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O’Reilly S, Kenny G, Alrawahneh T, Francois N, Gu L, Angeliadis M, de Masson d’Autume V, Garcia Leon A, Feeney ER, Yousif O, Cotter A, de Barra E, Horgan M, Mallon PWG, Gautier V. Development of a novel medium throughput flow-cytometry based micro-neutralisation test for SARS-CoV-2 with applications in clinical vaccine trials and antibody screening. PLoS One 2023; 18:e0294262. [PMID: 38033116 PMCID: PMC10688860 DOI: 10.1371/journal.pone.0294262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Quantifying neutralising capacity of circulating SARS-COV-2 antibodies is critical in evaluating protective humoral immune responses generated post-infection/post-vaccination. Here we describe a novel medium-throughput flow cytometry-based micro-neutralisation test to evaluate Neutralising Antibody (NAb) responses against live SARS-CoV-2 Wild Type and Variants of Concern (VOC) in convalescent/vaccinated populations. Flow Cytometry-Based Micro-Neutralisation Test (Micro-NT) was performed in 96-well plates using clinical isolates WT-B, WT-B.1.177.18 and/or VOCs Beta and Omicron. Plasma samples (All Ireland Infectious Diseases (AIID) Cohort) were serially diluted (8 points, half-log) from 1:20 and pre-incubated with SARS-CoV-2 (1h, 37°C). Virus-plasma mixture were added onto Vero E6 or Vero E6/TMPRSS2 cells for 18h. Percentage infected cells was analysed by automated flow cytometry following trypsinisation, fixation and SARS-CoV-2 Nucleoprotein intracellular staining. Half-maximal Neutralisation Titres (NT50) were determined using non-linear regression. Our assay was compared to Plaque Reduction Neutralisation Test (PRNT) and validated against the First WHO International Standard for anti-SARS-CoV-2 immunoglobulin. Both Micro-NT and PRNT achieved comparable NT50 values. Further validation showed adequate correlation with PRNT using a panel of secondary standards of clinical convalescent and vaccinated plasma samples. We found the assay to be reproducible through measuring both repeatability and intermediate precision. Screening 190 convalescent samples and 11 COVID-19 naive controls (AIID cohort) we demonstrated that Micro-NT has broad dynamic range differentiating NT50s <1/20 to >1/5000. We could also characterise immune-escape VOC Beta and Omicron BA.5, achieving fold-reductions in neutralising capacity similar to those published. Our flow cytometry-based Micro-NT is a robust and reliable assay to quantify NAb titres, and has been selected as an endpoint in clinical trials.
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Affiliation(s)
- Sophie O’Reilly
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Grace Kenny
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Tamara Alrawahneh
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Nathan Francois
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Lili Gu
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Matthew Angeliadis
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Valentin de Masson d’Autume
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Alejandro Garcia Leon
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Eoin R. Feeney
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland
| | - Aoife Cotter
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Eoghan de Barra
- Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin, Ireland
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Horgan
- Department of Infectious Diseases, Cork University Hospital, Wilton, Cork, Ireland
| | - Patrick W. G. Mallon
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Virginie Gautier
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland
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Kenny G, O’Reilly SR, Negi R, Garcia-Leon A, Alalwan D, Gaillard CM, Saini G, Inzitari R, Feeney E, Yousif O, Cotter A, de Barra E, Sadlier C, Crispie F, Doran P, Gautier V, Mallon P, BCh MB. 312. Performance and validation of an adaptable multiplex assay for detection of serologic response to SARS-CoV-2 infection or vaccination. Open Forum Infect Dis 2022. [PMCID: PMC9752414 DOI: 10.1093/ofid/ofac492.390] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background A wide array of assays to detect the serologic response to SARS-CoV-2 have been developed since the emergence of the pandemic. The majority of these are either qualitative or semi-quantitative, detect antibodies against one antigenic target, and are not adaptable to new antigens. Methods We developed a new, multiplex immunoassay to detect antibodies against the receptor binding domain, S1 and S2 spike subunits and nucleocapsid (N) antigens of SARS-CoV-2 (the CEPHR SARS-CoV-2 Serology Assay). This assay uses electrochemiluminescence technology which allows for a broad dynamic range, and a linker format which allows for the addition of new antigenic targets. We tested this assay on a series of biobanked samples and validated its performance against the Abbott SARS-CoV-2 IgG and Abbott SARS-CoV-2 IgG II assays, and the MesoScale Diagnostics V-PLEX SARS-CoV-2 Panel 2 Kit. Results Participant demographics are shown in Table 1. The mean (standard deviation (SD)) intra-assay (within plate) coefficient of variation (CV) of 80 plasma samples run on the same plate was 3.9% (2.9) for N, 3.8% (6.2) for RBD, 3.8% (5.9) for S1 and 3.9% (5.3) for S2. The mean (SD) inter-assay CV derived from 5 samples run across 3 days by two different operators was 11% (6.5) for N, 13% (5.7) for RBD, 14% (8.9) for S1 and 13% (5.1) for S2. In the convalescent group (n=193), overall sensitivity for each assay was; RBD 82% (95% CI 76-87), S1 86% (81-91%), S2 88% (83 – 92%) and N 72% (64 – 78%). Sensitivity improved when analysis included only individuals who were sampled more than 14 days from onset of symptoms (n=166), RBD 87% (81 – 95%), S1 91% (85 – 95%), S2 91% (85 – 95%) but not for the N-target (73% (66-80%)). In vaccinated individuals (n = 58), 100% (94-100%) had both detectable RBD and S1 antibodies. Overall specificity was 96% (87-99%) for RBD, 90% (78-97%) for S1, 94% (84-99%) for S2 and 90% (78-97%) for N. There was excellent correlation between the Abbott IgG II and both CEPHR anti-RBD IgG (rho 0.91) and CEPHR anti-S1 IgG (rho 0.9, both p < 0.001, Figure 1.) and the V-PLEX full spike and both CEPHR RBD IgG (rho 0.83) and S1 IgG (rho 0.82, both p < 0.001, Figure 4).
Participant demographics ![]() Correlation between CEPHR RBD, Abbott SARS-CoV-2 IgG II anti spike assay and V-PLEX Spike assay.
![]() Vertical dashed line represents CEPHR RBD positivity threshold, horizontal dashed line indicates Abbott positivity threshold. B: Correlation between CEPHR RBD and MSD V-PLEX Spike IgG. Vertical dashed line represents CEPHR RBD positivity threshold, no positivity threshold provided by MSD. Conclusion The CEPHR SARS-CoV-2 Serology Assay is a robust, customisable, multiplex serologic assay for the detection of several different IgG specific to SARS-CoV-2. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Grace Kenny
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Sophie R O’Reilly
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Dublin, Ireland
| | - Riya Negi
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Alejandro Garcia-Leon
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Dana Alalwan
- Centre for Experimental Pathogen Host Research, University College Dublin, Belfield, Dublin, Ireland
| | - Colette Marie Gaillard
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Gurvin Saini
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Rosanna Inzitari
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Eoin Feeney
- Department of St Vincent's University Hospital and Centre for Experimental Pathogen Host Research University College Dublin, Belfield, Dublin, Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland, Wexford, Wexford, Ireland
| | - Aoife Cotter
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland Department of Infectious Diseases, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland, Dublin, Dublin, Ireland
| | - Eoghan de Barra
- Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin 9, Ireland Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland, Dublin, Dublin, Ireland
| | - Corinna Sadlier
- Department of Infectious Diseases Cork University Hospital, Cork, Cork, Ireland
| | - Fiona Crispie
- Teagasc Food Research Centre, Moorepark, and APC Microbiome Ireland, Cork, Cork, Ireland
| | - Peter Doran
- 3School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Virginie Gautier
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
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Byrne J, Gu L, Negi R, Garcia-Leon A, Alalwan D, Gaillard CM, Saini G, Leamy K, Reynolds B, O’Gorman T, Kenny G, O’Broin C, Feeney ER, Yousif O, Cotter A, de Barra E, Horgan M, Landay A, Doran P, Gautier V, Mallon P. 1959. Lower B-Cell Responses Rather Than Circulating Antibody Titres Are Associated With SARS-CoV-2 Infection Post Third Dose COVID-19 Vaccination. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Which components of the immune response to SARS-CoV-2 vaccination best protect against subsequent infection remains unclear. We explored SARS-CoV-2 specific antibody and B-cell responses post 3rd dose vaccine and their relationship to subsequent SARS-CoV-2 infection.
Methods
In a multicentre prospective cohort, adult subjects provided samples before and 14 days (d14) post 3rd dose vaccine with Pfizer-BioNTech 162b2. At 18-22 weeks post vaccine, subjects self-reported SARS-CoV-2 infection (confirmed by PCR or antigen test). We used electrochemiluminescence assays to quantify antibodies to SARS-CoV-2 spike subunit 1 (S1), subunit 2 (S2) and receptor-binding domain (RBD) in plasma (reported in WHO IU/mL). In a subset of subjects, we assessed SARS-CoV-2 specific differentiated B-cell (plasma cell) and memory B-cell responses from peripheral blood mononuclear cells. Unstimulated plasma cells, and memory B cells stimulated with R848 and IL2, were seeded on plates coated with RBD or full Spike antigen and antigen-specific responses measured by ELISpot (Mabtech ELISpot, Sweden). We compared between group differences by Wilcoxon signed rank or Mann–Whitney tests. Data are median [IQR] unless specified.
Results
Of 133 subjects (age 43 [32-50], 81.2% female (table 1), 77 subjects in the B-cell subgroup (table 2)), 47 (35.3%) reported SARS-CoV-2 infection post 3rd vaccine. Antibody titres, plasma cell and memory B-cell responses all increased significantly at d14 post 3rd vaccine (Table 1 & 2, all P< 0.001). Although d14 antibody titres did not differ in those with and without subsequent infection (table 1), those reporting subsequent infection had significantly lower d14 RBD-specific plasma cells and a lower proportion of RBD-specific memory B-cells (Figure 1a-b, both P< 0.05). Similar results were observed with full-spike-specific memory B-cell responses (Figure 1d). The differences persisted when the non-infected group was restricted only to those reporting a confirmed close contact (n=26).
Conclusion
Infection following 3rd dose vaccine is associated with lower d14 circulating and memory B cell responses, but not antibody titres, suggesting B-cell responses better predict protection against subsequent SARS-CoV-2 infection.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Joanne Byrne
- Centre for Experimental Pathogen Host Research, University College Dublin , Ireland, Dublin , Ireland
| | - Lili Gu
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Riya Negi
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Alejandro Garcia-Leon
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Dana Alalwan
- Centre for Experimental Pathogen Host Research, University College Dublin , Belfield, Dublin , Ireland
| | - Colette Marie Gaillard
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Gurvin Saini
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Kelly Leamy
- School of Medicine, University College Dublin , Belfield, Dublin 4 , Ireland ; , Eccles St, Dublin 7, Ireland, Dublin, Dublin , Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital , Belfield, Dublin 4 , Ireland ; , Eccles St, Dublin 7, Ireland, Dublin, Dublin , Ireland
| | - Bearach Reynolds
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4 , Ireland ; , Elm Park, Dublin 4, Ireland, Dublin, Dublin , Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital , Belfield, Dublin 4 , Ireland ; , Elm Park, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Tessa O’Gorman
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4 , Ireland , Eccles St, Dublin 7, Ireland, Dublin, Dublin , Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital , Belfield, Dublin 4 , Ireland , Eccles St, Dublin 7, Ireland, Dublin, Dublin , Ireland
| | - Grace Kenny
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4 , Ireland ; , Elm Park, Dublin 4, Ireland, Dublin, Dublin , Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital , Belfield, Dublin 4 , Ireland ; , Elm Park, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Cathal O’Broin
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4 , Ireland ; , Elm Park, Dublin 4, Ireland, Dublin, Dublin , Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital , Belfield, Dublin 4 , Ireland ; , Elm Park, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Eoin R Feeney
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4 , Ireland ; , Elm Park, Dublin 4, Ireland, Dublin, Dublin , Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital , Belfield, Dublin 4 , Ireland ; , Elm Park, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital , Carricklawn, Wexford, Ireland, Wexford, Wexford , Ireland
| | - Aoife Cotter
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4 , Ireland , Eccles St, Dublin 7, Ireland, Dublin, Dublin , Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital , Belfield, Dublin 4 , Ireland , Eccles St, Dublin 7, Ireland, Dublin, Dublin , Ireland
| | - Eoghan de Barra
- Department of Infectious Diseases, Beaumont Hospital , Beaumont, Dublin 9 , Ireland , Dublin, Ireland, Dublin, Dublin , Ireland
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland , Beaumont, Dublin 9 , Ireland , Dublin, Ireland, Dublin, Dublin , Ireland
| | - Mary Horgan
- 8Department of Infectious Diseases, Cork University Hospital , Wilton, Co Cork, Ireland, Cork, Cork , Ireland
| | - Alan Landay
- Department of Internal Medicine, Rush University , Chicago, Il, USA, Chicago, Illinois
| | - Peter Doran
- School of Medicine, University College Dublin , Belfield, Dublin 4, Ireland, Dublin, Dublin , Ireland
| | - Virginie Gautier
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin , Belfield, Dublin 4, Ireland, Dublin, Dublin , Ireland
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O’Reilly SR, Kenny G, Alrawahneh T, Francois N, Angeliadis M, de Masson d’Autume V, Garcia-Leon A, Feeney E, Yousif O, Cotter A, de Barra E, Horgan M, Mallon P, BCh MB, Gautier V. 1057. Development of a Flow Cytometry-Based Micro-Neutralisation Assay to Evaluate Humoral Immunity Against SARS-CoV-2 Variants of Concern in Vaccine Trials. Open Forum Infect Dis 2022. [PMCID: PMC9752580 DOI: 10.1093/ofid/ofac492.898] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Quantifying neutralising capacity of circulating SARS-COV-2 antibodies is critical in evaluating protective humoral immune responses generated post-infection/post-vaccination. Here we describe a novel medium-throughput flow cytometry based micro-neutralisation assay to evaluate Neutralising Antibody (NAb) responses against live SARS-CoV-2 Wild Type (D641G) and Variants of Concern (VoC) in convalescent/vaccinated populations. Methods Micro-Neutralisation assay (Micro-NT) was performed in 96-well plates using clinical isolate 2019-nCoV/Italy-INMI1, D641G (SARS-CoV-2/human/IRL/AIIDV1446/2020) and/or VOCs Beta (SARS-CoV-2/human/IRL/AIIDV1752/2021) and Omicron (SARS-Cov-2/human/IRL/AIIDV2326/2021). Plasma samples (All Ireland Infectious Diseases (AIID) Cohort) were serially diluted (8 points, half-log) from 1/20 and pre-incubated with SARS-CoV-2 (1h, 37°C). Virus-plasma mixture were added onto VERO E6/VERO-E6 TMPRSS2 cells for 18h. Percentage infected cells was analysed by automated flow cytometry following trypsinisation, fixation and SARS-CoV-2 Nucleoprotein intracellular staining. Half-maximal Neutralisation Titres (NT50) was determined using four-parameter logistic regression. Our assay was compared to Plaque Reduction Neutralisation Test (PRNT) and validated against WHO anti-SARS-CoV-2 Immunoglobulin Standards. Results Using WHO Standards with low, medium or high anti-SARS-CoV-2 IgG, both Micro-NT and PRNT achieved comparable NT50 values (Table 1). Micro-NT was found to be highly reproducible (inter-assay CV of 11.39%). Screening 190 convalescent samples and 11 COVID-19 naive controls (AIID cohort) we achieved an assay sensitivity of 90% and specificity of 81%. We demonstrated that Micro-NT has broad dynamic range differentiating NT50s < 1/20 to > 1/5000 (Figure 1). We could also characterise immune-escape VoC, observing up to 10-fold reduction in NT50 against Beta (Figure 2).
NT50s of Low, Medium and High Titre Anti-SARS-CoV-2 IgG Standards measured against Live SARS-CoV-2 using PRNT and Micro-NT ![]() Neutralising Capacity of low, medium and high-titre anti-SARS-CoV-2 IgG (WHO, International Standards) against live SARS-CoV-2 (2019-nCoV/Italy-INMI1) measured using PRNT and Micro-NT Assays on Vero E6 cells, as well as the potency of NAbs in each sample in International Units (IU/ml) as determined by the WHO.
Dynamic Range of Micro-NT ![]() Micro-NT has a broad Dynamic Range, distinguishing low (A), medium (B) and high (C) neutralising plasma samples against live SARS-CoV-2 (2019-nCoV/Italy-INMI1) from a cohort of COVID-19 convalescent individuals (AIID cohort), as well as negative samples from COVID-19 naïve samples (D). Graphs show 3 representative samples of each NT50 range. (E) shows the population distribution of 190 Convalescent plasma samples as measured by Micro-NT on Vero E6 cells.
Reduced Neutralisation Capacities measured against SARS-CoV-2 VoC using Micro-NT ![]() Low (A), Medium (B) and High (C) anti-SARS-CoV-2 IgG (WHO Standards) show different neutralising capacities against WT (D614G) SARS-CoV-2 and variants Beta and Omicron, measured using Micro-NT on Vero-E6-TMPRSS2 cells. Conclusion Our flow-cytometry-based Micro-NT is a robust and reliable assay to quantify NAb titres, an important evaluation endpoint in clinical trials. It has higher throughput (96 well format versus 12 well) and reduced infection time (18h vs 48-96h) compared to the gold standard PRNT. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Sophie R O’Reilly
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Dublin, Ireland
| | - Grace Kenny
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland; Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Tamara Alrawahneh
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Nathan Francois
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Matthew Angeliadis
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Valentin de Masson d’Autume
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Alejandro Garcia-Leon
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland, Dublin, Dublin, Ireland
| | - Eoin Feeney
- Department of St Vincent's University Hospital and Centre for Experimental Pathogen Host Research University College Dublin, Belfield, Dublin, Ireland
| | - Obada Yousif
- 4Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland, Wexford, Wexford, Ireland
| | - Aoife Cotter
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Belfield, Dublin 4, Ireland; Department of Infectious Diseases, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland, Dublin, Dublin, Ireland
| | - Eoghan de Barra
- 6Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin 9, Ireland; Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland, Dublin, Dublin, Ireland
| | - Mary Horgan
- Department of Infectious Diseases, Cork University Hospital, Wilton, Co Cork, Ireland, Cork, Cork, Ireland
| | | | - M B BCh
- University College Dublin, Dublin, Dublin, Ireland
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Murphy DJ, Shahabuddin Y, Yambasu S, O'Donoghue K, Devane D, Cotter A, Gaffney G, Burke LA, Molloy EJ, Boland F. Digital fetal scalp stimulation (dFSS) versus fetal blood sampling (FBS) to assess fetal wellbeing in labour-a multi-centre randomised controlled trial: Fetal Intrapartum Randomised Scalp Stimulation Trial (FIRSST NCT05306756). Trials 2022; 23:848. [PMID: 36195894 PMCID: PMC9531493 DOI: 10.1186/s13063-022-06794-9] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiotocography (CTG) is a screening test used to detect fetal hypoxia in labour. It has a high false positive rate resulting in many potentially unnecessary caesarean sections. Fetal blood sampling (FBS) is a second-line test of the acid-base status of the fetus. It is used to provide either reassurance that it is safe for labour to continue or objective evidence of compromise so that delivery can be expedited. Digital fetal scalp stimulation (dFSS) to elicit a fetal heart rate acceleration is an alternative less invasive second-line test of fetal wellbeing. This study aims to provide robust evidence on the role of these two second-line tests in assessing fetal wellbeing and potentially preventing operative delivery. METHODS A multi-centre parallel group randomised controlled trial (RCT) is planned in four maternity centres in Ireland. The study aims to recruit 2500 nulliparous women with a term (≥37+0 weeks) singleton pregnancy who require a second-line test of fetal wellbeing in labour due to an abnormal CTG. Women will be allocated randomly to dFSS or FBS on a 1:1 ratio. The primary outcome is caesarean section. With 1250 women in each arm, the study will have 90% power to detect a difference of 5-6%, at a two-sided alpha significance level of 5%, assuming a caesarean section rate of at least 20% in the dFSS group. DISCUSSION If the proposed study shows evidence that dFSS is a safe, reliable and effective alternative to FBS, this would have ground-breaking implications for labour management worldwide. It could potentially lead to a reduction in invasive procedures and emergency caesarean sections. TRIAL REGISTRATION ClinicalTrials.gov NCT05306756. Registered on 31 March 2022. The trial commenced enrolment on 10 May 2022. Ethical committee approval has been granted by the Research Ethics Committee (REC) of each hospital: Dublin/CWIUH REC: 12.06.2019; Cork/UCC REC: 29.11.2019; Galway/NUIG REC: 06.09.2019; Limerick/UL REC: 30.09.2019.
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Affiliation(s)
- D J Murphy
- Academic Department of Obstetrics and Gynaecology, Coombe Women & Infants University Hospital & Trinity College, University of Dublin, Dublin, Ireland.
| | - Y Shahabuddin
- Academic Department of Obstetrics and Gynaecology, Coombe Women & Infants University Hospital & Trinity College, University of Dublin, Dublin, Ireland
| | - S Yambasu
- Academic Department of Obstetrics and Gynaecology, Coombe Women & Infants University Hospital & Trinity College, University of Dublin, Dublin, Ireland
| | - K O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics & Gynecology, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| | - D Devane
- University of Galway, School of Nursing and Midwifery, HRB-Trials Methodology Research Network, Evidence Synthesis Ireland and Cochrane Ireland, Galway, Ireland
| | - A Cotter
- Department of Obstetrics and Gynecology, University of Limerick, Limerick, Ireland
| | - G Gaffney
- Department of Obstetrics and Gynaecology, University of Galway, Galway, Ireland
| | - L A Burke
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - E J Molloy
- Department of Paediatrics, Trinity College Dublin, Dublin, Ireland
| | - F Boland
- Data Science Centre and the Department of General Practice, RCSI, Dublin, Ireland
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6
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Kenny G, McCann K, O’Brien C, Savinelli S, Tinago W, Yousif O, Lambert JS, O’Broin C, Feeney ER, De Barra E, Doran P, Mallon PWG, Cotter A, Muldoon E, Sheehan G, McGinty T, Lambert JS, Green S, Leamy K, Kenny G, McCann K, McCann R, O’Broin C, Waqas S, Savinelli S, Feeney E, Mallon PWG, Garcia Leon A, Miles S, Alalwan D, Negi R, de Barra E, McConkey S, Hurley K, Sulaiman I, Horgan M, Sadlier C, Eustace J, Kelly C, Bracken T, Whelan B, Low J, Yousif O, McNicholas B, Courtney G, Gavin P. Identification of Distinct Long COVID Clinical Phenotypes Through Cluster Analysis of Self-Reported Symptoms. Open Forum Infect Dis 2022; 9:ofac060. [PMID: 35265728 PMCID: PMC8900926 DOI: 10.1093/ofid/ofac060] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID. Methods This was an analysis within a multicenter, prospective cohort study of individuals with a confirmed diagnosis of COVID-19 and persistent symptoms >4 weeks from onset of acute symptoms. We performed a multiple correspondence analysis (MCA) on the most common self-reported symptoms and hierarchical clustering on the results of the MCA to identify symptom clusters. Results Two hundred thirty-three individuals were included in the analysis; the median age of the cohort was 43 (interquartile range [IQR], 36–54) years, 74% were women, and 77.3% reported a mild initial illness. MCA and hierarchical clustering revealed 3 clusters. Cluster 1 had predominantly pain symptoms with a higher proportion of joint pain, myalgia, and headache; cluster 2 had a preponderance of cardiovascular symptoms with prominent chest pain, shortness of breath, and palpitations; and cluster 3 had significantly fewer symptoms than the other clusters (2 [IQR, 2–3] symptoms per individual in cluster 3 vs 6 [IQR, 5–7] and 4 [IQR, 3–5] in clusters 1 and 2, respectively; P < .001). Clusters 1 and 2 had greater functional impairment, demonstrated by significantly longer work absence, higher dyspnea scores, and lower scores in SF-36 domains of general health, physical functioning, and role limitation due to physical functioning and social functioning. Conclusions Clusters of symptoms are evident in long COVID patients that are associated with functional impairments and may point to distinct underlying pathophysiologic mechanisms of disease.
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Affiliation(s)
- Grace Kenny
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Kathleen McCann
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Conor O’Brien
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Stefano Savinelli
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Willard Tinago
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland
| | - John S Lambert
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cathal O’Broin
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoin R Feeney
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoghan De Barra
- Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin, Ireland
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Patrick W G Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
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Ludgate S, Connolly SP, Fennell D, Muhamad MF, Welaratne I, Cotter A, McQuaid SE. Graves' disease associated with HIV disease and late immune reconstitution inflammatory syndrome following the initiation of antiretroviral therapy. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210094. [PMID: 34612207 PMCID: PMC8558905 DOI: 10.1530/edm-21-0094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/14/2021] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Both human immunodeficiency virus (HIV) and antiretroviral therapy (ART) are associated with endocrine dysfunction (1). The term 'immune reconstitution inflammatory syndrome' (IRIS) describes an array of inflammatory conditions that occur during the return of cell-mediated immunity following ART. Graves' disease (GD) occurs rarely as an IRIS following ART. In this study, we describe the case of a 40-year-old Brazilian female who was diagnosed with HIV following admission with cryptococcal meningitis and salmonellosis. At this time, she was also diagnosed with adrenal insufficiency. Her CD4 count at diagnosis was 17 cells/µL which rose to 256 cells/µL over the first 3 months of ART. Her HIV viral load, however, consistently remained detectable. When viral suppression was finally achieved 21 months post diagnosis, an incremental CD4 count of 407 cells/µL over the following 6 months ensued. Subsequently, she was diagnosed with a late IRIS to cryptococcus 32 months following initial ART treatment, which manifested as non-resolving lymphadenitis and resolved with high-dose steroids. Following the initiation of ART for 45 months, she developed symptomatic Graves' hyperthyroidism. At this time, her CD4 count had risen to 941 cells/µL. She has been rendered euthyroid on carbimazole. This case serves to remind us that GD can occur as an IRIS post ART and typically has a delayed presentation. LEARNING POINTS Endocrinologists should be aware of the endocrine manifestations of HIV disease, in particular, thyroid pathology. Endocrinologists should be aware that IRIS can occur following the initiation of ART. Thyroid dysfunction can occur post ART of which Graves' disease (GD) is the most common thyroid manifestation. GD as a manifestation of ART-induced IRIS can have a delayed presentation. Infectious disease physicians should be aware of endocrine manifestations associated with HIV and ART.
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Affiliation(s)
- S Ludgate
- Department of Diabetes and Endocrinology, Dublin, Ireland
| | - S P Connolly
- Department of Infectious Diseases, Dublin, Ireland
| | - D Fennell
- Department of Diabetes and Endocrinology, Dublin, Ireland
| | - M F Muhamad
- Department of Diabetes and Endocrinology, Dublin, Ireland
| | - I Welaratne
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Cotter
- Department of Infectious Diseases, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - S E McQuaid
- Department of Diabetes and Endocrinology, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Hayes-Ryan D, Khashan AS, Hemming K, Easter C, Devane D, Murphy DJ, Hunter A, Cotter A, McAuliffe FM, Morrison JJ, Breathnach FM, Dempsey E, Kenny LC, O'Donoghue K. Placental growth factor in assessment of women with suspected pre-eclampsia to reduce maternal morbidity: a stepped wedge cluster randomised control trial (PARROT Ireland). BMJ 2021; 374:n1857. [PMID: 34389547 PMCID: PMC8361324 DOI: 10.1136/bmj.n1857] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether the addition of placental growth factor (PlGF) measurement to current clinical assessment of women with suspected pre-eclampsia before 37 weeks' gestation would reduce maternal morbidity without increasing neonatal morbidity. DESIGN Stepped wedge cluster randomised control trial from 29 June 2017 to 26 April 2019. SETTING National multisite trial in seven maternity hospitals throughout the island of Ireland PARTICIPANTS: Women with a singleton pregnancy between 20+0 to 36+6 weeks' gestation, with signs or symptoms suggestive of evolving pre-eclampsia. Of the 5718 women screened, 2583 were eligible and 2313 elected to participate. INTERVENTION Participants were assigned randomly to either usual care or to usual care plus the addition of point-of-care PlGF testing based on the randomisation status of their maternity hospital at the time point of enrolment. MAIN OUTCOMES MEASURES Co-primary outcomes of composite maternal morbidity and composite neonatal morbidity. Analysis was on an individual participant level using mixed-effects Poisson regression adjusted for time effects (with robust standard errors) by intention-to-treat. RESULTS Of the 4000 anticipated recruitment target, 2313 eligible participants (57%) were enrolled, of whom 2219 (96%) were included in the primary analysis. Of these, 1202 (54%) participants were assigned to the usual care group, and 1017 (46%) were assigned the intervention of additional point-of-care PlGF testing. The results demonstrate that the integration of point-of-care PlGF testing resulted in no evidence of a difference in maternal morbidity-457/1202 (38%) of women in the control group versus 330/1017 (32%) of women in the intervention group (adjusted risk ratio (RR) 1.01 (95% CI 0.76 to 1.36), P=0.92)-or in neonatal morbidity-527/1202 (43%) of neonates in the control group versus 484/1017 (47%) in the intervention group (adjusted RR 1.03 (0.89 to 1.21), P=0.67). CONCLUSIONS This was a pragmatic evaluation of an interventional diagnostic test, conducted nationally across multiple sites. These results do not support the incorporation of PlGF testing into routine clinical investigations for women presenting with suspected preterm pre-eclampsia, but nor do they exclude its potential benefit. TRIAL REGISTRATION ClinicalTrials.gov NCT02881073.
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Affiliation(s)
- D Hayes-Ryan
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
| | - A S Khashan
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - K Hemming
- University of Birmingham, United Kingdom
| | - C Easter
- University of Birmingham, United Kingdom
| | - D Devane
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- HRB Trials Methodology Research Network
- National University of Ireland, Galway, Ireland
| | - D J Murphy
- Trinity College Dublin & Coombe Women & Infants University Hospital Dublin 8, Republic of Ireland
| | - A Hunter
- Royal Jubilee Maternity Hospital, Belfast, Northern Ireland
| | - A Cotter
- University Maternity Hospital Limerick & University of Limerick
| | - F M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - J J Morrison
- Department of Obstetrics & Gynaecology, National University of Ireland Galway
| | - F M Breathnach
- Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square W, Dublin 1, Ireland
| | - E Dempsey
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
| | - L C Kenny
- Department of Women's and Children's Health, Liverpool Women's Hospital, University of Liverpool, UK
| | - K O'Donoghue
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
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Connellan D, Diffley K, McCabe J, Cotter A, McGinty T, Sheehan G, Ryan K, Cullen W, Lambert JS, Callaly EL, Kyne L. Documentation of Do-Not-Attempt-Cardiopulmonary-Resuscitation orders amid the COVID-19 pandemic. Age Ageing 2021; 50:1048-1051. [PMID: 33909020 PMCID: PMC8135469 DOI: 10.1093/ageing/afab075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: The COVID-19 pandemic has brought the decision-making process regarding cardiopulmonary resuscitation (CPR) into focus. The aim of this study is to compare rates of Do-Not-Attempt CPR (DNACPR) documentation in older hospitalised patients before and during the COVID-19 pandemic. Methods: This was a retrospective repeated cross-sectional study. Data including co-morbidities and resuscitation status was collected on 300 patients with COVID-19 hospitalised from March 1st to May 31s t 2020. DNACPR documentation rates in patients aged ≥65 years with a diagnosis of COVID-19 were compared to those without COVID-19 admitted during the same period and also compared to documentation rates pre-COVID-19 pandemic (March 1st to May 31s t 2019). Results: Of 300 COVID-19-positive patients, 28% had a DNACPR order documented during their admission. Of 131 older (≥65 years) patients with COVID-19, 60.3% had a DNACPR order compared to 25.4% of 130 older patients without COVID-19 (p < 0.0001). During a comparable time period pre-pandemic, 15.4% of 130 older patients had a DNACPR order in place (p < 0.0001). Fifty percent of DNACPR orders were recorded within 24 hours of a positive swab result for SARS-CoV-2. Of older COVID-19-positive patients, 39.2% were referred to palliative care services and 70.2% survived. Conclusion: The COVID-19 pandemic has prompted more widespread and earlier decision-making regarding resuscitation status. Although case-fatality-rates were higher for older hospitalised patients with COVID-19, many older patients survived the illness. Advance care planning should be prioritised in all patients and should remain good clinical practice despite the pandemic.
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Affiliation(s)
- David Connellan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Kara Diffley
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John McCabe
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Aoife Cotter
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Tara McGinty
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Gerard Sheehan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Karen Ryan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Walter Cullen
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - John S Lambert
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | | | - Lorraine Kyne
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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10
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Connellan D, Diffley K, McCabe J, Cotter A, McGinty T, Sheehan G, Ryan K, Cullen W, Lambert J, Callaly E, Kyne L. 484 CHANGING PRACTICES OF DECISION MAKING REGARDING DO-NOT-ATTEMPT-CARDIOPULMONARY-RESUSCITATION ORDERS AMID THE COVID-19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8344931 DOI: 10.1093/ageing/afab117.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The COVID-19 pandemic has brought the decision-making process regarding cardiopulmonary resuscitation into focus. This study aims to analyse Do-Not-Attempt CPR (DNACPR) documentation in older hospitalised patients before and during the COVID-19 pandemic.
Methods
This was a retrospective repeated cross-sectional study. Data including co-morbidities and resuscitation status was collected on 300 patients with COVID-19 hospitalised from March 1st to May 31 s t 2020. DNACPR documentation rates in patients aged ≥65 years with a diagnosis of COVID-19 were compared to those without COVID-19 admitted during the same period. Pre-COVID-19 pandemic DNACPR documentation rates were also examined. Factors associated with DNACPR order instatement during the first wave of the COVID-19 pandemic were identified.
Results
Of 300 COVID-19-positive patients, 28% had a DNACPR order documented during their admission. 50% of DNAR orders were recorded within 24 hours of a positive swab result for SARS-CoV-2. Of 131 patients aged 65 years or over within the cohort admitted with COVID-19, 60.3% had a DNACPR order compared to 25.4% of 130 patients ≥65 without COVID-19 (p < 0.0001). During a comparable time period pre-pandemic, 15.4% of 130 older patients had a DNACPR order in place (p < 0.0001). Independent associations with DNACPR order documentation included increasing age (Odds Ratio [O.R.] 1.12; 95% CI 1.05-1.21); nursing home resident status (O.R. 3.57; 95% CI 1.02-12.50); frailty (O.R. 3.34; 95% CI 1.16-9.61) and chronic renal impairment (O.R. 5.49; 1.34-22.47). The case-fatality-rate of older patients with COVID-19 was 29.8% versus 5.4% without COVID-19. Of older COVID-19-positive patients, 39.2% were referred to palliative care services and 70.2% survived.
Conclusion
The COVID-19 pandemic has prompted more widespread and earlier decision-making regarding resuscitation status. Although case-fatality-rates were higher for older hospitalised patients with COVID-19, many older patients survived the illness. Advance care planning should be prioritised in all patients and should remain clinical practice despite the pandemic.
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Affiliation(s)
- D Connellan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - K Diffley
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - J McCabe
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - A Cotter
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - T McGinty
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - G Sheehan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - K Ryan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - W Cullen
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - J Lambert
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - E Callaly
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - L Kyne
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
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Blair M, Côté JM, Cotter A, Lynch B, Redahan L, Murray PT. Nephrotoxicity from Vancomycin Combined with Piperacillin-Tazobactam: A Comprehensive Review. Am J Nephrol 2021; 52:85-97. [PMID: 33735856 DOI: 10.1159/000513742] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies have identified the combination of vancomycin with piperacillin-tazobactam (VPT) to be associated with increased nephrotoxicity. Multiple, large cohort studies have found this widely used combination to have a higher risk of nephrotoxicity than other regimens in a variety of populations. SUMMARY This review summarizes the epidemiology and clinical features of VPT-associated acute kidney injury (AKI). Potential mechanisms involved in the pathogenesis of this phenomenon are also discussed. Key Message: VPT-associated nephrotoxicity is a recently recognized clinical entity. Clinical strategies to minimize the risk of toxicity in this setting include antimicrobial stewardship, monitoring of kidney function, and emerging data supporting the potential role for novel biomarkers in predicting and managing AKI.
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Affiliation(s)
- Matthew Blair
- Division of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jean-Maxime Côté
- Service of Nephrology, Department of Medicine, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
- Clinical Research Centre, University College Dublin, Dublin, Ireland
| | - Aoife Cotter
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Breda Lynch
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lynn Redahan
- Division of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patrick T Murray
- Division of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland,
- Clinical Research Centre, University College Dublin, Dublin, Ireland,
- Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland,
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12
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O’Kelly B, Cronin C, Connolly SP, Cullen W, Avramovic G, McHugh T, O’Connor E, Cotter A, Doran P, McGinty T, O’Callaghan DS, Gaine S, Sheehan G, Brazil E, Marsh B, Lambert JS. What is the clinical course of patients hospitalised for COVID-19 treatment Ireland: a retrospective cohort study in Dublin’s North Inner City (the ‘Mater 100’). HRB Open Res 2020. [DOI: 10.12688/hrbopenres.13138.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Ireland has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While several cohorts from China have been described, there is little data describing the epidemiological and clinical characteristics of Irish patients with COVID-19. To improve our understanding of this infection we performed a retrospective review of patient data to examine the clinical characteristics of patients admitted for COVID-19 hospital treatment. Methods: Demographic, clinical and laboratory data on the first 100 patients admitted to Mater Misericordiae University Hospital for in-patient COVID-19 treatment after onset of the outbreak in March 2020 was extracted from patient records. Results: The median age was 45 years (interquartile range [IQR] =34-64 years), 58% were male, and 63% were Irish nationals. Patients had symptoms for a median of five days before diagnosis (IQR=2.5-7 days), most commonly cough (72%), fever (65%), dyspnoea (37%), fatigue (28%), myalgia (27%) and headache (24%). Of all cases, 54 had at least one pre-existing chronic illness (most commonly hypertension, diabetes mellitus or asthma). At initial assessment, the most common abnormal findings were: C-reactive protein >7.0mg/L (74%), ferritin >247μg/L (women) or >275μg/L (men) (62%), D-dimer >0.5μg/dL (62%), chest imaging (59%), NEWS Score (modified) of ≥3 (55%) and heart rate >90/min (51%). Supplemental oxygen was required by 27 patients, of which 17 were admitted to the intensive care unit - 14 requiring ventilation. Antiviral therapy was administered to 40 patients (most commonly hydroxychloroquine or lopinavir/ritonavir). Four died, 17 were admitted to intensive care, and 74 were discharged home, with nine days the median hospital stay (IQR=6-11). Conclusion: Our findings reinforce the consensus of COVID-19 as an acute life-threatening disease and highlights the importance of laboratory (ferritin, C-reactive protein, D-dimer) and radiological parameters, in addition to clinical parameters. Further cohort studies followed longitudinally are a priority.
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Cullen W, Avramovic G, Broughan J, Burke MC, Cotter A, Crowley D, Downey J, Duggan P, Fawsitt R, Guerandel A, Hennessy E, Kelleher C, Mills G, McCombe G, McHugh T, O’Connor E, Perrotta C, Lambert JS. Study Protocol: Prospective, observational, cohort study of COVID-19 in General Practice (North Dublin COVID-19 Cohort [‘ANTICIPATE’] Study). HRB Open Res 2020. [DOI: 10.12688/hrbopenres.13135.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: It is accepted that COVID-19 will have considerable long-term consequences, especially on people’s mental and physical health and wellbeing. Although the impacts on local communities have been immense, there remains little data on long term outcomes among patients with COVID-19 who were managed in general practice and primary care. This study seeks to address this knowledge gap by examining how the COVID-19 pandemic has impacted the medium and long-term health and wellbeing of patients attending general practice, especially their mental health and wellbeing. Methods: The study will be conducted at 12 general practices in the catchment area of the Mater Misericordiae University Hospital, i.e. the North Dublin area, an area which has experienced an especially high COVID-19 incidence. Practices will be recruited from the professional networks of the research team. A member of the general practice team will be asked to identify patients of the practice who attended the practice after 16/3/20 with a confirmed or presumptive diagnosis of COVID-19 infection. Potential participants will be provided with information on the study by the clinical team. Data will be collected on those patients who consent to participate by means of an interviewer-administered questionnaire and review of clinical records. Data will be collected on health (especially mental health) and wellbeing, quality of life, health behaviours, health service utilisation, and wider impacts of COVID-19 at recruitment and at two follow up time points (6, 12 months). Deliverables: The project involves collaboration with Ireland’s Health Service Executive, Ireland East Hospital Group, and the Mater Misericordiae University Hospital, Dublin. The study is funded by the Health Research Board. Findings will inform health policies that attenuate the adverse impacts of COVID-19 on population mental health and health generally.
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Ryom L, Cotter A, De Miguel R, Béguelin C, Podlekareva D, Arribas JR, Marzolini C, Mallon P, Rauch A, Kirk O, Molina JM, Guaraldi G, Winston A, Bhagani S, Cinque P, Kowalska JD, Collins S, Battegay M. 2019 update of the European AIDS Clinical Society Guidelines for treatment of people living with HIV version 10.0. HIV Med 2020; 21:617-624. [PMID: 32885559 PMCID: PMC7754379 DOI: 10.1111/hiv.12878] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [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] [Accepted: 04/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The European AIDS Clinical Society (EACS) Guidelines cover key aspects of HIV management with major updates every two years. GUIDELINE HIGHLIGHTS The 2019 Guidelines were extended with a new section focusing on drug-drug interactions and other prescribing issues in people living with HIV (PLWH). The recommendations for treatment-naïve PLWH were updated with four preferred regimens favouring unboosted integrase inhibitors. A two-drug regimen with dolutegravir and lamivudine, and a three-drug regimen including doravirine were also added to the recommended initial regimens. Lower thresholds for hypertension were expanded to all PLWH and for cardiovascular disease prevention, the 10-year predicted risk threshold for consideration of antiretroviral therapy (ART) modification was lowered from 20% to 10%. Frailty and obesity were added as new topics. It was specified to use urine albumin to creatinine ratio to screen for glomerular disease and urine protein to creatinine ratio for tubular diseases, and thresholds were streamlined with the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations. Hepatitis C virus (HCV) treatment recommendations were split into preferred and alternative treatment options. The algorithm for management of recently acquired HCV infection was updated and includes recommendations for early chronic infection management. Treatment of resistant tuberculosis (TB) was streamlined with the World Health Organization (WHO) recommendations, and new tables on immune reconstitution inflammatory syndrome, on when to start ART in the presence of opportunistic infections and on TB drug dosing were included. CONCLUSIONS The EACS Guidelines underwent major revisions of all sections in 2019. They are available in four different formats including a new interactive web-based version and are translated into Chinese, French, German, Japanese, Portuguese, Russian and Spanish.
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Affiliation(s)
- L Ryom
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Cotter
- University College Dublin Centre for Experimental Pathogen Host Research, Dublin, Ireland
| | - R De Miguel
- Infectious Diseases Unit, La Paz Hospital, Madrid, Spain
| | - C Béguelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Podlekareva
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J R Arribas
- Infectious Diseases Unit, La Paz Hospital, Madrid, Spain
| | - C Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel and University of Basel, Basel, Switzerland.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Pgm Mallon
- University College Dublin Centre for Experimental Pathogen Host Research, Dublin, Ireland
| | - A Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - O Kirk
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J M Molina
- Department of Infectious Diseases, St Louis and Lariboisière Hospitals, APHP and University of Paris, Paris, France
| | - G Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - S Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free London NHS Trust, Institute of Global Health, University College London, London, UK
| | - P Cinque
- Division of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - J D Kowalska
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - M Battegay
- Division of Infectious Diseases et Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
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15
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O'Carroll O, MacCann R, O'Reilly A, Dunican EM, Feeney ER, Ryan S, Cotter A, Mallon PW, Keane MP, Butler MW, McCarthy C. Remote monitoring of oxygen saturation in individuals with COVID-19 pneumonia. Eur Respir J 2020; 56:13993003.01492-2020. [PMID: 32616588 PMCID: PMC7331654 DOI: 10.1183/13993003.01492-2020] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 01/16/2023]
Abstract
Coronavirus disease 2019 (COVID-19), an illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has spread rapidly worldwide, resulting in significant mortality and placing major strain on healthcare systems. Although the clinical course is variable, one in five patients will require hospitalisation for management, with older age and the presence of comorbidities increasing the risk of more severe disease [1–3]. The median time from first onset of symptoms to development of acute respiratory distress syndrome in those who progress to severe disease is estimated to be 8.0 days [4]. Remote monitoring of oxygen saturation in cases of COVID-19 pneumonia may facilitate discharge, relieving burden on bed demand and allowing safe follow-up for this disease in which the sequelae are unknownhttps://bit.ly/3cTXnZU
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Affiliation(s)
- Orla O'Carroll
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Rachel MacCann
- Dept of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Aoife O'Reilly
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Eleanor M Dunican
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Eoin R Feeney
- Dept of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Silke Ryan
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Aoife Cotter
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Patrick W Mallon
- Dept of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Michael P Keane
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Marcus W Butler
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland .,School of Medicine, University College Dublin, Dublin, Ireland
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16
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Winston A, Cotter A, Gisslen M, Mallon PWG, Cinque P. Response to: ‘How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well‐treated HIV‐positive population?’. HIV Med 2020; 21:e17-e18. [DOI: 10.1111/hiv.12874] [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] [Received: 01/29/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A Winston
- Department of Infectious Disease Imperial College London London UK
| | - A Cotter
- St. Vincent’s University Hospital and School of Medicine University College Dublin Dublin Ireland
| | - M Gisslen
- Department of Infectious Diseases Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Infectious Diseases Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - PWG Mallon
- St. Vincent’s University Hospital and School of Medicine University College Dublin Dublin Ireland
| | - P Cinque
- Department of Infectious Diseases IRCCS San Raffaele Scientific Institute Milan Italy
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17
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McCarthy C, Savinelli S, Feeney ER, Butler MW, O'Broin C, Ryan S, O'Neill L, Murphy DJ, Gallagher CG, McKone EF, Waqas S, Cotter A, Doran P, Keane MP, Mallon PW. Tocilizumab therapy in individuals with COVID-19 infection and hyperinflammatory state. Respirology 2020; 25:1090-1094. [PMID: 32696570 PMCID: PMC7404856 DOI: 10.1111/resp.13912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Stefano Savinelli
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Eoin R Feeney
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Cathal O'Broin
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Silke Ryan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Lorraine O'Neill
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Charles G Gallagher
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Edward F McKone
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Sarmad Waqas
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Aoife Cotter
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick W Mallon
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
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18
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Feeney E, Wallace D, Cotter A, Tinago W, McCarthy C, Keane D, Hussain R, Alvarez Barco E, Doran P, Mallon P. The COVIRL-001 Trial: A multicentre, prospective, randomised trial comparing standard of care (SOC) alone, SOC plus hydroxychloroquine monotherapy or SOC plus a combination of hydroxychloroquine and azithromycin in the treatment of non- critical, SARS-CoV-2 PCR-positive population not requiring immediate resuscitation or ventilation but who have evidence of clinical decline: A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:430. [PMID: 32450915 PMCID: PMC7247433 DOI: 10.1186/s13063-020-04407-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eoin Feeney
- St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Deborah Wallace
- School of Medicine, University College Dublin, Dublin, Ireland.
| | - Aoife Cotter
- School of Medicine, University College Dublin, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - Willard Tinago
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - David Keane
- St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Rabia Hussain
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Peter Doran
- School of Medicine, University College Dublin, Dublin, Ireland.,HRB-Trial Methodology Research Network, Galway, Ireland
| | - Patrick Mallon
- St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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19
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Hehir MP, Burke N, Burke G, Turner MJ, Breathnach FM, Mcauliffe FM, Morrison JJ, Dornan S, Higgins J, Cotter A, Geary MP, Mcparland P, Daly S, Cody F, Dicker P, Tully E, Malone FD. Sonographic markers of fetal adiposity and risk of Cesarean delivery. Ultrasound Obstet Gynecol 2019; 54:338-343. [PMID: 30887629 DOI: 10.1002/uog.20263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/11/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Increased fetal size is associated with shoulder dystocia during labor and subsequent need for assisted delivery. We sought to investigate if increased fetal adiposity diagnosed sonographically in late pregnancy is associated with increased risk of operative delivery. METHODS This secondary analysis of the Genesis Study recruited 2392 nulliparous women with singleton pregnancy in cephalic presentation, in a prospective, multicenter study, to examine prenatal and intrapartum predictors of Cesarean delivery. Participants underwent ultrasound and clinical evaluation between 39 + 0 and 40 + 6 weeks' gestation. Data on fetal biometry were not revealed to patients or to their managing clinicians. A fetal adiposity composite of fetal thigh adiposity and fetal abdominal wall thickness was compiled for each infant in order to determine whether fetal adiposity > 90th centile was associated with an increased risk of Cesarean or operative vaginal delivery. RESULTS After exclusions, data were available for 2330 patients. Patients with a fetal adiposity composite > 90th centile had a higher maternal body mass index (BMI) (25 ± 5 kg/m2 vs 24 ± 4 kg/m2 ; P = 0.005), birth weight (3872 ± 417 g vs 3585 ± 401 g; P < 0.0001) and rate of induction of labor (47% (108/232) vs 40% (834/2098); P = 0.048) than did those with an adiposity composite ≤ 90th centile. Fetuses with adiposity composite > 90th centile were more likely to require Cesarean delivery than were those with adiposity composite ≤ 90th centile (P < 0.0001). After adjusting for birth weight, maternal BMI and need for induction of labor, fetal adiposity > 90th centile remained a risk factor for Cesarean delivery (P < 0.0001). A fetal adiposity composite > 90th centile was more predictive of the need for unplanned Cesarean delivery than was an estimated fetal weight > 90th centile (odds ratio, 2.20 (95% CI, 1.65-2.94; P < 0.001) vs 1.74 (95% CI, 1.29-2.35; P < 0.001). Having an adiposity composite > 90th centile was not associated with an increased likelihood of operative vaginal delivery when compared with having an adiposity composite ≤ 90th centile (P = 0.37). CONCLUSIONS Fetuses with increased adipose deposition are more likely to require Cesarean delivery than are those without increased adiposity. Consideration should, therefore, be given to adding fetal thigh adiposity and abdominal wall thickness to fetal sonographic assessment in late pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M P Hehir
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - N Burke
- Rotunda Hospital, Dublin, Ireland
| | - G Burke
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - M J Turner
- University College Dublin Centre for Human Reproduction, School of Medicine and Medical Science, Coombe Women and Infants Maternity Hospital, Dublin, Ireland
| | - F M Breathnach
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - F M Mcauliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - J J Morrison
- Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
| | - S Dornan
- Royal Jubilee Maternity Hospital, Belfast, Ireland
| | - J Higgins
- University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - A Cotter
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | | | - P Mcparland
- National Maternity Hospital, Dublin, Ireland
| | - S Daly
- Coombe Women and Infants Maternity Hospital, Dublin, Ireland
| | - F Cody
- Rotunda Hospital, Dublin, Ireland
| | - P Dicker
- Epidemiology & Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Tully
- Rotunda Hospital, Dublin, Ireland
| | - F D Malone
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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20
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Cremona A, O'Gorman C, Cotter A, Saunders J, Donnelly A. Effect of exercise modality on markers of insulin sensitivity and blood glucose control in pregnancies complicated with gestational diabetes mellitus: a systematic review. Obes Sci Pract 2018; 4:455-467. [PMID: 30338116 PMCID: PMC6180709 DOI: 10.1002/osp4.283] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 12/29/2017] [Revised: 05/24/2018] [Accepted: 05/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIM Exercise can be used as a strategy to attenuate hyperglycaemia experienced during gestational diabetes mellitus (GDM). To maximize its use for clinical management, the most effective modality should be identified. The purpose of this review is to elucidate the most effective modality of exercise on insulin sensitivity and blood glucose control in pregnant women with or at risk of GDM. METHODS A search was undertaken in MEDLINE, PubMed, Scopus, CINAHL, the Cochrane Library, Embase and the Maternity & Infant Healthcare Database. Studies that met inclusion criteria were randomized controlled trials and case-controlled studies, which compared exercise interventions with standard care during pregnancy in women with or at risk of GDM. RESULTS Two interventions using resistance training, eight using aerobic exercise and two using a combination of both modalities were included. The interventions showed consistently that requirements of insulin therapy, dosage, and latency to administration were improved in the exercise groups. Less consistent results were observed for capillary blood glucose measurements; however, both modalities and combination of modalities were effective at improving blood glucose control in already diagnosed patients and pregnant women with obesity. Discrepancies in the timing of intervention, GDM diagnostic criteria, and the different measures used to assess glucose metabolism make it difficult to draw clear recommendations. CONCLUSION Exercising three times per week for 40-60 min at 65-75% age-predicted heart rate maximum using cycling, walking or circuit training as a modality improved glycaemic control in GDM patients and reduced incidence of GDM in pregnant women with obesity. Further studies looking specifically at the effects of different modalities of exercise on glucose metabolism with combined strategies to enhance insulin sensitivity should be explored to maximize benefits for GDM pregnancies. Consistency in design and delivery of exercise-only interventions is required to make recommendations on a suitable exercise prescription in this population. In practice, adherence to consensus in diagnostic cut-offs for GDM diagnosis is fundamental for standardizing future research.
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Affiliation(s)
- A. Cremona
- Graduate Entry Medical SchoolUniversity of LimerickLimerickIreland
- Irish Nutrition and Dietetic InstituteDublinIreland
| | - C. O'Gorman
- Graduate Entry Medical SchoolUniversity of LimerickLimerickIreland
| | - A. Cotter
- Graduate Entry Medical SchoolUniversity of LimerickLimerickIreland
| | - J. Saunders
- SCU/CSTAR @ ULUniversity of LimerickLimerickIreland
| | - A. Donnelly
- Physical Education and Sports ScienceUniversity of LimerickLimerickIreland
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21
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Alvarez E, Mcginty T, Cotter A, Sabin C, Babu S, McDermott A, Chen R, Macken A, Brady J, Kavanagh E, Mccarthy G, Compston J, Mallon P. Analysis of quality-adjusted life years (QALYs) in HIV-positive and HIV-negative subjects enrolled to the UPBEAT (Understanding the Pathology of Bone Disease in HIV Infected Subjects) cohort. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30361-7] [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] Open
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22
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O’Connell S, Lillis D, Cotter A, O’Dea S, Tuite H, Fleming C, Crowley B, Fitzgerald I, Dalby L, Barry H, Shields D, Norris S, Plunkett PK, Bergin C. Opt-Out Panel Testing for HIV, Hepatitis B and Hepatitis C in an Urban Emergency Department: A Pilot Study. PLoS One 2016; 11:e0150546. [PMID: 26967517 PMCID: PMC4788349 DOI: 10.1371/journal.pone.0150546] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/15/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Studies suggest 2 per 1000 people in Dublin are living with HIV, the level above which universal screening is advised. We aimed to assess the feasibility and acceptability of a universal opt-out HIV, Hepatitis B and Hepatitis C testing programme for Emergency Department patients and to describe the incidence and prevalence of blood-borne viruses in this population. METHODS An opt-out ED blood borne virus screening programme was piloted from March 2014 to January 2015. Patients undergoing blood sampling during routine clinical care were offered HIV 1&2 antibody/antigen assay, HBV surface antigen and HCV antibody tests. Linkage to care where necessary was co-ordinated by the study team. New diagnosis and prevalence rates were defined as the new cases per 1000 tested and number of positive tests per 1000 tested respectively. RESULTS Over 45 weeks of testing, of 10,000 patient visits, 8,839 individual patient samples were available for analysis following removal of duplicates. A sustained target uptake of >50% was obtained after week 3. 97(1.09%), 44(0.49%) and 447(5.05%) HIV, Hepatitis B and Hepatitis C tests were positive respectively. Of these, 7(0.08%), 20(0.22%) and 58(0.66%) were new diagnoses of HIV, Hepatitis B and Hepatitis C respectively. The new diagnosis rate for HIV, Hepatitis B and Hepatitis C was 0.8, 2.26 and 6.5 per 1000 and study prevalence for HIV, Hepatitis B and Hepatitis C was 11.0, 5.0 and 50.5 per 1000 respectively. CONCLUSIONS Opt-out blood borne viral screening was feasible and acceptable in an inner-city ED. Blood borne viral infections were prevalent in this population and newly diagnosed cases were diagnosed and linked to care. These results suggest widespread blood borne viral testing in differing clinical locations with differing population demographic risks may be warranted.
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Affiliation(s)
- Sarah O’Connell
- Department of Genito-Urinary Medicine and Infectious Disease, St James’s Hospital, Dublin, Ireland
| | - Darren Lillis
- Emergency Medicine Department, St James’s Hospital, Dublin, Ireland
| | - Aoife Cotter
- Department of Genito-Urinary Medicine and Infectious Disease, St James’s Hospital, Dublin, Ireland
| | - Siobhan O’Dea
- Department of Genito-Urinary Medicine and Infectious Disease, St James’s Hospital, Dublin, Ireland
| | - Helen Tuite
- Infectious Diseases Department, Galway University Hospital, Dublin, Ireland
| | - Catherine Fleming
- Infectious Diseases Department, Galway University Hospital, Dublin, Ireland
| | - Brendan Crowley
- Microbiology Department, St James’s Hospital, Dublin, Ireland
| | - Ian Fitzgerald
- Microbiology Department, St James’s Hospital, Dublin, Ireland
| | - Linda Dalby
- Microbiology Department, St James’s Hospital, Dublin, Ireland
| | - Helen Barry
- Microbiology Department, St James’s Hospital, Dublin, Ireland
| | - Darragh Shields
- Emergency Medicine Department, St James’s Hospital, Dublin, Ireland
| | - Suzanne Norris
- Hepatology Department, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Colm Bergin
- Department of Genito-Urinary Medicine and Infectious Disease, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
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23
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Acton JP, Cotter A, Nakib TA, Meegan MJ. 6,6-Dimethyl-6, 11-Dihydro(1)Benzothiopyrano(4,3-b) Indoles: Novel Polycyclic Heteroaromatic Compounds. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1985.tb14205.x] [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: 11/27/2022]
Affiliation(s)
- J P Acton
- Department of Pharmaceutical Chemistry, Trinity College, 18 Shrewsbury Road, Dublin 4, Ireland
| | - A Cotter
- Department of Pharmaceutical Chemistry, Trinity College, 18 Shrewsbury Road, Dublin 4, Ireland
| | - T Al Nakib
- Department of Pharmaceutical Chemistry, Trinity College, 18 Shrewsbury Road, Dublin 4, Ireland
| | - M J Meegan
- Department of Pharmaceutical Chemistry, Trinity College, 18 Shrewsbury Road, Dublin 4, Ireland
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24
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Cotter A, Lambert J, O'Gorman P. Multicentric Castleman's disease & HIV infection. Ir Med J 2009; 102:294-295. [PMID: 19902650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report the case of a 35 year patient from Nigeria who presented with fever and splenomegaly. The initial diagnosis was Salmonellosis. However, relapsing symptoms lead to a re-evaluation and ultimately a diagnosis of Multicentric Castleman's Disease (MCD). There is no gold standard treatment but our patient responded to Rituximab and Highly active anti-retroviral therapy. MCD is a rare, aggressive disease that should be considered in a HIV positive patient presenting with fever and significant lymphadenopathy.
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Affiliation(s)
- A Cotter
- Department Infectious Diseases, Mater Misericordiae University Hospital, Eccles St., Dublin 7 and University College Dublin, School of Medicine & Medical Sciences, Dublin.
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25
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Cotter A, Ryan CA. The pool chlorine hypothesis and asthma among boys. Ir Med J 2009; 102:79-82. [PMID: 19489195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
UNLABELLED Swimming pool sanitation has largely been concerned with the microbiological quality of pool water, which is normally treated using a number of chlorine products. Recent studies have pointed to the potential hazards of chlorine by-products to the respiratory epithelium, particularly in indoor, poorly ventilated, pools. The aim of our study was to elucidate whether chronic exposure to indoor chlorinated swimming pools was associated with an increased likelihood of the development of asthma in boys. METHODS The subjects were boys aged between 6 and 12 years. Data was collected by means of parental responses to a standardized asthma questionnaire (ISAAC: International Study of Asthma and Allergies in Childhood), supplemented with additional questions regarding frequency of attendance, number of years attendance, whether the child is a swimming team member. The questionnaire return rate was 71/% (n = 121). 23 boys were excluded on the basis that they had asthma before they started swimming (n = 97). There was a significant association between number of years a boy had been swimming and the likelihood of wheezing in the last 12 months (p = 0.009; OR = 1.351; 95% CI = 1.077-1.693) and diagnosed asthma (p = 0.046; OR = 1.299; 95% CI = 1.004-1.506). The greater the number the number of years a boy had been attending an indoor, chlorinated pool, the greater the likelihood of wheezing in the last 12 months or "had asthma". Age, parental smoking habits and being a swimming team member had no association with any of the asthma variables examined. Swimming pool attendance may be a risk factor in asthma in boys.
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Affiliation(s)
- A Cotter
- Department of Paediatrics and Child Health, UCC, Cork University Maternity Hospital, Wilton, Cork
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Cotter A, Treacy A, O'Keane C, Mulligan N, Lambert J. Cutaneous T-cell lymphoma presenting as a ten month history of unilateral facial swelling. Ir Med J 2008; 101:151-152. [PMID: 18624265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 25-year-old fisherman presented with a ten-month history of unilateral facial swelling involving his lower lip and eyelids. The differential diagnosis for oro-facial swelling is extensive including congenital, infective, inflammatory and neoplastic processes. Biopsies revealed a cutaneous T cell lymphoma.
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Affiliation(s)
- A Cotter
- Department of Infectious Disease, Mater Misericordiae Hospital, Dublin.
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Cotter A, Gardeil F, Varley M, Skinner J, Turner MJ. Are the immediate complications of conisation with the large loop similar to those with the knife? J OBSTET GYNAECOL 2004; 20:63-4. [PMID: 15512470 DOI: 10.1080/01443610063499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
One hundred patients underwent conisation with large loop excision of the transformation zone. The overall immediate complication rate was 6%. There were no preoperative complications. Three patients were treated with antibiotics for infection and three patients had a secondary haemorrhage. No patient required a blood transfusion or cervical suturing and no patient returned to the operating theatre.
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Affiliation(s)
- A Cotter
- Coombe Women's Hospital, Dublin, Ireland
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Newberg A, Cotter A, Udeshi M, Brinkman F, Glosser G, Alavi A, Clark C. Brain metabolism in the cerebellum and visual cortex correlates with neuropsychological testing in patients with Alzheimer's disease. Nucl Med Commun 2003; 24:785-90. [PMID: 12813197 DOI: 10.1097/01.mnm.0000080249.50447.99] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was designed to measure glucose metabolic deficits in areas not typically recognized as abnormal on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scans in patients with Alzheimer's disease (AD), and to correlate such findings with subtle neuropsychological impairment. FDG-PET scans on 38 AD patients with no clinical evidence of visual, spatial or motor deficits were acquired on the PET HEAD scanner 40 min following the intravenous administration of 115 microCi.kg-1 of FDG. All FDG-PET scans were analysed blindly using a region of interest (ROI) template with regions for the primary visual cortex (PVC), secondary visual cortex (SVC) and cerebellum. Counts from the ROIs of these regions were normalized to whole brain activity and the results were compared with psychometric and neuropsychological measures. A number of significant correlations were found between these structures and various neuropsychological measures (P<0.05). Specifically, there were significant correlations between clock drawing and the cerebellum activity; memory and activity in the PVC, SVC and cerebellum; social score and activity in the PVC and left cerebellum; judgement and activity in the right SVC and right PVC; and the overall Mini-Mental State Examination and activity in the PVC, SVC and cerebellum. The results of this study suggest that metabolism in areas not typically recognized as abnormal on FDG-PET scans in AD, such as the PVC, SVC and cerebellum, is correlated with deficits in neuropsychological function. This may have important clinical and pathophysiological implications in the study of AD and other illnesses of dementia.
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Affiliation(s)
- A Newberg
- Department of Radiology and Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Bruhn C, Bruhn J, Cotter A, Garrett C, Klenk M, Powell C, Stanford G, Steinbring Y, West E. Consumer Attitudes Toward Use of Probiotic Cultures. J Food Sci 2002. [DOI: 10.1111/j.1365-2621.2002.tb08754.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Whitney C, Cotter A, Festin M, Parekh F, Limpongsanurak S, Gaitan H, Tolosa J. 404 International multicenter study of group B streptococcal colonization in pregnant women. Am J Obstet Gynecol 2001. [DOI: 10.1016/s0002-9378(01)80436-1] [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: 11/27/2022]
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Cotter A. Improving services for older people. Prof Nurse 2001; 16:1132. [PMID: 12029916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Cotter A, Greene R, Turner M. What do Irish women know about cervical screening? Ir Med J 1999; 92:428-9. [PMID: 10967864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
In anticipation of the launch of the national cervical screening programme, a questionnaire was distributed amongst 200 women on the maternity wards of the Coombe Women's Hospital. The questionnaires revealed that 24% of the women surveyed never had a smear test and 50% of these did not know how the test was performed. The majority of all women did not know what a smear test showed and 26% did not know the meaning of an abnormal smear. Irish women's knowledge of cervical screening is limited, and the success of the proposed programme will depend on an improvement in public information and education.
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Affiliation(s)
- A Cotter
- Coombe Women's Hospital, Dublin, Ireland
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Cotter A, Meyer J, Roberts S. The transition from hospital to long-term institutional care. Nurs Times 1998; 94:54-6. [PMID: 9791517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The focus of this article is user and carer involvement in the transition of older people from acute hospital to continuing institutional long-term care. The policy context and research of relevant studies are reviewed. Findings from an action research project currently in progress further elucidate the concerns of older users and carers.
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Affiliation(s)
- A Cotter
- Department of Adult Nursing, St Bartholomew's School of Nursing and Midwifery, City University, London
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Cotter A. A new lease of life. Nurs Times 1998; 94:58-9. [PMID: 9661477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- A Cotter
- St. Bartholomew's Department of Nursing and Midwifery, City University, London
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Byrne B, Cotter A, Molloy E, Turner M. Should pregnant women be screened for drugs of abuse? Ir Med J 1998; 91:29. [PMID: 9563256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rocha E, Gouveia-Oliveira A, Cotter A, Laranjeiro A, Sousa A, Mendes F, Teixeira H, Galvão J, Miguel JM. [Risk factors for cerebrovascular stroke in a cohort of hypertensive patients]. Rev Port Cardiol 1997; 16:543-56, 508. [PMID: 9303608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To identify stroke risk factors in hypertensive patients and the probability of stroke in relation to those risk factors and follow-up. STUDY DESIGN A cohort study (patients with high blood pressure). MATERIAL AND METHODS 707 hypertensive patients were studied (Hypertension Register) in what concerns stroke incidence until 1992 (n = 126), considering one case per individual. The following variables were analysed: age, sex, body mass index (Quetelet), systolic and diastolic blood pressure, heart rate, types of hypertension (JNC-IV), left ventricular hypertrophy, changes in ST segment and T wave (Minnesota Code), fundi, angina pectoris, heart failure, central nervous (neurological) disturbances, antihypertensive treatment, smoking, serum potassium, serum sodium, blood urea, creatinine, uric acid, blood sugar, diabetes and cholesterol, in the initial record. Individually, in relation to the control of hypertension, the subjects were classified according to the casual recording of normal blood pressure, the absence of drug treatment, diastolic pressure > 114 mmHg and, at the end of 1992, according to survival, causes of death and follow-up. Stroke risk factors have been identified by multivariate analysis (Cox regression model). The survival probability (without stroke) was defined by Kaplan-Meier method. RESULTS It was possible to maintain the epidemiological surveillance, from 1975 to 1992, of 598 cases. From those, 109 hypertensive patients were victims of at least one episode of non transient cerebral ischaemia, during their follow-up of 10.5 years. From the characteristics studied, only five were identified at risk factors. The adjusted relative risks and confidence intervals (95% CI) were the following: age: 1.08 (1.06-1.10); diastolic pressure > 114 mmHg: 1.96 (1.32-2.91); neurological disturbances 4.64 (2.99-7.2); diabetes: 2.57 (1.62-4.05) and left ventricular hypertrophy: 1.34 (1.13-1.58). CONCLUSIONS As far as stroke is concerned: a) Age, diabetes, a casual measurement of diastolic blood pressure > 114 mmHg and left ventricular hypertrophy (electrocardiogram) were the risk factors identified; b) Prevention should include blood pressure and diabetes control, although this disease has shown more risk than a casual measurement of severe hypertension; c) Its occurrence, in this model, has only partly been explained, therefore it has become necessary to deepen the study of the risk profile.
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Affiliation(s)
- E Rocha
- Centro de Estudos de Cardiologia Preventiva, INSA, Lisboa
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Cotter A. Nursing must fight to reclaim a valuable role in continuing care. Nurs Times 1997; 93:15. [PMID: 9197744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Cotter A. Look again. Elderly care counts. Nurs Times 1997; 93:37. [PMID: 9095969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Cotter A. An ill for every pill? Nurs Times 1983; 79:12-4. [PMID: 6558527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Cotter A. Pressure sore! Nursing 1982; 2:14-6. [PMID: 6926540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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