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Maxwell C, Forrest P. The role of ECMO support in airway procedures. BJA Educ 2023; 23:248-255. [PMID: 37389276 PMCID: PMC10300492 DOI: 10.1016/j.bjae.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/08/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- C. Maxwell
- Royal Prince Alfred Hospital, Sydney, Australia
| | - P. Forrest
- Royal Prince Alfred Hospital, Sydney, Australia
- Sydney University Medical School, Sydney, Australia
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House SC, Tandon P, O'Connor K, Maxwell C, Kennedy E, Snelgrove J, DeBuck A, Brar M, Huang V. A91 INTERACTIONS BETWEEN PREGNANCY, DELIVERY, AND ILEAL POUCH-ANAL ANASTOMOSIS FOR INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE CHART REVIEW. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991144 DOI: 10.1093/jcag/gwac036.091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects people in their reproductive years of life. Surgical treatment for medically refractory UC involves surgery over 2-3 stages, which includes a subtotal colectomy followed by creation of an ileal pouch-anal anastomosis (IPAA), known as a “J pouch”. The IPAA allows preservation of fecal continence and avoids the psychosocial impacts of a stoma. The IPAA procedure is a deep pelvic surgery, which may impact pregnancy outcomes. Caesarean section (C-section) delivery is often performed to avoid anal sphincter and J pouch damage from vaginal delivery. However, literature demonstrates conflicting results regarding the risks of C-section compared to vaginal delivery, including the impact on pouch function. Surveys of clinicians also report varying delivery recommendations. Purpose To describe the delivery methods, pregnancy outcomes and postpartum course of IBD patients with IPAA at Mount Sinai Hospital. Method A retrospective chart review is being performed for female patients at Mount Sinai Hospital (Toronto, Ontario) with a diagnosis of IBD and an IPAA. Eligible patients completed a pregnancy from January 1, 2002-February 1, 2021 post-IPAA surgery and had variables of interest accessible in their electronic medical record. Variables of interest include demographics, pregnancy history, IBD characteristics, IPAA surgery details, pregnancy outcomes, mode of delivery and characteristics, and postpartum complications. Clinical data will be presented as means, medians and frequencies. Differences between variables of interest will be evaluated with Student’s t-test or chi-squared test. Result(s) Three avenues of patient identification yielded 1113 patients to be screened. Inclusion criteria were met for 71 patients and chart review is complete for 36 patients who had a total of 53 pregnancies and delivered 56 babies. Most patients (49%) had a two-stage IPAA surgery, 21% required a three-stage surgery and 30% were undocumented. Most patients’ (55%) IPAA was created through laparotomy, while 13% was through laparoscopic procedure and 32% was undocumented. Seventy-four percent of deliveries were through C-section (75% of primiparous), 69% of which were indicated to protect the patient’s J pouch and 31% for an obstetrical indication. The remaining 26% of deliveries were vaginal, 29% of which were assisted with forceps or vacuum, 57% had tears (37.5% first-, 37.5% second-, and 25% third-degree) and 50% had an episiotomy. Conclusion(s) At Mount Sinai Hospital, most IBD patients with an IPAA who completed a pregnancy had a history of laparotomy to create their IPAA. Most patients (74%) with IBD and an IPAA are delivering through C-section, and mainly to protect their J pouch, which is in line with reports in the literature. Most patients had a tear or episiotomy during vaginal delivery. Rates of third-degree tears may be higher than in the general population. Trends will be further elucidated with advancement of the study. Disclosure of Interest None Declared
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Affiliation(s)
- S C House
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - P Tandon
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | | | - C Maxwell
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - E Kennedy
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - J Snelgrove
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - A DeBuck
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - M Brar
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - V Huang
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
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Tandon P, Huang V, Feig D, Sakin R, Maxwell C, Gao Y, Fell D, Seow C, Snelgrove J, Nguyen GC. A214 WOMEN WITH INFLAMMATORY BOWEL DISEASE HAVE INCREASED HEALTH-CARE UTILIZATION DURING PREGNANCY AND POSTPARTUM COMPARED TO THOSE WITHOUT INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991121 DOI: 10.1093/jcag/gwac036.214] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Compared to those without inflammatory bowel disease (IBD), women with IBD may have increased health-care utilization during pregnancy and postpartum. This may lead to significant morbidity and decrease in quality of life. Characterizing this health-care use is important for health-policy purposes to determine methods to shift care to the ambulatory setting. Purpose We aimed to compare health-care utilization of women with and without IBD during preconception, pregnancy and postpartum. Method We accessed administrative databases and validated algorithms at the Institute of Clinical Evaluative Services (ICES) in Ontario to identify women (age 18-55) with and without IBD who had a completed live, singleton pregnancy between 2003 and 2018. The primary outcome was to characterize differences in emergency department (ED) visits and hospitalizations between women with and without IBD during the 12 months preconception, pregnancy, and in the 12 months postpartum. The secondary outcome was to assess differences in prenatal care between women with and without IBD. Multivariable negative binomial regression with generalizing estimating equations, accounting for multiple pregnancies for each patient, was performed to report incidence rate ratios (IRR) with 95% confidence intervals (95% CI). Covariates included maternal age at conception, location of residence at conception (rural vs. urban), socioeconomic status (using surrogate marker of neighborhood income quintile), and maternal comorbidity. Result(s) 9158 pregnancies in 6163 women with IBD and 1,729,411 pregnancies in 1,091,013 women without IBD were included. Women with IBD were older at time of delivery and had greater pre-pregnancy comorbidities. During pregnancy, women with IBD were more likely to visit the ED (IRR 1.13, 95% CI,1.08-1.18) and be hospitalized (IRR 1.11, 95% CI,1.01-1.21) for non-IBD specific reasons. Similarly, during postpartum, women with IBD were more likely to visit the ED (IRR 1.21, 95% CI, 1.15-1.27) and be hospitalized (IRR 1.18, 95% CI, 1.05-1.32) for non-IBD specific reasons. Venous thromboembolic events accounted for 7.0% of all postpartum hospitalizations in women with IBD compared to 2.7% in those without IBD (p<0.0001). There was no difference in ED visits and hospitalizations between women with and without IBD in preconception. Finally, women with IBD had greater number of prenatal visits with obstetricians during pregnancy and were more likely to receive a first trimester prenatal visit compared to those without IBD. Conclusion(s) Compared to those without IBD, women with IBD are more likely to visit the ED and be hospitalized during pregnancy and postpartum, particularly for venous thromboembolic events. Efforts should be made from a health policy perspective to increase access to ambulatory care for patients with IBD during the peripartum period which in turn may reduce acute setting health-services utilization. Please acknowledge all funding agencies by checking the applicable boxes below CCC Disclosure of Interest None Declared
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Affiliation(s)
| | | | | | | | | | | | | | - C Seow
- University of Calgary, Calgary, Canada
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Mathiyalagan G, Broni E, Jogendran R, O'Connor K, Kennedy E, Steiman A, Maxwell C, Omar A, Piguet V, Alavi A, Weizman A, Huang V. A85 ASSESSING THE IMPACT OF A DEDICATED RAPID INTERDISCIPLINARY IBD CLINIC ON PATIENT WAIT TIMES, REPORTED OUTCOMES, AND SATISFACTION OF CARE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991230 DOI: 10.1093/jcag/gwac036.085] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) is a chronic fluctuating condition where patients can experience periods of active disease and remission. Timely access to care has been shown to be impactful on important disease outcomes. In January 2020, we implemented a rapid assessment IBD program consisting of expedited access to interdisciplinary care and close monitoring of patients. Purpose To assess the impact of the rapid assessment program on access to care, disease activity, and patient satisfaction. Method Once informed consent was obtained, patients were enrolled into the RAPID IBD program. This program consisted of four close monitoring time points at baseline, 1, 2, and 3 months, as well as two follow up time points at 6 and 12 months. At each timepoint patients completed questionnaires that evaluated disease activity, using the Modified Harvey Bradshaw Index (mHBI) for Crohn’s disease (CD), partial Mayo (pMayo) score and Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis patients. At baseline, 3, 6, and 12 months, patients were also assessed on mental health, using the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7), and satisfaction of care, using the CACHE questionnaire. Result(s) Between January 2020 – August 2021, 216 patients were referred to the RAPID IBD program. The mean time from referral to clinical assessment was 8.1 days. Of those referred, 143 (71 CD, 62 UC, 6 IBDU, and 4 Query IBD) patients consented to and completed the 12-month RAPID IBD study. 34.9% of patients who had active disease at baseline achieved remission by 3 months (Table 1). At baseline 44.8% and 28.4% of patients experienced moderate to severe depression and anxiety, respectively. The greatest improvement in mental health was seen at 2 months where the proportion of patients experiencing moderate to severe depression and anxiety decreased to 27.5% and 18.3%, respectively (Table 2). Patient satisfaction, specific to clinical care, improved from a baseline score of 69.1% to 74.1% at 3 months (Table 3). Image ![]()
Conclusion(s) Implementation of a dedicated RAPID IBD clinic program reveals shorter wait times to be seen in clinic. By three months of enrollment, patients demonstrate improvements in clinical response, mental health, and satisfaction of care. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; AMO Innovation Funding Disclosure of Interest None Declared
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Affiliation(s)
| | | | | | | | | | | | | | | | - V Piguet
- Women's College Hospital, Toronto, Canada
| | - A Alavi
- Women's College Hospital, Toronto, Canada
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Komarraju A, Maxwell C, Kung JW, Mhuircheartaigh JN, Kim W, Wu JS. Causes and diagnostic utility of musculoskeletal MRI recall examinations. Clin Radiol 2023; 78:e221-e226. [PMID: 36517267 DOI: 10.1016/j.crad.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/30/2022] [Accepted: 11/05/2022] [Indexed: 12/15/2022]
Abstract
AIM To determine the causes and diagnostic utility of musculoskeletal (MSK) magnetic resonance imaging (MRI) recall examinations. MATERIALS AND METHODS An institutional review board-approved retrospective review was conducted of all MSK MRI examinations performed at a single academic institution over 10 years where radiologists requested the patient return for additional imaging. The reason for the recall was documented. Recalls were reviewed in consensus by two MSK radiologists to determine whether additional sequences resulted in a change in the final report. Recall causes were divided into four categories: (1) radiologist-related: incorrect field of view (FOV) or incorrect protocol; (2) technologist-related: incorrect FOV or incorrect/incomplete protocol performed, or technically poor-quality images; (3) patient-related motion artefact; (4) unexpected lesion discovered. Fisher's exact test was used to assess for statistical significance. RESULTS The recall rate was 0.25% (156/62,930). Of the total 129 recalls returning for imaging, 42 (33%) were radiologist-related, 45 (35%) were technologist-related, six (5%) were patient-related, and 36 (28%) had an unexpected lesion requiring additional sequences. For clinical utility, 42% resulted in a change from the initial report. Recalls due to radiologist error, incorrect FOV, or unexpected lesion caused a significant change in the final report; however, recalls due to technologist error, patient motion artefact, or incorrect protocol did not. CONCLUSION MRI MSK recalls are uncommon, and the most common reasons are incorrect FOV, incorrect protocol, and unexpected lesion. Radiologist-related errors in protocols and FOV led to a significant change in the final report and should be targeted as areas for improvement to reduce recall examinations.
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Affiliation(s)
- A Komarraju
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - C Maxwell
- Scripps Clinic Medical Group, 10666 North Torrey Pines Rd, La Jolla, CA 92037, USA
| | - J W Kung
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - J N Mhuircheartaigh
- Department of Radiology, School of Medicine, University of Limerick, V94T9Pk, Ireland
| | - W Kim
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - J S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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Han X, Tsai K, Allaire JM, Crowley SM, Lorentzian A, Maxwell C, Vallance B. A2 MUCUS DEFICIENCY IMPACTS INTESTINAL EPITHELIAL CELL PROLIFERATION INDEPENDENT OF THE MICROBIOTA. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859385 DOI: 10.1093/jcag/gwab049.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Intestinal homeostasis is highly dependent on the proliferation and differentiation of intestinal epithelial cells (IEC). IEC arise from intestinal stem cells (ISCs) that reside at the bottom of intestinal crypts. Following proliferation, the IEC migrate up as transient amplifying (TA) cells, and differentiate into mature IEC subtypes. When this process is disrupted, it can lead to aberrant IEC proliferation and differentiation. Mucus production by secretory goblet cells is also crucial for intestinal homeostasis, as mucus separates the IEC from luminal microbiota. Surprisingly, mice lacking Muc2, the main protein component of mucus, display increased distal colonic IEC proliferation and crypt hyperplasia at baseline, suggesting a relationship between Muc2 production and IEC proliferation. Aims We investigated how mucus production impacts IEC proliferation and differentiation in the intestinal crypt. Methods We used wildtype (Muc2+/+) and Muc2 deficient (Muc2-/-) littermates to measure distal colon crypt length and IEC proliferation pattern via microscopy. Organoids were also derived from distal colons of Muc2+/+ and Muc2-/- mice, and quantified for size, density and proliferation for 7 days to test whether the hyper-proliferation phenotype was also seen in vitro, thus epithelial-intrinsic. Crypts and organoids were collected for RNA sequencing to examine changes in IEC proliferation pathways. Proliferation assessments were repeated in germ-free (GF) Muc2+/+ and Muc2-/- mice. Muc2-/- mice were also cross-bred with Lgr5-EGFP-IRES-CreERT2 mice to investigate the contribution of ISCs to IEC hyperproliferation resulting from Muc2 deficiency. Results Significant crypt hyperplasia was observed in the distal colons of Muc2-/- mice in concert with a > twofold increase in Ki67+ TA cells as compared to Muc2+/+ mice. Similarly, Muc2-/- organoids also displayed significantly greater size, density and an increased number of Ki67+ cells than Muc2+/+ organoids. Hyperproliferation was also seen in GF mice and organoids, suggesting that mucus impacts IEC proliferation independent of the microbiome. Muc2-/- Lgr5-EGFP+ mice showed no significant increase in numbers of Lgr5+ cells, indicating that Muc2 deficiency does not directly impact ISC number, but rather their proliferation and differentiation reflected in increased numbers of TA cells. RNA-sequencing results suggested that changes in lipid metabolism may underlie the increased IEC proliferation seen in Muc2-/- mice. Conclusions Mucus not only promotes IEC homeostasis by separating luminal bacteria from the intestinal epithelium, but also intrinsically modifies IEC proliferation independent of the microbiota. Taken together, our results emphasize the importance of mucus in controlling gut health through mechanisms independent of its role in barrier function. Funding Agencies CCC, CIHRC.H.I.L.D Foundation
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Affiliation(s)
- X Han
- Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - K Tsai
- Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - J M Allaire
- Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - S M Crowley
- Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - A Lorentzian
- Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - C Maxwell
- Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - B Vallance
- Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Nguyen DM, Tandon P, Govardhanam V, Hanna Y, Tao JJ, Cepo J, Maxwell C, Huang V. A177 INADEQUATE OR EXCESSIVE GESTATIONAL WEIGHT GAIN IN INFLAMMATORY BOWEL DISEASE AND IMPACT ON PREGNANCY AND NEONATAL OUTCOMES. J Can Assoc Gastroenterol 2022. [DOI: 10.1093/jcag/gwab049.176] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with inflammatory bowel disease (IBD) are at a risk of adverse pregnancy outcomes. Prior studies have suggested that inadequate gestational weight gain is associated with preterm birth and intrauterine growth restriction.
Aims
We sought to characterize the proportion of people with IBD who gain inadequate or excessive weight during pregnancy and how this affects pregnancy and neonatal outcomes.
Methods
Pregnant patients with ulcerative colitis (UC), Crohn’s disease (CD), and inflammatory bowel disease unclassified (IBD-U) were identified retrospectively at Mount Sinai Hospital from 2016 to 2020. Total gestational weight gain (GWG) was calculated as the difference of the weight recorded at time of labor and pre-pregnancy weight. GWG was categorized as inadequate GWG, adequate GWG, and excessive GWG based on the pre-pregnancy body-mass index and standards set by the U.S. Institute of Medicine. Neonatal-related outcomes were also recorded for each patient and included preterm delivery, small for gestational age (SGA) and large for gestational age (LGA). Multiple logistic regression was used to assess the association between gestational weight gain and outcomes while controlling for maternal age, history of gestational diabetes, and preconception disease activity.
Results
225 pregnancies were included (106 UC, 115 CD, 4 IBD-U). Forty-eight patients (21.3%) had inadequate, 91 (40.4%) adequate, and 86 (38.2%) excessive GWG. People of East Asian, African, and Hispanic ethnicity were more likely to have inadequate GWG. People with inadequate GWG were more likely than those with excessive GWG to have lower preconception BMI (21.7 vs 25.5 kg/m2, P=0.001). IBD type was not associated with inadequate GWG or excessive GWG, though people with inadequate GWG were 2-fold less likely to be on anti-TNF therapy. People with excessive GWG were more likely than those with adequate GWG to have babies with higher birth weight (3,364g vs 3,132g, P=0.003). People with inadequate GWG were not at increased risk of SGA compared to those with adequate GWG (adjusted odds ratio (aOR), 1.01; 95% CI: 0.37 – 2.71, P=0.99). Those with excessive GWG were substantially less likely to have an infant with SGA (aOR, 0.23; 95% CI: 0.07 – 0.72, P=0.01). On multivariable logistic regression analysis, excessive GWG was not associated with increased odds of delivering infants with LGA (aOR, 1.46; 95% CI: 0.54 – 3.95, P=0.46). There was no association between non-adequate gestational weight gain and preterm delivery or Caesarean delivery.
Conclusions
Less than half of persons with IBD have adequate GWG during pregnancy. Inadequate GWG was not associated with poor neonatal outcomes, and excessive GWG appeared to protect against delivering infants born SGA.
Funding Agencies
None
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Affiliation(s)
- D M Nguyen
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, ON, Canada
| | - P Tandon
- University of Toronto Department of Medicine, Toronto, ON, Canada
| | - V Govardhanam
- University of Toronto Department of Medicine, Toronto, ON, Canada
| | - Y Hanna
- University of Toronto Department of Medicine, Toronto, ON, Canada
| | - J J Tao
- University of Toronto Department of Medicine, Toronto, ON, Canada
| | - J Cepo
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics and Gynecology, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - V Huang
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, ON, Canada
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Tandon P, O’Connor K, Steinhart H, Deshpande A, Maxwell C, Huang V. A174 PERCEPTIONS OF CANNABIS USE IN WOMEN WITH INFLAMMATORY BOWEL DISEASE OF REPRODUCTIVE AGE: A CROSS-SECTIONAL STUDY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859278 DOI: 10.1093/jcag/gwab049.173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cannabis use in inflammatory bowel disease (IBD) may lead to improvement in pain and general health perception. However, its use during pregnancy may result in adverse outcomes such as preterm birth and altered fetal brain development. It remains unknown how women with IBD perceive Cannabis use during pregnancy and whether they discuss its use with their health-care providers.
Aims
To determine practices in, and perceptions of, cannabis use during pregnancy in women with IBD of reproductive age.
Methods
Women with IBD (age 18–45) were recruited at Mount Sinai Hospital and via social media platforms. Participants anonymously completed surveys on baseline demographics and IBD characteristics. They also completed a Cannabis questionnaire which asked about current use, perceived risks during pregnancy, and discussions with health-care providers. Categorical variables were reported as frequencies and compared using the chi-square test. Continuous variables were reported as medians and compared using the Mann-Whitney U test.
Results
Sixty-four women were included, 26 (40.6%) with ulcerative colitis, 37 (57.8%) with Crohn’s disease, and 1 (1.6%) with indeterminate colitis. Nineteen (29.7%) were preconception, 40 (62.5%) were pregnant, and 5 (7.8%) were post-partum. Eleven (18.0%) patients reported current Cannabis use, 4 (6.3%) during pregnancy. Cannabis users were more likely to have discussed its use with a health-care provider compared to non-users (45.5% vs. 5.7%, p<0.001) and had longer IBD duration (12.00 vs. 9.00 years, p=0.05). Twenty-five (42.4%) were unsure of the risks of Cannabis use in pregnancy, of which only two had discussed this with a health-care provider. Reasons for fear of Cannabis use included risk of fetal oxygen restriction (n=13, 20.3%), impact on brain development (n=29, 46.0%), and risk of fetal respiratory issues (n=18, 28.6%). Only eight (12.5%) patients reported having a conversation about Cannabis use during pregnancy with their health-care provider; all of whom felt its consumption was unsafe during pregnancy.
Conclusions
Many women with IBD report being unsure of risks of Cannabis use during pregnancy. With the legalization of Cannabis in Canada, it is imperative patients and health-care providers discuss the risks and benefits of its use, particularly during vulnerable times such as pregnancy.
Funding Agencies
None
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Affiliation(s)
- P Tandon
- University of Toronto, Woodbridge, ON, Canada
| | - K O’Connor
- University of Toronto, Woodbridge, ON, Canada
| | - H Steinhart
- University of Toronto, Woodbridge, ON, Canada
| | - A Deshpande
- University of Toronto, Woodbridge, ON, Canada
| | - C Maxwell
- University of Toronto, Woodbridge, ON, Canada
| | - V Huang
- University of Toronto, Woodbridge, ON, Canada
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Tandon P, O’Connor K, Maxwell C, Nguyen GC, Huang VW. A176 THE IMPACT OF COVID-19 ON ANXIETY, DEPRESSION, AND STRESS IN WOMEN WITH INFLAMMATORY BOWEL DISEASE: A CROSS-SECTIONAL SURVEY. J Can Assoc Gastroenterol 2021. [PMCID: PMC7958723 DOI: 10.1093/jcag/gwab002.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Women with inflammatory bowel disease (IBD) are at an increased risk of mental-health illness and reduced fertility.
Aims
To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental-health and pregnancy plans of women with IBD.
Methods
Women with IBD (age 18–45) were asked to anonymously complete surveys on baseline demographics, IBD characteristics, and mental health comorbidities. They were also asked to comment on prior symptoms consistent with COVID-19 and whether they were tested for the virus. Finally, patients were asked to complete three mental health surveys to reflect on anxiety (Generalized Anxiety Disorder-7 (GAD7)), depression (Patient Health Questionnaire-9 (PHQ9)), and stress (Perceived Stress Scale (PSS)) symptoms prior to and during the pandemic. Total scores were reported as continuous variables and means with standard deviations (SD) were compared using paired T-tests.
Results
Twenty-nine patients (12 UC, 17 CD) were included. 14 patients were preconception, 12 were pregnant, and 3 were post-partum. The mean age was 31.4 (SD 3.7). Fifteen of 29 (51.7%) of patients were on anti-tumor necrosis factor therapy. Twelve (41.4%) and 6 (20.7%) patients had pre-morbid anxiety and depression prior to the pandemic. COVID-19 symptoms were reported in 8 patients (27.5%). Six patients had undergone COVID-19 testing, all of whom had a negative test. Four patients indicated that COVID-19 had negatively affected their plans for pregnancy, with reasons reported including fear of the hospital (n=1), fear of COVID-19 impact on the fetus (n=2), and uncertainty on the duration of COVID-19 (n=1). During the pandemic, fourteen of 28 (50%) patients experienced symptoms of anxiety (GAD score > 5), with a majority (70%) experiencing mild symptoms (score 5–9). During the pandemic, 60.7% (17/28) and 71.4% (20/28) reported symptoms of depression (PHQ9 > 4) and at least moderate stress (PSS > 14) respectively. Furthermore, compared to pre-pandemic, 57.1% (16/28) and 67.9% (19/28) had an increase in depression and stress symptoms during the pandemic respectively. This appeared to only apply to those with CD, but not UC (Table 1). Compared to pre-pandemic, those with stricturing CD appeared to have higher stress scores whereas those with fistulizing and perianal disease appeared to have higher depression scores during the COVID-19 pandemic (Table 1). A lower house-hold income and a reduction in exercise during the COVID-19 pandemic appeared to increase the risk of stress, depression, and anxiety symptoms.
Conclusions
Over half of women with IBD indicate worsening of anxiety, depression, and stress symptoms during the COVID-19 pandemic. It remains critical that health-care professionals address these mental health concerns during these otherwise difficult times.
Funding Agencies
None
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Affiliation(s)
- P Tandon
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - K O’Connor
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - G C Nguyen
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - V W Huang
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Tandon P, Hanna Y, Cepo J, Maxwell C, Huang VW. A180 RISK FACTORS FOR INADEQUATE GESTATIONAL WEIGHT GAIN IN PREGNANT PATIENTS WITH INFLAMMATORY BOWEL DISEASES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.178] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with inflammatory bowel disease (IBD) are at a risk of inadequate gestational weight-gain (GWG) which in turn may increase the risk of adverse pregnancy outcomes.
Aims
To determine the risk factors for inadequate GWG in these patients and to determine the impact on adverse pregnancy outcomes.
Methods
Pregnant patients with IBD, both ulcerative colitis (UC) and Crohn’s disease (CD), were identified retrospectively at the Mount Sinai Hospital from 2016 to 2020. Total gestational weight-gain (GWG) was calculated as the difference of the weight recorded at time of labor and pre-pregnancy weight. GWG was further stratified into less than adequate, adequate, and more than adequate based on the pre-pregnancy body-mass index and standards set by the U.S. Institute of Medicine. Pregnancy-related outcomes were also recorded for each patient. Disease activity was recorded at each trimester visit and defined by a fecal calprotectin (FCP) > 250 ug/g. Differences in the mean GWG were compared using independent T-test with standard deviations (SD) whereas categorical variables were compared using the Chi-square (x2) test.
Results
71 pregnancies in 71 patients were included (33 UC and 38 CD). Thirteen patients (18.3%) had less than adequate, 23 (32.4%) adequate, and 35 (49.3%) more than adequate GWG. Of the 33 patients with UC, 4 (12.2%) had less than adequate, 15 (45.5%) had adequate, and 14 (42.4%) had more than adequate GWG. Of the 38 patients with CD, 9 (23.7%) had less than adequate, 8 (21.1%) had adequate, and 21 (55.3%) had more than adequate GWG (p=0.07) for CD vs. UC). In those with CD, both fistulizing and stricturing CD phenotypes appeared to be numerically associated with inadequate GWG. Specifically, none of the 13 patients with fistulizing CD had adequate GWG compared to 32.0% (8/25) in those without fistulizing disease (p=0.07). Similarly, only 2/22 (9.1%) of those with stricturing CD had adequate GWG compared to 6/16 (37.5%) in those without stricturing disease (p=0.07). Furthermore, of seven patients with active disease in the first trimester, only one had adequate GWG (14.3%) compared to 37.5% (3/8) of those in clinical remission (p=0.044). Active disease in trimesters two and three was not associated with inadequate GWG. Finally, the mean GWG was higher in those undergoing Cesarean (37.8 kg (SD 14.1) vs. 30.4 kg (SD 10.5), p=0.014)) and emergency Cesarean delivery (43.5 kg (SD 17.6) vs. 31.9 kg (SD 10.7) (p=0.004) compared to vaginal delivery respectively.
Conclusions
Patients with CD, but not UC, and those with active disease in the first trimester, are at risk of inadequate GWG during pregnancy. In those with larger GWG, a higher rate of emergency Cesarean birth was noted. Optimal intervention to achieve recommended gestational weight-gains in patients with IBD remains to be determined.
Funding Agencies
None
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Affiliation(s)
- P Tandon
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Y Hanna
- University of Toronto, Mississauga, ON, Canada
| | - J Cepo
- Registered Dietitian, Mount Sinai Hospital, Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada, Toronto, ON, Canada
| | - V W Huang
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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11
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Buffone E, Jogendran R, Broni E, O’Connor K, Panayotova K, Kennedy E, Steiman A, Maxwell C, Alavi A, Weizman AV, Huang VW. A105 RAPID INTERDISCIPLINARY IBD CLINIC RESULTS IN TIMELY IBD WAIT TIMES, IMPROVED PATIENT SATISFACTION & PATIENT REPORTED OUTCOMES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.103] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inflammatory Bowel Disease (IBD) patients often have disease flares and extraintestinal manifestations such as rashes, arthralgias & perianal fistulas that require timely assessments. We implemented a Rapid Interdisciplinary IBD program at Mount Sinai Hospital with expedited consultation by an IBD specialist and referral with clinical need to collaborative colorectal surgeon, dermatologist, rheumatologist, and/or high-risk obstetrician. The RAPID program includes an online IBD Dashboard for patients to respond to questionnaires which is closely monitored 90 days post-enrolment by the IBD nurse.
Aims
To assess the implementation of an Interdisciplinary IBD Clinic & online IBD Dashboard monitoring system on the ability to increase patient satisfaction regarding their IBD care.
Methods
Upon consent into the RAPID IBD program, patients are enrolled to the IBD Dashboard and complete a Patient Satisfaction (CACHE) questionnaire at baseline, 3, 6, 12 months follow up and clinical disease activity scores at baseline, 1, 2, 3 months post enrollment; the Modified Harvey Bradshaw Index (mHBI) for Crohn’s disease (CD); partial Mayo score and Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC) and IBD unclassified (IBDU) patients. Results were compared pre/post enrollment with changes in median and interquartile ranges (IQR).
Results
109 patients were referred to RAPID, 88 (49 CD, 33 UC, 6 IBDU) enrolled & 62 consented to IBD Dashboard monitoring. Of those enrolled, 40 patients were referred based on flaring of clinical scores, 23 with potential flare or complication, 17 with acute extraintestinal manifestations, 4 pregnant and 4 with perianal disease. Median 4 (2–7) days to first GI IBD clinic. 15 patients were referred to dermatology, 12 to colorectal surgery, 8 to rheumatology and 3 to obstetrics. 6 patients visited the ER within the first 90 days after enrollment, with 1 (1–2) ER visits. Patient satisfaction improved from baseline 73.5% (68.4%-77.4%) (n=53) to 82.3% (75.5% - 84.0%) at 3 months (n=28). Clinical responses were seen post enrollment with a decrease in mHBI of 3.0 at 2 months, 1.5 on the 6-point Mayo (SF + RB) at 1 & 3 months and patient defined significant improvement in SCCAI greater than 1.5 after 1 month.
Conclusions
Preliminary results with RAPID IBD program demonstrate a short time to be seen by an IBD specialist, improvement in patient satisfaction and clinical responses in mHBI, pMayo and SCCAI scores 1–3 months post enrollment.
Funding Agencies
AMO
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Affiliation(s)
- E Buffone
- Mount Sinai Hospital, Toronto, ON, Canada
| | | | - E Broni
- Mount Sinai Hospital, Toronto, ON, Canada
| | - K O’Connor
- Mount Sinai Hospital, Toronto, ON, Canada
| | | | - E Kennedy
- Mount Sinai Hospital, Toronto, ON, Canada
| | - A Steiman
- Mount Sinai Hospital, Toronto, ON, Canada
| | - C Maxwell
- Mount Sinai Hospital, Toronto, ON, Canada
| | - A Alavi
- Women’s College Hospital, Toronto, ON, Canada
| | | | - V W Huang
- Mount Sinai Hospital, Toronto, ON, Canada
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12
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D'Souza R, Ashraf R, Rowe H, Zipursky J, Clarfield L, Maxwell C, Arzola C, Lapinsky S, Paquette K, Murthy S, Cheng MP, Malhamé I. Pregnancy and COVID-19: pharmacologic considerations. Ultrasound Obstet Gynecol 2021; 57:195-203. [PMID: 32959455 PMCID: PMC7537532 DOI: 10.1002/uog.23116] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
In this review, we summarize evidence regarding the use of routine and investigational pharmacologic interventions for pregnant and lactating patients with coronavirus disease 2019 (COVID-19). Antenatal corticosteroids may be used routinely for fetal lung maturation between 24 and 34 weeks' gestation, but decisions in those with critical illness and those < 24 or > 34 weeks' gestation should be made on a case-by-case basis. Magnesium sulfate may be used for seizure prophylaxis and fetal neuroprotection, albeit cautiously in those with hypoxia and renal compromise. There are no contraindications to using low-dose aspirin to prevent placenta-mediated pregnancy complications when indicated. An algorithm for thromboprophylaxis in pregnant patients with COVID-19 is presented, which considers disease severity, timing of delivery in relation to disease onset, inpatient vs outpatient status, underlying comorbidities and contraindications to the use of anticoagulation. Nitrous oxide may be administered for labor analgesia while using appropriate personal protective equipment. Intravenous remifentanil patient-controlled analgesia should be used with caution in patients with respiratory depression. Liberal use of neuraxial labor analgesia may reduce the need for emergency general anesthesia which results in aerosolization. Short courses of non-steroidal anti-inflammatory drugs can be administered for postpartum analgesia, but opioids should be used with caution due to the risk of respiratory depression. For mechanically ventilated pregnant patients, neuromuscular blockade should be used for the shortest duration possible and reversal agents should be available on hand if delivery is imminent. To date, dexamethasone is the only proven and recommended experimental treatment for pregnant patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen. Although hydroxycholoroquine, lopinavir/ritonavir and remdesivir may be used during pregnancy and lactation within the context of clinical trials, data from non-pregnant populations have not shown benefit. The role of monoclonal antibodies (tocilizumab), immunomodulators (tacrolimus), interferon, inhaled nitric oxide and convalescent plasma in pregnancy and lactation needs further evaluation. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R. D'Souza
- Division of Maternal‐Fetal Medicine, Department of Obstetrics & GynaecologyMount Sinai Hospital, University of TorontoTorontoCanada
- Lunenfeld‐Tanenbaum Research InstituteTorontoCanada
| | - R. Ashraf
- Division of Maternal‐Fetal Medicine, Department of Obstetrics & GynaecologyMount Sinai Hospital, University of TorontoTorontoCanada
| | - H. Rowe
- Neonatal and Pediatric PharmacySurrey Memorial Hospital, Fraser HealthSurreyCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
| | - J. Zipursky
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
- Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
| | - L. Clarfield
- Faculty of MedicineUniversity of TorontoTorontoCanada
| | - C. Maxwell
- Division of Maternal‐Fetal Medicine, Department of Obstetrics & GynaecologyMount Sinai Hospital, University of TorontoTorontoCanada
| | - C. Arzola
- Department of Anesthesiology and Pain MedicineMount Sinai Hospital, University of TorontoTorontoCanada
| | - S. Lapinsky
- Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
| | - K. Paquette
- Division of NeonatologyMontreal Children's HospitalMontrealCanada
- Department of PediatricsMcGill UniversityMontrealCanada
- Research Institute of the McGill University Health CentreMontrealCanada
| | - S. Murthy
- Division of Critical Care, Department of PaediatricsUniversity of British ColumbiaVancouverCanada
- BC Children's Hospital and Sunny Hill Health CentreVancouverBCCanada
| | - M. P. Cheng
- Research Institute of the McGill University Health CentreMontrealCanada
- Divisions of Infectious Diseases and Medical Microbiology, Department of Medicine, McGill University Health CentreMcGill UniversityMontrealCanada
- McGill Interdisciplinary Initiative in Infection and ImmunityMontrealCanada
| | - I. Malhamé
- Research Institute of the McGill University Health CentreMontrealCanada
- Division of General Internal Medicine, Department of Medicine, McGill University Health CentreMcGill UniversityMontrealCanada
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Peska E, Balki M, Maxwell C, Ye XY, Downey K, Carvalho JCA. Oxytocin at elective caesarean delivery: a dose-finding study in women with obesity. Anaesthesia 2020; 76:918-923. [PMID: 33227150 DOI: 10.1111/anae.15322] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Prophylactic oxytocin administration at the third stage of labour reduces blood loss and the need for additional uterotonic drugs. Obesity is known to be associated with an increased risk of uterine atony and postpartum haemorrhage. It is unknown whether women with obesity require higher doses of oxytocin in order to achieve adequate uterine tone after delivery. The purpose of this study was to establish the bolus dose of oxytocin required to initiate effective uterine contraction in 90% of women with obesity (the ED90 ) at elective caesarean delivery. We conducted a double-blind dose-finding study using the biased coin up-down design method. Term pregnant women with a BMI ≥ 40 kg.m-2 undergoing elective caesarean delivery under regional anaesthesia were included. Those with conditions predisposing to postpartum haemorrhage were not included. Oxytocin was administered as an intravenous bolus over 1 minute upon delivery of the fetus. With the first woman receiving 0.5 IU, oxytocin doses were administered according to a sequential allocation scheme. The primary outcome measure was satisfactory uterine tone, as assessed by the operating obstetrician 2 minutes after administration of the oxytocin bolus. Secondary outcomes included the need for rescue uterotonic drugs, adverse effects and estimated blood loss. We studied 30 women with a mean (SD) BMI of 52.3 (7.6) kg.m-2 . The ED90 for oxytocin was 0.75 IU (95%CI 0.5-0.93 IU) by isotonic regression and 0.78 IU (95%CI 0.68-0.88 IU) by the Dixon and Mood method. Our results suggest that women with a BMI ≥ 40 kg.m-2 require approximately twice as much oxytocin as those with a BMI < 40 kg.m-2 , in whom an ED90 of 0.35 IU (95%CI 0.15-0.52 IU) has previously been demonstrated.
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Affiliation(s)
- E Peska
- Department of Anaesthesia, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - M Balki
- Department of Anaesthesia, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada.,Department of Anaesthesiology and Pain Medicine and Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada
| | - X Y Ye
- Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - K Downey
- Department of Anaesthesia, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - J C A Carvalho
- Department of Anaesthesia, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada.,Department of Anaesthesiology and Pain Medicine and Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada
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14
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Kim D, Maxwell C, Chiu T, Rahimi A, Johns C, Schroeder S, Gu X, Zhao B. Safety and Accuracy of Active Breathing Coordinator Assisted Deep Inspiration Breathhold Technique in Delivery of Radiation Therapy for Locally Advanced Breast Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Tzadikevitch-Geffen K, Melamed N, Aviram A, Sprague AE, Maxwell C, Barrett J, Mei-Dan E. Neonatal outcome by planned mode of delivery in women with a body mass index of 35 or more: a retrospective cohort study. BJOG 2020; 128:900-906. [PMID: 32790132 DOI: 10.1111/1471-0528.16467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare neonatal outcomes of women with a body mass index (BMI) of ≥35 kg/m2 who underwent a trial of labour with those of women who underwent a planned primary caesarean section (CS). DESIGN A retrospective cohort study of births between April 2012 and March 2014. SETTING A provincial database: Better Outcomes Registry & Network (BORN) Ontario, Canada. POPULATION A cohort of 8752 women with a BMI of ≥35 kg/m2 who had a singleton birth at 38-42 weeks of gestation. METHODS Neonatal outcomes were compared between women who underwent a trial of labour (with either a successful vaginal birth or intrapartum CS) and those who underwent a planned CS. MAIN OUTCOME MEASURE A composite of any of the following outcomes: intrapartum neonatal death, neonatal intensive care unit admission, 5-minute Apgar score of <7 or umbilical artery pH of <7.1. RESULTS During the study period, 8433 (96.4%) women had a trial of labour and 319 (3.6%) had a planned CS. Intrapartum CS was performed in 1644 (19.5%) cases. There was no association between planned mode of delivery and the primary outcome (aOR 0.80, 95% CI 0.59-1.07). The primary outcome was lower among women who had a successful trial of labour (aOR 0.67, 95% CI 0.50-0.91) and was higher among women who had a failed trial of labour (aOR 1.74, 95% CI 1.21-2.48), compared with women who underwent a planned CS. CONCLUSIONS In women with a BMI of ≥35 kg/m2 at a gestational age of 38-42 weeks, neonatal outcomes are comparable between planned vaginal delivery and planned CS, although a failed trial of labour is at risk of adverse neonatal outcome. TWEETABLE ABSTRACT Neonatal outcomes are not affected by planned mode of delivery in women who are obese, with a BMI of ≥35 kg/m2 .
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Affiliation(s)
- K Tzadikevitch-Geffen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - A Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - A E Sprague
- Better Outcomes Registry & Network Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - C Maxwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jfr Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - E Mei-Dan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
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16
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Leung K, Tandon P, Govardhanam V, Maxwell C, Huang V. A220 A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RISK OF ADVERSE NEONATAL OUTCOME IN INFLAMMATORY BOWEL DISEASE AND PREGNANCY. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.219] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) often affects women in their child-bearing years. These women may be at an increased risk of adverse neonatal outcomes.
Aims
The aim of this study was to evaluate the risk of these outcomes in this population of patients, with an emphasis of determining risk factors for development of these conditions.
Methods
Medline, Embase, and Cochrane library were searched through to May 2019 for studies reporting adverse neonatal outcomes in IBD patients. Weighted odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the risk of these outcomes in patients with IBD compared to healthy controls, with risk factors such as disease activity and medication exposure also being assessed.
Results
Sixty studies were included (8194 pregnancies with inflammatory bowel disease and 3253 healthy pregnancies). Compared to healthy controls, patients with inflammatory bowel disease were more likely to deliver infants with low birth weight (LBW) (OR 2.78, 95% CI 1.16–6.66) and infants who were admitted to the neonatal intensive care unit (NICU) (OR 3.33, 95% CI 1.83–6.05). Patients with Crohn’s disease had an increased risk of infants born with congenital anomalies (OR 3.03, 95% CI, 1.43–6.42), whereas patients with ulcerative colitis had an increased risk of preterm delivery (OR 2.68, 95% CI, 1.12–6.43). Active disease increased the risk of preterm birth (OR 2.06, 95% CI 1.21–3.51), LBW (OR 2.96, 95% CI 1.54–5.70), and small for gestation age (OR 2.62, 95% CI 1.18–5.83) compared to disease in remission. Tumor necrosis factor antagonists was associated with increased risk of NICU admission (OR 2.42, 95% CI 1.31–4.45) and LBW (OR 1.54, 95% CI, 1.01–2.35).
Conclusions
Patients with inflammatory bowel disease are at an increased risk of developing adverse neonatal outcomes such as preterm birth, LBW, congenital anomalies, and NICU admissions. Patients with clinically active disease and those exposed to anti-TNF therapy may be at higher risk of developing these adverse outcomes. The findings of this study are important to communicate to patients and healthcare providers alike. Furthermore, this information may help to mitigate these risks through collaborative specialized care during pregnancy in order to reduce the overall morbidity and mortality for both mother and baby.
Funding Agencies
None
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Affiliation(s)
- K Leung
- University of Toronto, Toronto, ON, Canada
| | - P Tandon
- University of Toronto, Toronto, ON, Canada
| | | | - C Maxwell
- University of Toronto, Toronto, ON, Canada
| | - V Huang
- University of Toronto, Toronto, ON, Canada
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Govardhanam V, Tandon P, Leung K, Maxwell C, Huang V. A250 SYSTEMATIC REVIEW WITH META-ANALYSIS: ADVERSE PREGNANCY-RELATED OUTCOMES WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) is a chronic inflammatory condition. While it is reported that IBD may result in adverse pregnancy-related outcomes, its effects on placental related diseases are relatively not known.
Aims
The aim of our work was to determine the risk of adverse pregnancy outcomes in patients with IBD.
Methods
Medline, Embase, and Cochrane library were searched for studies that reported adverse maternal and obstetrical outcomes in patients with IBD. Weighted odds ratios (OR) with 95% confidence intervals (CI) were calculated for the risk of these outcomes in patients with IBD compared to healthy controls.
Results
Fifty-three studies were included (7917 patients with IBD and 3253 healthy controls). Cesarean delivery was more common in patients with IBD compared to healthy controls (OR 1.79, 95% CI, 1.16–2.77). This remained significant for UC (OR 1.80, 95% CI, 1.21–2.90) but not CD (OR 1.48, 95% CI, 0.94–2.34). Similarly, gestational diabetes occurred more commonly in IBD (OR 2.96, 95% CI, 1.47–5.98). Furthermore, the incidences of placental diseases were low, 2.0% (95% CI, 0.9–3.1%) for pre-eclampsia, 3.3% (95% CI, 0–7.2%) for placental abruption, 0.5% (95% CI, 0.2–0.9%) for placenta previa, and 0.3% (95% CI, 0–0.5%) for chorioamnionitis. Finally, patients with IBD were more likely to experience preterm premature rupture of membranes (PPROM, OR 12.10, 95% CI, 2.15–67.98), but not an early pregnancy loss (OR 1.63, 95% CI 0.49–5.43). Anti-tumour necrosis factor therapy was not associated with chorioamnionitis (OR 1.12, 95% CI, 0.16–7.67), early pregnancy loss (OR 1.49, 95% CI, 0.83- 2.64), and placenta previa (OR 1.58, 95% CI, 0.30–8.47).
Conclusions
Patients with IBD are more likely to develop adverse pregnancy-related outcomes such as Gestational Diabetes and PPROM. Pregnancy in patients with IBD should be considered a high-risk period and as such, a multi-disciplinary team, including gastroenterologists, obstetricians and maternal-fetal medicine specialists, is necessary to recognize and effectively manage adverse obstetrical outcomes in order to reduce overall morbidity and mortality.
Funding Agencies
None
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Affiliation(s)
| | - P Tandon
- University of Toronto, Woodbridge, ON, Canada
| | - K Leung
- Internal Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - C Maxwell
- University of Toronto, Woodbridge, ON, Canada
| | - V Huang
- University of Toronto, Woodbridge, ON, Canada
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18
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Andrew MK, Dupuis-Blanchard S, Maxwell C, Giguere A, Keefe J, Rockwood K, St John P. Social and societal implications of frailty, including impact on Canadian healthcare systems. J Frailty Aging 2019; 7:217-223. [PMID: 30298169 DOI: 10.14283/jfa.2018.30] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Frailty has many social and societal implications. Social circumstances are key both as contributors to frail older adults' health outcomes and as practical facilitators or barriers to intervention and supports. Frailty also has important societal implications for health systems and social care policy. In this discussion paper, we use a social ecology framework to consider the social and societal implications and impact of frailty at each level, from the individual, through relationships with family and friend caregivers, institutions, health systems, neighborhoods and communities, to society at large. We conclude by arguing that attention to these issues at a policy level is critical. We identify three target actions: 1) Social dimensions of frailty should be systematically considered when frailty is assessed. 2) Action is needed at the level of policies and programs to improve support for caregivers. 3) Policy review across all portfolios will benefit from a social frailty lens.
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Affiliation(s)
- M K Andrew
- Melissa K Andrew, Division of Geriatric Medicine, Dalhousie University, Veterans' Memorial Building, 5155 Veterans' Memorial Lane, Halifax NS, B3H 2E1, , phone: (902) 473-4995, fax: (902) 473-1050
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Herrick R, McEvers T, Maxwell C, Lawrence T. 482 Association of cattle nutritional and management conditions to liver abscess incidence. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.590] [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: 11/14/2022] Open
Affiliation(s)
- R Herrick
- Beef Carcass Research Center/West Texas A&M University,Canyon, TX, United States
| | - T McEvers
- Dean Cluck Feedyard,Canyon, TX, United States
| | - C Maxwell
- Elanco Animal Health,Canyon, Texas, United States
| | - T Lawrence
- Beef Carcass Research Center/West Texas A&M University,Canyon, TX, United States
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Knapp J, Tsai T, Maxwell C, Apple J, Chewning J. PSIV-4 The effect of peptide product and ZnO on growth performance in nursery pigs fed different levels of crude protein diets. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.715] [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: 11/12/2022] Open
Affiliation(s)
- J Knapp
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Wichita, KS, United States
| | - T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - C Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - J Apple
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - J Chewning
- Swine Research Services, Inc.,Springdale, AR, United States
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Wang X, Tsai T, Chewning J, Maxwell C. PSI-8 Characterizing biological functions of Lactobacillus brevis 1E1 in porcine jejunal epithelial cell line (IPEC-J2). J Anim Sci 2018. [DOI: 10.1093/jas/sky404.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- X Wang
- University of Arkansas,Fayetteville, AR, United States
| | - T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, AR, United States
| | - J Chewning
- Swine Research Services, Inc.,Springdale, AR, Springdale, AR, United States
| | - C Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, AR, United States
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Herrick R, Rogers C, Jones T, McEvers T, Brown T, Maxwell C, Lawrence T. 481 Association of liver abscess presence and severity with trim loss, harvest yield, carcass grading performance, lung lesions, and value of fed Holsteins. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Herrick
- Beef Carcass Research Center/West Texas A&M University,Canyon, TX, United States
| | - C Rogers
- West Texas A&M University,Canyon, TX, United States
| | - T Jones
- West Texas A&M University,Canyon, TX, United States
| | - T McEvers
- Dean Cluck Feedyard,Canyon, TX, United States
| | - T Brown
- Cargill Meat Solutions,Canyon, TX, United States
| | - C Maxwell
- Elanco Animal Health,Canyon, Texas, United States
| | - T Lawrence
- Beef Carcass Research Center/West Texas A&M University,Canyon, TX, United States
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Wei X, Tsai T, Maxwell C, Zhao J. PSXII-42 Peptide product (FPM), zinc oxide and lactobacillus acidophilus fermented product (LAFP) alter gut microbiota of nursery pigs. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- X Wei
- University of Arkansas,Fayetteville, AR, United States
| | - T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - C Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - J Zhao
- University of Arkansas,Fayetteville, AR, United States
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Herrick R, Rogers C, McEvers T, Amachawadi R, Nagaraja T, Maxwell C, Lawrence T. 484 Exploratory observational quantification of liver abscess incidence, specific to region and cattle type, and their associations to viscera value and bacterial flora. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Herrick
- Beef Carcass Research Center/West Texas A&M University,Canyon, TX, United States
| | - C Rogers
- West Texas A&M University,Canyon, TX, United States
| | - T McEvers
- Dean Cluck Feedyard,Canyon, TX, United States
| | - R Amachawadi
- Kansas State University College of Veterinary Science,Manhattan, KS, United States
| | - T Nagaraja
- Kansas State University,Manhattan, KS, United States
| | - C Maxwell
- Elanco Animal Health,Canyon, TX, United States
| | - T Lawrence
- Beef Carcass Research Center/West Texas A&M University,Canyon, TX, United States
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Wang J, Dietrich M, Bell S, Maxwell C, Simmons S, Kripalani S. CHANGE IN VULNERABILITY AMONG OLDER CARDIAC ADULTS AFTER HOSPITAL DISCHARGE: ROLE OF POST-ACUTE HOME HEALTH. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2864] [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: 11/12/2022] Open
Affiliation(s)
| | | | - S Bell
- Department of Medicine, Vanderbilt University Medical Center
| | - C Maxwell
- Vanderbilt University, School of Nursing
| | - S Simmons
- Center for Quality Aging, Vanderbilt University Medical Center
| | - S Kripalani
- Department of Medicine, Vanderbilt University Medical Center
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Affiliation(s)
- C Pickering
- University of Texas Health Science Center San Antonio
| | | | - C Maxwell
- Michigan State University, School of Criminal Justice
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Liu S, Nolan M, Aghel N, Belford L, Silversides C, Hines M, Thompson K, Amir E, Maxwell C, Thavendiranathan P. CARDIAC OUTCOMES IN PREGNANT WOMEN WITH TREATED CANCER. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.356] [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: 11/26/2022] Open
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Maxwell C, Pike K, Friesen C. Sports Nutrition Knowledge, Perceptions, Resources, and Advice Given by Certified CrossFit Trainers. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pickering C, Maxwell C. RECRUITMENT, RETENTION AND DATA COLLECTION WITH VICTIMS OF ELDER ABUSE IDENTIFIED FROM POLICE REPORTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C.Z. Pickering
- School of Nursing, University of Texas Health Science Center San Antonio, San Antonio, Texas,
| | - C. Maxwell
- School of Criminal Justice, Michigan State University, East Lansing, Michigan
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Maxwell C, Dietrich M, Miller R. PHYSICAL FRAITY AND ONE-YEAR READMISSIONS AMONG GERIATRIC TRAUMA PATIENTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C. Maxwell
- Vanderbilt University School Of Nursing,
Nashville, Tennessee,
| | - M.S. Dietrich
- Vanderbilt University School Of Nursing,
Nashville, Tennessee,
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Ellman R, Maxwell C, Finch R, Shayo D. Malaria and anaemia at different altitudes in the Muheza district of Tanzania: childhood morbidity in relation to level of exposure to infection. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1998.11813336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Paterson N, Sharma AM, Maxwell C, Greenblatt EM. Obesity-related health status is a better predictor of pregnancy with fertility treatment than body mass index: a prospective study. Clin Obes 2016; 6:243-8. [PMID: 27242175 DOI: 10.1111/cob.12149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/19/2016] [Accepted: 04/22/2016] [Indexed: 11/29/2022]
Abstract
This study assessed whether an obesity-related health status instrument (Edmonton obesity scoring system - EOSS) or body mass index (BMI) better predicted pregnancy rates in overweight women undergoing fertility treatments. A prospective cohort study was conducted on patients with a BMI ≥ 25 kg m(-2) undergoing a fertility treatment cycle (ovulation induction, superovulation, or in vitro fertilization). Obesity-related health status including blood pressure, blood work, health history, and functional assessment were assessed. A total of 101 patients were included in the study with an average age of 36.3 ± 4.2 years and a mean BMI of 31.8 ± 5.2 kg m(-2) . EOSS was found to be statistically predictive of pregnancy rate/cycle (OR 0.51, 95% CI 0.27-0.94; P = 0.03), whereas BMI was not (OR 0.95, 95% CI 0.86-1.05). A similar trend was seen for clinical pregnancy rate/cycle started. However, the association between clinical pregnancy rates and EOSS or BMI did not reach statistical significance (OR 0.53, P = 0.06 and OR 0.98, P = 0.62 respectively). Our results demonstrated that EOSS better predicted pregnancy rates after fertility treatments than BMI. In fact, for every EOSS stage increased by one unit, the odds of pregnancy were approximately halved. A multi-centre study powered for live birth is warranted to establish effective pre-fertility management of overweight women.
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Affiliation(s)
- N Paterson
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
| | - A M Sharma
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - C Maxwell
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
| | - E M Greenblatt
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
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Maxwell C, McDonald S, Mei-Dan E, Murphy K, Jose C, Asztalos E, Melamed N, Barrett J. W-OBS-MFM-MD-118 Mode of Delivery in Women with Extreme Obesity: Planned Vaginal Delivery Compared with Planned Caesarean Section. Journal of Obstetrics and Gynaecology Canada 2016. [DOI: 10.1016/j.jogc.2016.04.046] [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: 11/26/2022]
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34
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Eichorn D, Lesenskyj A, Maxwell C, Moore S, Cruciani R. (195) The feasibility and value of using the SOAPP®-R to predict substance abuse in an outpatient pain clinic. The Journal of Pain 2016. [DOI: 10.1016/j.jpain.2016.01.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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35
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Cook D, Apple J, Maxwell C, Bassinger K, Young A, Johnson T, Kim H, Tsai T. Effects of crystalline amino acid supplementation of reduced crude protein (RCP) diet on net energy basis on Longissimus muscle (LM) quality of growing-finishing swine. Meat Sci 2015. [DOI: 10.1016/j.meatsci.2014.09.056] [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: 11/25/2022]
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36
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Kapadia MZ, Park CK, Beyene J, Giglia L, Maxwell C, McDonald SD. Can we safely recommend gestational weight gain below the 2009 guidelines in obese women? A systematic review and meta-analysis. Obes Rev 2015; 16:189-206. [PMID: 25598037 DOI: 10.1111/obr.12238] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 12/24/2022]
Abstract
A systematic review was conducted to determine the risk of adverse pregnancy outcomes with gestational weight gain (GWG) below the 2009 Institute of Medicine guidelines compared with within the guidelines in obese women. MEDLINE, Embase, Cochrane Register, CINHAL and Web of Science were searched from 1 January 2009 to 31 July 2014. Quality was assessed using a modified Newcastle-Ottawa scale. Three primary outcomes were included: preterm birth, small for gestational age (SGA) and large for gestational age (LGA). Eighteen cohort studies were included. GWG below the guidelines had higher odds of preterm birth (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.07-2.00) and SGA (AOR 1.24; 95% CI 1.13-1.36) and lower odds of LGA (AOR 0.77; 95% CI 0.73-0.81) than GWG within the guidelines. Across the three obesity classes, the odds of SGA and LGA did not show any notable gradient and remained unexplored for preterm birth. Decreased odds were noted for macrosomia (AOR 0.64; 95% CI 0.54-0.77), gestational hypertension (AOR, 0.70; 95% CI 0.53-0.93), pre-eclampsia (AOR 0.90; 95% CI 0.82-0.99) and caesarean (AOR 0.87; 95% CI 0.82-0.92). GWG below the guidelines cannot be routinely recommended but might occasionally be individualized for certain women, with caution, taking into account other known risk factors.
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Affiliation(s)
- M Z Kapadia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
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Marshall D, Vanderby S, Carter M, Wasylak T, Mosher DP, Noseworthy T, Maxwell C, MacDonald K, Frank C. What Could the Future Hold? Simulating the Demand for Osteoarthritis (oa) Care in Alberta to Plan a Sustainable Oa Care System. Value Health 2014; 17:A389. [PMID: 27200891 DOI: 10.1016/j.jval.2014.08.2664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- D Marshall
- University of Calgary, Calgary, AB, Canada
| | - S Vanderby
- University of Saskatchewan, Saskatoon, SK, Canada
| | - M Carter
- University of Toronto, Toronto, ON, Canada
| | - T Wasylak
- Alberta Health Services, Calgary, AB, Canada
| | - D P Mosher
- University of Calgary, Calgary, AB, Canada
| | - T Noseworthy
- University of Calgary, Alberta Health Services, Calgary, AB, Canada
| | - C Maxwell
- University of Waterloo, Waterloo, ON, Canada
| | | | - C Frank
- Alberta Innovates Health Solutions, Calgary, AB, Canada
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Baumbach H, Naskou J, Yang Y, Niederacher D, Maxwell C, Fehm T, Fleisch M, Honisch E, Mei Q. BRCA1-abhängige Expression des „Receptor for Hyaluron Mediated Motility“ (RHAMM) in Mammakarzinomen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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39
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Ponce CH, Brown MS, Osterstock JB, Cole NA, Lawrence TE, Soto-Navarro S, MacDonald J, Lambert BD, Maxwell C. Effects of wet corn distillers grains with solubles on visceral organ mass, trace mineral status, and polioencephalomalacia biomarkers of individually-fed cattle. J Anim Sci 2014; 92:4034-46. [PMID: 25023807 DOI: 10.2527/jas.2014-7695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Twenty-four steers (initial BW = 385 ± 1.1 kg) were blocked by BW and randomly assigned to 3 dietary treatments (0, 30, or 60% wet distillers grains with solubles [WDGS]; DM basis) and were fed individually to determine the effect of WDGS on live growth and carcass performance, visceral organ mass, trace mineral status, and polioencephalomalacia biomarkers. Steers were slaughtered at 125, 150, 164, and 192 d (2 blocks/slaughter date) when external fat depth was approximately 1.3 cm based on visual appraisal. Steers fed 30% WDGS had greater DMI than those fed 0 or 60% WDGS (P < 0.05), and steers fed 60% WDGS had the lowest carcass-adjusted ADG (P < 0.09) of the 3 treatments. Nonetheless, WDGS concentration did not alter feed efficiency (P > 0.41) on either live or carcass-adjusted basis. Steers fed 30% WDGS had greater liver S and Mn concentrations (DM basis) and lower liver Fe concentrations than control steers (P < 0.10; initial values used as a covariate), and feeding 60% WDGS decreased liver Cu and increased liver Fe (P < 0.10) compared with feeding 30% WDGS. Cytochrome c oxidase (COX) activity in brain tissue tended to be decreased with 60 vs. 30% WDGS (P = 0.12), and COX activity decreased linearly (P = 0.06) in lung tissue as dietary WDGS concentration increased. Likewise, gut fill linearly increased (P = 0.01) with increasing WDGS concentration. Feeding 30% WDGS increased fractional mass (g/kg of empty BW) of the small intestine (P < 0.10) compared with controls, whereas 60% WDGS increased fractional kidney mass (P < 0.10) compared with 30% WDGS. Overall, results suggest that gut fill, Cu status, and COX activity seem to be compromised by WDGS when fed at 60% of diet DM in diets based on steam-flaked corn, which suggests a greater susceptibility to polioencephalomalacia.
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Affiliation(s)
- C H Ponce
- West Texas A&M University, Canyon, TX
| | - M S Brown
- West Texas A&M University, Canyon, TX
| | | | | | | | | | - J MacDonald
- Department of Animal Sciences, Tarleton State University, Stephenville, TX
| | | | - C Maxwell
- West Texas A&M University, Canyon, TX
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Al-Obaidly S, Parrish J, Murphy KE, Maxwell C. Maternal pre-gravid body mass index and obstetric outcomes in twin gestations. J Perinatol 2014; 34:425-8. [PMID: 24603456 DOI: 10.1038/jp.2014.29] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/27/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the impact of maternal pre-gravid and/or first trimester overweight and obesity, and the adverse obstetrics outcome in twin pregnancies. STUDY DESIGN This is a retrospective study of women who delivered viable twins after 23 weeks of gestation with available prepregnancy body mass index (BMI) and/or were at their earliest visit during the first trimester of pregnancy in the period 2007-2011. The patients were divided into four subgroups according to their BMI (underweight, normal weight, overweight and obese) according to the WHO classification and their outcomes were compared. Obstetrical outcomes of interest including gestational diabetes, gestational hypertension, preterm birth, antepartum hemorrhage, intrahepatic cholestasis of pregnancy, method of delivery and neonatal intensive care unit (NICU) admission were all studied and compared. RESULT Electronic records of 1228 pregnant subjects who delivered twins were abstracted. Five hundred and four patients with twin gestations with available BMI were identified (underweight BMI<18.5% (n=22), normal weight BMI 18.5-24.9% (n=260), overweight 25-29.9% (n=114) and obese ⩾30% (n=108)). Obstetric complications occurred more often in the overweight and obese groups as compared with the normal weight group. There was an increased risk of gestational diabetes in overweight and obese women (odds ratio (OR), 3.3; 95% confidence interval (CI) 1.52-7.3; P=0.001) and (OR, 3.2; 95% CI, 1.41-7.1; P=0.002), respectively. There was an increased risk of gestational hypertension in the obese group compared with the normal weight group (OR, 2.29; 95% CI, 1.1-4.7; P=0.02) but not in the overweight group (OR, 1.71; 95% CI, 0.8-3.6; P=0.1). In addition, an increased risk of very preterm delivery (<32 weeks) in the overweight group and obese groups was seen when compared with the normal weight group (OR, 2.2; 95% CI, 1.18-4.20; P=0.014 and OR, 2; 95% CI, 1.024-3.91; P=0.04, respectively). Increased rate of cesarean section in the obese group was seen when compared with the normal weight group (OR, 2; 95% CI, 1.2-3.4; P=0.006). Risks of antepartum hemorrhage, intrahepatic cholestasis and NICU admission were similar between the groups. CONCLUSION In addition to the known obstetrics complications associated with twin gestations, the pregnancy outcomes in twins are further adversely influenced by increased maternal prepregnancy BMI.
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Affiliation(s)
- S Al-Obaidly
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - J Parrish
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - K E Murphy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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Bass B, Perez V, Yang H, Tsai T, Holzgraefe D, Chewning J, Maxwell C. Impact of Pichia guilliermondii on sow, litter, and weaned pig immune performance. J Anim Sci 2013; 90 Suppl 4:445-7. [PMID: 23365405 DOI: 10.2527/jas.53982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Three groups of gestating gilts and sows (Exp. 1; n = 98) were used to determine the effects of Pichia guilliermondii (Pg), a whole yeast product (CitriStim, ADM Alliance Nutrition), on dam and litter immune parameters. At breeding, gilts and sows were allotted to 1 of 3 treatments maintained through lactation: sow control (SC) diet or SC supplemented with 0.1 (S1) or 0.2% (S2) Pg. Pigs from groups 1 (Exp. 2) and 2 (Exp. 3) were weaned (21 d) and allotted in a 3 (SC, S1, or S2) × 2 [nursery with Pg (NPg) or without Pg (NC)] factorial arrangement in a randomized complete block design. In Exp. 2 blood samples were collected on days 5 and 28 postweaning for analysis. In Exp. 3, 36 pigs were individually penned and challenged with lipopolysaccharide (25 μg/kg BW intramuscular; 0 h). Individual BW, ADFI, and rectal temperature (RT) were collected at -48, -24, 0, 24, and 48 h and blood samples were collected at 0, 5, and 24 h for analysis. In Exp. 1, total neutrophil count (NEU) and neutrophil:lymphocyte ratio (NLR) were greater on day 110 of gestation (P < 0.05) in S1 than SC. At weaning there was a liner increase (P < 0.05) in NEU, NLR, and percentage of total leukocytes (PTL) that were NEU as level of Pg increased in sow diets. In Exp. 2, pigs from S1 had increased (P < 0.05) overall IgG than SC. The PTL that were eosinophils was greater in pigs from S2 fed NPg on day 5 than NC (P < 0.05) and increased in all pigs from S2 on day 28 (sow linear, P < 0.1). On day 28, total leukocytes and eosinophils were increased in pigs from SC [quadratic response (Q), P < 0.05]. In Exp. 3, a linear increase (P < 0.05) in ADFI was observed at -24 to 0 h, -48 to 0 h, and 24 to 48 h as the level of Pg increased in sow diets. There was a linear increase in RT at -48, -24, 0, and 5 h with increasing Pg inclusion in sow diets (P < 0.05). However, RT decreased more from 5 to 24 h in pigs from sows receiving Pg. The number of monocytes and PTL that were monocytes were higher in S2 compared to SC and S1 (P < 0.05). Also, NEU were reduced at 5 h in S1 (P < 0.05), NLR was lower in S2 at 0 h and S1 at 5 h, IL-1β concentration was greater in SC at 0 h and S1 at 5 h, and IL-6 concentration was greater in S2 at 0 h and S1 at 5 h (P < 0.05). Furthermore, blood urea N (BUN) was higher in NC at 0 and 5 h than NPg (P < 0.05). In conclusion, Pg appears to impact immune response criteria of sows and weaned pigs.
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Affiliation(s)
- B Bass
- University of Arkansas, Fayetteville, AR, USA
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Khatua S, Brown R, Pearlman M, Vats T, Satge D, Stiller C, Rutkowski S, von Bueren AO, Lacour B, Sommelet D, Nishi M, Massimino M, Garre ML, Moreno F, Hasle H, Jakab Z, Greenberg M, von der Weid N, Kuehni C, Zurriaga O, Vicente ML, Peris-Bonet R, Benesch M, Vekemans M, Sullivan S, Rickert C, Fisher PG, Von Behren J, Nelson DO, Reynolds P, Fukuoka K, Yanagisawa T, Suzuki T, Koga T, Wakiya K, Adachi JI, Mishima K, Fujimaki T, Matsutani M, Nishikawa R, Gidding C, Schieving J, Wesseling P, Ligtenberg M, Hoogerbrugge N, Jongmans M, Crosier S, Nicholson SL, Robson K, Jacques T, Wharton S, Bown N, Michalski A, Pizer B, Clifford S, Sanden E, Visse E, Siesjo P, Darabi A, Nousome D, Lupo PJ, Scheurer ME, Nulman I, Barrera M, Maxwell C, Koren G, Gorelyshev S, Matuev K, Lubnin A, Laskov M, Lemeneva N, Mazerkina N, Khuhlaeva E, Muller K, Bruns F, Pietsch T, Rutkowski S, Kortmann RD, Krishnatry R, Shirsat N, Kunder R, Epari S, Gupta T, Kurkure P, Vora T, Arora B, Moiyadi A, Jalali R, Swieszkowska E, Dembowska-Baginska B, Drogosiewicz M, Filipek I, Perek-Polnik M, Grajkowska W, Perek D, Johnston D, Cyr J, Strother D, Lafay-Cousin L, Fryer C, Scheinemann K, Carret AS, Fleming A, Larouche V, Bouffet E, Friedrich C, Gnekow AK, Fleischhack G, Kramm CM, Fruehwald MC, Muller HL, Calaminus G, Kordes U, Faldum A, Pietsch T, Warmuth-Metz M, Kortmann RD, Jung I, Kaatsch P, Rutkowski S, Caretti V, Bugiani M, Boor I, Schellen P, Vandertop WP, Noske DP, Kaspers G, Wurdinger T, Wesseling P, Robinson G, Chingtagumpala M, Adesina A, Dalton J, Santi M, Sievert A, Wright K, Armstrong G, Boue D, Olshefski R, Scott S, Huang A, Cohn R, Gururangan S, Bowers D, Gilbertson R, Gajjar A, Ellison D, Chick E, Donson A, Owens E, Smith AA, Madden JR, Foreman NK, Bakry D, Aronson M, Durno C, Hala R, Farah R, Amayiri N, Alharbi Q, Shamvil A, Ben-Shachar S, Constantini S, Rina D, Ellise J, Keiles S, Pollet A, Qaddoumi I, Gallinger S, Malkin D, Bouffet E, Hawkins C, Tabori U, Trivedi M, Goodden J, Chumas P, Tyagi A, O'kane R, Trivedi M, Goodden J, Chumas P, Tyagi A, O'Kane R, Crimmins D, Picton S, Elliott M. EPIDEMIOLOGY. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos100] [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: 11/12/2022] Open
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Capaldi⁎ R, Murray J, Collmman C, Maxwell C, Xie J. Evaluating the broader metabolic effects of mitochondrial diseases. Mitochondrion 2011. [DOI: 10.1016/j.mito.2011.03.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Davies AH, Barrett I, Pambid MR, Hu K, Stratford AL, Freeman S, Berquin IM, Pelech S, Hieter P, Maxwell C, Dunn SE. YB-1 evokes susceptibility to cancer through cytokinesis failure, mitotic dysfunction and HER2 amplification. Oncogene 2011; 30:3649-60. [PMID: 21423216 PMCID: PMC3121916 DOI: 10.1038/onc.2011.82] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Y-box binding protein-1 (YB-1) expression in the mammary gland promotes breast carcinoma that demonstrates a high degree of genomic instability. In the present study, we developed a model of premalignancy to characterize the role of this gene during breast cancer initiation and early progression. Antibody microarray technology was used to ascertain global changes in signal transduction following the conditional expression of YB-1 in human mammary epithelial cells (HMEC). Cell cycle associated proteins were frequently altered with the most dramatic being LIM Kinase 1/2 (LIMK1/2). Consequently, the misexpression of LIMK1/2 was associated with cytokinesis failure that acted as a precursor to centrosome amplification. Detailed investigation revealed that YB-1 localized to the centrosome in a phosphorylation-dependent manner where it complexed with pericentrin and γ-tubulin. This was found to be essential in maintaining the structural integrity and microtubule nucleation capacity of the organelle. Prolonged exposure to YB-1 led to rampant acceleration toward tumourigenesis with the majority of cells acquiring numerical and structural chromosomal abnormalities. Slippage through the G1/S checkpoint due to overexpression of cyclin E promoted continued proliferation of these genomically compromised cells. As malignancy further progressed, we identified a subset of cells harbouring HER2 amplification. Our results recognize YB-1 as a cancer susceptibility gene with the capacity to prime cells for tumourigenesis.
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Affiliation(s)
- A H Davies
- Laboratory of Oncogenomic Research, Departments of Pediatrics and Experimental Medicine, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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Alba R, Phillips A, Mackie S, Gillikin N, Maxwell C, Brune P, Ridley W, Fitzpatrick J, Levine M, Harris S. Improvements to the International Life Sciences Institute Crop Composition Database. J Food Compost Anal 2010. [DOI: 10.1016/j.jfca.2010.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
This study examines the role of HER1 signaling in the differentiation of proliferative extravillous trophoblast (EVT) into invasive EVT. Using the JAR choriocarcinoma cell line and placental villous explants as experimental models and immunohistochemical assessment of protein markers of EVT differentiation (downregulation of HER1 and Cx40 and upregulation of HER2 and alpha1 integrin), we show that the ability of decidual conditioned medium (DCM) to induce HER1/2 switching was abrogated in the presence of the HER1 antagonist, AG1478. Similarly, epidermal growth factor (EGF) treatment resulted in the downregulation of HER1 and an upregulation of HER2 expression, whereas co-incubation of EGF with AG1478 inhibited this response. However, EGF did not downregulate Cx40 or induce migration of EVT. In contrast, heparin-binding epidermal-like growth factor (HBEGF) stimulated dose-dependent JAR cell migration, which was inhibited by both AG1478 and AG825 (HER2 antagonist). Western blot analysis of HER1 activation demonstrated that HBEGF-mediated phosphorylation of the HER1 Tyr992 and Tyr1068 sites, while EGF activated the Tyr1045 site. Moreover, HBEGF induced a stronger and more sustained activation of both the mitogen-activated protein kinase and phosphoinositol 3 kinase (PIK3) signaling pathways. Migration assays using a panel of signaling pathway inhibitors demonstrated that the HBEGF-mediated migration was dependent on the PIK3 pathway. These results demonstrate that HBEGF-mediated HER1 signaling through PIK3 is an important component of EVT invasion.
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Affiliation(s)
- J K Wright
- Women's and Infants' Health Research Centre, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Shabbir M, Costa L, Fouts T, Schaub C, Kistner-Griffin E, Maxwell C, Rogers K, Stuart R. Higher Rates Of Fatal Bacterial And Invasive Fungal Infections, But No Difference In Cytomegalovirus (CMV) Reactivation Seen With The Use Of Alemtuzumab In A Reduced Intensity Conditioning Regimen. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.378] [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: 11/28/2022]
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Malima RC, Oxborough RM, Tungu PK, Maxwell C, Lyimo I, Mwingira V, Mosha FW, Matowo J, Magesa SM, Rowland MW. Behavioural and insecticidal effects of organophosphate-, carbamate- and pyrethroid-treated mosquito nets against African malaria vectors. Med Vet Entomol 2009; 23:317-325. [PMID: 19941597 DOI: 10.1111/j.1365-2915.2009.00837.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Three insecticides - the pyrethroid deltamethrin, the carbamate carbosulfan and the organophosphate chlorpyrifos-methyl - were tested on mosquito nets in experimental huts to determine their potential for introduction as malaria control measures. Their behavioural effects and efficacy were examined in Anopheles gambiae Giles s.s. (Diptera: Culicidae) and Anopheles funestus Giles s.s. in Muheza, Tanzania, and in Anopheles arabiensis Patton and Culex quinquefasciatus Say in Moshi, Tanzania. A standardized dosage of 25 mg/m(2) plus high dosages of carbosulfan (50 mg/m(2), 100 mg/m(2) and 200 mg/m(2)) and chlorpyrifos-methyl (100 mg/m(2)) were used to compare the three types of insecticide. At 25 mg/m(2), the rank order of the insecticides for insecticide-induced mortality in wild An. gambiae and An. funestus was, respectively, carbosulfan (88%, 86%) > deltamethrin (79%, 78%) > chlorpyrifos-methyl (35%, 53%). The rank order of the insecticides for blood-feeding inhibition (reduction in the number of blood-fed mosquitoes compared with control) in wild An. gambiae and An. funestus was deltamethrin > chlorpyrifos-methyl > carbosulfan. Carbosulfan was particularly toxic to endophilic anophelines at 200 mg/m(2), killing 100% of An. gambiae and 98% of An. funestus that entered the huts. It was less effective against the more exophilic An. arabiensis (67% mortality) and carbamate-resistant Cx quinquefasciatus (36% mortality). Carbosulfan deterred anophelines from entering huts, but did not deter carbamate-resistant Cx quinquefasciatus. Deltamethrin reduced the proportion of insects engaged in blood-feeding, probably as a consequence of contact irritancy, whereas carbosulfan seemed to provide personal protection through deterred entry or perhaps a spatial repellent action. Any deployment of carbosulfan as an individual treatment on nets should be carried out on a large scale to reduce the risk of diverting mosquitoes to unprotected individuals. Chlorpyrifos-methyl was inferior to deltamethrin in terms of mortality and blood-feeding inhibition and would be better deployed on a net in combination with a pyrethroid to control insecticide-resistant mosquitoes.
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Affiliation(s)
- R C Malima
- Amani Centre, National Institute for Medical Research, Muheza, Tanzania
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Carlisle J, Fang J, Maxwell C, Glasgow R, Hilden K, Ollerenshaw J. Abstract No. 263: New Fluoroscopic Method for Percutaneous Gastrostomy in an Animal Model and Clinical Practice. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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