasive GN bacterial isolates from eight UK NNUs. European Committee on Antimicrobial Susceptibility Testing breakpoints were applied. MIC was correlated with clinical outcome using multivariable regression analysis. RESULTS 118 isolates from 116 patients were analysed. The median birth gestation and postnatal age was 27 weeks (IQR 24.6-32.3) and 20 days (IQR 5-44), respectively. Pathogens included Escherichia coli (51%), Klebsiella spp (23%) and Enterobacter spp (22%). 10-day attributable mortality was 18.1% (21 patients) with the highest mortality from Pseudomonas aeruginosa infections. ESBL producers accounted for 13.8% of the isolates. In regression analysis, increasing gentamicin MIC was associated with increased mortality in gentamicin treated patients across the full MIC range (OR per loge increase in MIC: 2.29; 95% CI 1.23 to 4.26, p=0.009), including susceptible isolates only (MIC ≤4) (OR 3.05; 95% CI 1.10 to 8.46, p=0.032). CONCLUSIONS Neonatal mortality from GN infections remains high and is associated with increasing gentamicin MIC, even for isolates deemed susceptible. A better understanding of population-specific MICs and aminoglycoside dosing is required to guide empiric antibiotic treatment.
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Affiliation(s)
- Alison Kent
- Paediatric Infectious Disease Research Group, St George's, University of London, London, UK
| | | | - Irene M Monahan
- Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Julia Bielicki
- Paediatric Infectious Disease Research Group, St George's, University of London, London, UK
| | - Timothy D Planche
- Institute of Infection and Immunity, St George's, University of London, London, UK.,Department of Medical Microbiology, St George's Healthcare NHS Trust, London, UK
| | - Paul T Heath
- Paediatric Infectious Disease Research Group, St George's, University of London, London, UK
| | - Mike Sharland
- Paediatric Infectious Disease Research Group, St George's, University of London, London, UK
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Kent A, Shakir F. Redo Modified Laparoscopic Colposuspension. J Minim Invasive Gynecol 2016; 22:S249. [PMID: 27679180 DOI: 10.1016/j.jmig.2015.08.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- A Kent
- Minimal Access Training Therpy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - F Shakir
- Minimal Access Training Therpy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
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Shakir F, Jan H, Pearson C, Haines P, Rae-Mitchell W, Kent A. Uterine Endometriosis - Incidence in Patients Undergoing Laparoscopic Surgery for Severe Recto-Vaginal Endometriosis. A Prospective Cohort Study. J Minim Invasive Gynecol 2016; 22:S30. [PMID: 27679201 DOI: 10.1016/j.jmig.2015.08.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- F Shakir
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - H Jan
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - C Pearson
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - P Haines
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - W Rae-Mitchell
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - A Kent
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
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Kent A, Ladhani SN, Andrews NJ, Scorrer T, Pollard AJ, Clarke P, Hughes SM, Heal C, Menson E, Chang J, Satodia P, Collinson AC, Faust SN, Goldblatt D, Miller E, Heath PT. Schedules for Pneumococcal Vaccination of Preterm Infants: An RCT. Pediatrics 2016; 138:peds.2015-3945. [PMID: 27503351 DOI: 10.1542/peds.2015-3945] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Premature infants have a higher risk of invasive pneumococcal disease and are more likely to have lower vaccine responses compared with term infants. Increasingly, immunization schedules are including a reduced, 2-dose, pneumococcal conjugate vaccine priming schedule. Our goal was to assess the immunogenicity of 3 commonly used 13-valent pneumococcal conjugate vaccine (PCV13) priming schedules in premature infants and their response to a 12-month booster dose. METHODS Premature infants (<35 weeks' gestation) were randomized to receive PCV13 at 2 and 4 months (reduced schedule); 2, 3, and 4 months (accelerated schedule); or 2, 4, and 6 months (extended schedule). All infants received a 12-month PCV13 booster. Serotype-specific pneumococcal immunoglobulin G (IgG) for PCV13 serotypes was measured by using enzyme-linked immunosorbent assay 1 month after the primary and booster vaccinations. RESULTS A total of 210 infants (median birth gestation, 29(+6) weeks; range, 23(+2)-34(+6) weeks) were included. After the primary vaccination, 75% (95% confidence interval [CI], 62-85), 88% (95% CI, 76-95), and 97% (95% CI, 87-99) of participants had protective antibody concentrations for at least one-half the PCV13 serotypes for the reduced, accelerated, and extended schedules, respectively. After the booster vaccination, participants receiving the extended schedule had significantly lower (P < .05) geometric mean concentrations compared with reduced (for 9 of 13 serotypes) and accelerated (for 4 of 13 serotypes) schedules, but nearly all participations, regardless of schedule or serotype, had seroprotective IgG concentrations. CONCLUSIONS A reduced priming schedule of PCV13 resulted in higher post-booster IgG concentrations but lower post-primary concentrations. The optimum vaccine schedule for preterm infants will therefore depend on when they are most at risk for invasive pneumococcal disease.
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Affiliation(s)
- Alison Kent
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, United Kingdom;
| | | | - Nick J Andrews
- Statistics, Modelling and Economics Department, Public Health England, Colindale, London, United Kingdom
| | - Tim Scorrer
- Neonatal Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Paul Clarke
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Stephen M Hughes
- Department of Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Carrie Heal
- Neonatal Unit, Stepping Hill Hospital, Stockport, United Kingdom
| | - Esse Menson
- Department of Paediatric Infectious Diseases, Evelina London Children's Hospital, London, United Kingdom
| | - John Chang
- Neonatal Unit, Croydon University Hospital, London, United Kingdom
| | - Prakash Satodia
- Neonatal Unit, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | - Saul N Faust
- NIHR Welcome Trust Clinical Research Facility, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; and
| | | | | | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, United Kingdom
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Kent A, Ladhani SN, Andrews NJ, Matheson M, England A, Miller E, Heath PT. Pertussis Antibody Concentrations in Infants Born Prematurely to Mothers Vaccinated in Pregnancy. Pediatrics 2016; 138:peds.2015-3854. [PMID: 27255149 DOI: 10.1542/peds.2015-3854] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Maternal antenatal pertussis-containing vaccination is recommended for the prevention of neonatal pertussis, but the ability of maternal vaccination to protect premature infants is unknown. We hypothesized that that infants born prematurely to antenatally vaccinated women would have higher pertussis antibody concentrations than those born to unvaccinated women. METHODS Mothers had been offered a combined tetanus, diphtheria, 5-component acellular pertussis, inactivated polio vaccine from 28 weeks' gestation as part of their routine antenatal care. Premature infants of vaccinated and unvaccinated mothers enrolled in a randomized controlled trial of pneumococcal conjugate vaccine schedules had antibody concentrations (pertussis toxin, filamentous hemoagglutinin [FHA], and fimbriae 2 and 3) measured at 2 months (before primary vaccination), 5 months (1 month after primary vaccination), and 12 months of age. RESULTS Mothers of 31 (19%) of 160 premature infants had received combined tetanus, diphtheria, 5-component acellular pertussis, inactivated polio vaccine in pregnancy. Compared with infants of unvaccinated mothers, those born to vaccinated mothers had significantly higher antibody concentrations at 2 months for all measured vaccine antigens (P < .001). The number of days between maternal vaccination and delivery and immunoglobulin G concentration at 2 months of age was positively correlated for pertussis toxin (P = .011) and FHA (P = .001). After primary immunization, infants of vaccinated mothers had significantly lower antibody concentrations for FHA (P = .003) compared with infants of unvaccinated mothers; these differences had resolved by 12 months of age. CONCLUSIONS Maternal vaccination administered early in the third trimester may provide protection for infants born prematurely.
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Affiliation(s)
- Alison Kent
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, United Kingdom;
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, United Kingdom; Immunisation, Hepatitis, and Blood Safety Department, Public Health England, Colindale, London, United Kingdom
| | - Nick J Andrews
- Statistics, Modelling, and Economic Department, Public Health England, London, United Kingdom; and
| | - Mary Matheson
- Immunoassay Laboratory, Public Health England, Porton Down, United Kingdom
| | - Anna England
- Immunoassay Laboratory, Public Health England, Porton Down, United Kingdom
| | - Elizabeth Miller
- Immunisation, Hepatitis, and Blood Safety Department, Public Health England, Colindale, London, United Kingdom
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, United Kingdom
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Abstract
A review of the literature was carried out to determine the importance of pre-hospital scene times and how it can be affected. In the UK, and certain centres in North America, mortality and morbidity in critically injured patients appears to be related to scene times. The majority of these patients only require basic life support at the scene. Consequently the possible benefits of more advanced procedure need to be compared with the transportation period, the time needed to mobilize a medical team and skill proficiency. Cardiovascular resuscitation procedures in particular require reappraisal. Though haemostasis is essential, there is little evidence to support the use of fluid resuscitation in nontrapped urban patients with a significant haemorrhage problem. In contrast patients who are not bleeding do appear to benefit from advanced life support procedures even though this increases scene time. There is therefore a need for pre-hospital paramedic workers to triage patients so that appropriate resuscitation can be carried out.
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Affiliation(s)
| | - A Kent
- Hope Hospital, Salford, UK
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Tamborini A, Jahns H, McAllister H, Kent A, Harris B, Procoli F, Allenspach K, Hall EJ, Day MJ, Watson PJ, O'Neill EJ. Bacterial Cholangitis, Cholecystitis, or both in Dogs. J Vet Intern Med 2016; 30:1046-55. [PMID: 27203848 PMCID: PMC5084764 DOI: 10.1111/jvim.13974] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 12/02/2015] [Revised: 02/12/2016] [Accepted: 04/27/2016] [Indexed: 12/18/2022] Open
Abstract
Background Bacterial cholangitis and cholecystitis are rarely reported, poorly characterized diseases in the dog. Objectives To characterize the clinical features of these conditions. Animals Twenty‐seven client‐owned dogs with bacterial cholangitis, cholecystitis, or both. Methods Multicenter, retrospective cases series of dogs with bacterial cholangitis, cholecystitis, or both, presenting January 2000 to June 2011 to 4 Veterinary Schools in Ireland/United Kingdom. Interrogation of hospital databases identified all cases with the inclusion criteria; histopathologically confirmed cholangitis or cholecystitis and bile culture/cytology results supporting a bacterial etiology. Results Twenty‐seven dogs met the inclusion criteria with approximately 460 hepatitis cases documented over the same study period. Typical clinical pathology findings were increases in liver enzyme activities (25/26), hyperbilirubinemia (20/26), and an inflammatory leukogram (21/24). Ultrasound findings, although nonspecific, aided decision‐making in 25/26 cases. The most frequent hepatobiliary bacterial isolates were Escherichia coli (n = 17; 16 cases), Enterococcus spp. (n = 8; 6 cases), and Clostridium spp. (n = 5; 5 cases). Antimicrobial resistance was an important feature of aerobic isolates; 10/16 E. coli isolates resistant to 3 or more antimicrobial classes. Biliary tract rupture complicated nearly one third of cases, associated with significant mortality (4/8). Discharged dogs had a guarded to fair prognosis; 17/18 alive at 2 months, although 5/10 re‐evaluated had persistent liver enzyme elevation 2–12 months later. Conclusion and Clinical Significance Bacterial cholangitis and cholecystitis occur more frequently than suggested by current literature and should be considered in dogs presenting with jaundice and fever, abdominal pain, or an inflammatory leukogram or with ultrasonographic evidence of gallbladder abnormalities.
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Affiliation(s)
- A Tamborini
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - H Jahns
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - H McAllister
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - A Kent
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - B Harris
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - F Procoli
- Department of Veterinary Clinical Sciences, Royal Veterinary College, London, UK
| | - K Allenspach
- Department of Veterinary Clinical Sciences, Royal Veterinary College, London, UK
| | - E J Hall
- School of Veterinary Sciences, University of Bristol, Bristol, UK
| | - M J Day
- School of Veterinary Sciences, University of Bristol, Bristol, UK
| | - P J Watson
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - E J O'Neill
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
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Strehl C, Bijlsma JWJ, de Wit M, Boers M, Caeyers N, Cutolo M, Dasgupta B, Dixon WG, Geenen R, Huizinga TWJ, Kent A, de Thurah AL, Listing J, Mariette X, Ray DW, Scherer HU, Seror R, Spies CM, Tarp S, Wiek D, Winthrop KL, Buttgereit F. Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force. Ann Rheum Dis 2016; 75:952-7. [DOI: 10.1136/annrheumdis-2015-208916] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/13/2016] [Indexed: 12/30/2022]
Abstract
There is convincing evidence for the known and unambiguously accepted beneficial effects of glucocorticoids at low dosages. However, the implementation of existing recommendations and guidelines on the management of glucocorticoid therapy in rheumatic diseases is lagging behind. As a first step to improve implementation, we aimed at defining conditions under which long-term glucocorticoid therapy may have an acceptably low level of harm. A multidisciplinary European League Against Rheumatism task force group of experts including patients with rheumatic diseases was assembled. After a systematic literature search, breakout groups critically reviewed the evidence on the four most worrisome adverse effects of glucocorticoid therapy (osteoporosis, hyperglycaemia/diabetes mellitus, cardiovascular diseases and infections) and presented their results to the other group members following a structured questionnaire for final discussion and consensus finding. Robust evidence on the risk of harm of long-term glucocorticoid therapy was often lacking since relevant study results were often either missing, contradictory or carried a high risk of bias. The group agreed that the risk of harm is low for the majority of patients at long-term dosages of ≤5 mg prednisone equivalent per day, whereas at dosages of >10 mg/day the risk of harm is elevated. At dosages between >5 and ≤10 mg/day, patient-specific characteristics (protective and risk factors) determine the risk of harm. The level of harm of glucocorticoids depends on both dose and patient-specific parameters. General and glucocorticoid-associated risk factors and protective factors such as a healthy lifestyle should be taken into account when evaluating the actual and future risk.
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Abstract
Purpose: To perform a retrospective audit of cases of uterine arteriovenous malformations (UAVM) at The Canberra Hospital and review of recent literature reporting pregnancies occurring after the diagnosis of UAVM aiming to devise a diagnostic and treatment protocol to optimise pregnancy post UAVM. Methods: A retrospective audit of cases of UAVM at the Canberra Hospital from a prospectively managed patient database was performed. A search of the electronic database PubMed, for articles between 2000-2011 relating to pregnancy post UAVM. Individual case studies were analysed separately to case series. Results: The study included 28 individual studies and five case series (61 women). Average age was 29.5 ± 6.7 (range 18-42). Most women (24, 85.7%, 100% in case series) presented with abnormal vaginal bleeding; 11 (41%) individuals presented post interruption of pregnancy. All women had had a previous pregnancy (mean gravidity 3.1 ± 3.1, range 1-15 for case studies) and only four women (14.2 %) had no history of uterine trauma. Only one woman (3.6 %) did not have any ultrasound and most women underwent colour Doppler ultrasonography (20, 71.4% in case studies; 61, 83.6% in case series). Of the women, 72 (53.6 % of case studies, 78.1 % of case series) were treated with uterine artery embolisation, seven (25%) were treated expectantly. A total of 63 pregnancies occurred post treatment, seven (13.9%) ending in miscarriage. Average time to conceive post diagnosis was 19 months ± 16.3 (range 2-72). A total of 54 healthy infants were born to mothers post AVM diagnosis. Conclusion: UAVM are likely to exist on a continuum with other pregnancy related pathologies, such as sub involution of the placental bed, making a single best diagnostic and treatment plan difficult. However, this study shows that successful uncomplicated pregnancy is achievable for women after the diagnosis of UAVM.
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Affiliation(s)
- Rebeka Eling
- Australian National University Medical School Canberra Australian Capital Territory Australia
| | - Alison Kent
- Australian National UniversityMedical SchoolCanberraAustralian Capital TerritoryAustralia; Dept of NeonatologyCanberra HospitalWodenAustralian Capital TerritoryAustralia
| | - Meiri Robertson
- Australian National UniversityMedical SchoolCanberraAustralian Capital TerritoryAustralia; Fetal Medicine UnitCanberra HospitalWodenAustralian Capital TerritoryAustralia
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Kent A, Shakir F, Rockall T. Laparoscopic Hysterectomy Intrafascial (LHi) Following Pelvic Vein Embolization With Coils. J Minim Invasive Gynecol 2015; 22:S215. [DOI: 10.1016/j.jmig.2015.08.765] [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: 11/16/2022]
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Orefice R, Dahlstrom J, Kent A, Sethna F. Of babies with fetal growth restriction (FGR) at term what proportion have placental findings that have implications for future pregnancies. Placenta 2015. [DOI: 10.1016/j.placenta.2015.07.321] [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: 10/23/2022]
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De Wit M, Bakker M, van Bodegom-Vos L, Buch M, Caeyers N, Carluccio A, Geenen R, Greiff R, Glüsing B, Gossec L, Kent A, Poldema I, Vliet Vlieland T, Wiek D, Schipper K. OP0245-PARE Helping Patients to Make Informed Decisions. The Pare Guide to Disseminate Eular Recommendations Among Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6069] [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: 11/03/2022]
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Iro MA, Khatami A, Marshall ASJ, Pace D, Voysey M, McKenna J, Campbell D, Attard-Montalto S, Finn A, White C, Faust SN, Kent A, Heath PT, MacLeod E, Stanford E, Findlow H, Almond R, Bai X, Borrow R, Snape MD, Pollard AJ. Immunological effect of administration of sequential doses of Haemophilus influenzae type b and pneumococcal conjugate vaccines in the same versus alternating limbs in the routine infant immunisation schedule: an open-label randomised controlled trial. The Lancet Infectious Diseases 2015; 15:172-80. [DOI: 10.1016/s1473-3099(14)71057-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shakir F, Jan H, Kent A. A case of laparoscopic surgical excision of a bulletproof nodule from the pelvic side wall. J OBSTET GYNAECOL 2014; 34:751. [PMID: 25340850 DOI: 10.3109/01443615.2014.923818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- F Shakir
- Department of Obstetrics and Gynaecology, Royal Surrey County Hospital , Guildford , UK
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Abstract
Toxicity has limited the use of aminoglycosides and adult studies report high rates of both ototoxicity and nephrotoxicity. Conversely paediatric studies have shown lower rates and extended interval dosing may have reduced toxicity further. We review the animal and human evidence for aminoglycoside toxicity in neonates including mechanisms, measurement and rates of toxicity; and differences between aminoglycosides and dosing regimens. We discuss genetic susceptibility and the impact of other synergistic effects.
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Affiliation(s)
- Alison Kent
- Paediatric Infectious Diseases Research Group, Division of Clinical Sciences, St. George's, University of London, London, UK
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Lunghi T, Kaniewski J, Bussières F, Houlmann R, Tomamichel M, Kent A, Gisin N, Wehner S, Zbinden H. Experimental bit commitment based on quantum communication and special relativity. Phys Rev Lett 2013; 111:180504. [PMID: 24237497 DOI: 10.1103/physrevlett.111.180504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Indexed: 06/02/2023]
Abstract
Bit commitment is a fundamental cryptographic primitive in which Bob wishes to commit a secret bit to Alice. Perfectly secure bit commitment between two mistrustful parties is impossible through asynchronous exchange of quantum information. Perfect security is however possible when Alice and Bob split into several agents exchanging classical and quantum information at times and locations suitably chosen to satisfy specific relativistic constraints. Here we report on an implementation of a bit commitment protocol using quantum communication and special relativity. Our protocol is based on [A. Kent, Phys. Rev. Lett. 109, 130501 (2012)] and has the advantage that it is practically feasible with arbitrary large separations between the agents in order to maximize the commitment time. By positioning agents in Geneva and Singapore, we obtain a commitment time of 15 ms. A security analysis considering experimental imperfections and finite statistics is presented.
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Affiliation(s)
- T Lunghi
- Group of Applied Physics, University of Geneva, CH-1211 Genève 4, Switzerland
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