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Donald PR, Ahmed A, Burman WJ, Cotton MF, Graham SM, Mendel C, McIlleron H, Mac Kenzie WR, Nachman S, Schaaf HS, Starke JR, Wingfield C, Hesseling AC. Requirements for the clinical evaluation of new anti-tuberculosis agents in children. Int J Tuberc Lung Dis 2013; 17:794-9. [DOI: 10.5588/ijtld.12.0567] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P. R. Donald
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A. Ahmed
- Center for Pediatric Research, Carolinas Medical Center, Charlotte, North Carolina, USA; and University of North Carolina, Chapel Hill, North Carolina, USA
| | - W. J. Burman
- Infectious Diseases Clinic of Denver Public Health, Denver Health Hospital, Denver, Colorado, USA
| | - M. F. Cotton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S. M. Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia
| | - C. Mendel
- The Global Alliance for TB Drug Development, New York, New York, USA
| | - H. McIlleron
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - W. R. Mac Kenzie
- Tuberculosis Trials Consortium, Clinical Research Branch, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S. Nachman
- Department of Pediatrics, Health Science Center, State University of New York at Stony Brook, Stony Brook, New York, USA
| | - H. S. Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - C. Wingfield
- TB/HIV Project, Treatment Action Group, New York, New York, USA
| | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Horsburgh CR, Haxaire-Theeuwes M, Lienhardt C, Wingfield C, McNeeley D, Pyne-Mercier L, Keshavjee S, Varaine F. Compassionate use of and expanded access to new drugs for drug-resistant tuberculosis. Int J Tuberc Lung Dis 2012; 17:146-52. [PMID: 23211610 DOI: 10.5588/ijtld.12.0017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Several new classes of anti-tuberculosis agents are likely to become available in the coming decade. Ensuring prompt access to these drugs for patients without other treatment options is an important medical and public health issue. This article reviews the current state of 'compassionate use' and 'expanded access' programs for these new drugs, and identifies several shortcomings that will limit patient access to the drugs. A series of five steps is outlined that will need to be taken by national health bodies, international agencies and non-governmental organizations to prevent undue delays in access to new tuberculosis drugs for patients who could benefit from them. Following these steps can ensure that patients will be able to benefit from access to these drugs, while minimizing the risk of emergence of resistance to the drug.
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Affiliation(s)
- C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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Sester M, Giehl C, McNerney R, Kampmann B, Walzl G, Cuchí P, Wingfield C, Lange C, Migliori GB, Kritski AL, Meyerhans A. Challenges and perspectives for improved management of HIV/Mycobacterium tuberculosis co-infection. Eur Respir J 2011; 36:1242-7. [PMID: 21119204 DOI: 10.1183/09031936.00040910] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
HIV and Mycobacterium tuberculosis (MTB) are two widespread and highly successful microbes whose synergy in pathogenesis has created a significant threat for human health globally. In acknowledgement of this fact, the European Union (EU) has funded a multinational support action, the European Network for global cooperation in the field of AIDS and TB (EUCO-Net), that brings together experts from Europe and those regions that bear the highest burden of HIV/MTB co-infection. Here, we summarise the main outcome of the EUCO-Net project derived from an expert group meeting that took place in Stellenbosch (South Africa) (AIDS/TB Workshop on Research Challenges and Opportunities for Future Collaboration) and the subsequent discussions, and propose priority areas for research and concerted actions that will have impact on future EU calls.
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Affiliation(s)
- M Sester
- Dept of Transplant and Infection Immunology, Institute of Virology, University of the Saarland, Homburg, Germany
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Abstract
An in vitro study of rottweiler and racing greyhound cranial cruciate ligaments revealed that the rottweiler ligaments had a significantly greater cross-sectional area at their distal attachments. Mechanical testing showed that the ultimate load related to body mass was significantly higher in the extended racing greyhound stifle during cranial tibial loading to failure, as were linear stiffness, tensile strength and tangent modulus. During ligament axis loading to failure, the only significant difference in structural and mechanical properties recorded between the two breeds was a greater ultimate strain for the greyhound ligament with the stifle joint flexed. Energy absorbed by the ligament complex at failure during cranial tibial loading was twice that for ligament axis loading for both breeds. The clinical significance is that the rottweiler cranial cruciate ligament is more vulnerable to damage as it requires half the load per unit body mass that the greyhound requires to cause a rupture.
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Affiliation(s)
- C Wingfield
- Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, Edinburgh
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Abstract
An in vitro biomechanical study of cadaver stifles from rottweilers and racing greyhounds was undertaken to evaluate the contribution of the cranial cruciate ligament to stifle joint stability. This was performed at differing stifle joint angles, first with the joint capsules and ligaments intact and then with all structures removed except for the cranial cruciate ligament. Craniocaudal laxity increased in both breeds as stifle flexion increased. The rottweiler stifle showed greater craniocaudal joint laxity than the racing greyhound at all joint angles between 150 degrees and 110 degrees, but the actual increases in joint laxity between these joint angles were similar for both breeds. Tibial rotation during craniocaudal loading of the stifle increased craniocaudal laxity in both breeds during joint flexion. The relative contribution of the cranial cruciate ligament to cranial stability of the stifle joint increased as the joint flexed and was similar in both breeds.
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Affiliation(s)
- C Wingfield
- Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, Summerhall, Edinburgh
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