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Fung LW, Yan VK, Kwan C, Kwok WC, Lam DC, McDonald CF, Bloom CI, Wong IC, Chan EW. SABINA + Hong Kong: a territory wide study of prescribing trends and outcomes associated with the use of short-acting β2 agonists in the Chinese population. BMC Pulm Med 2024; 24:232. [PMID: 38745268 PMCID: PMC11094848 DOI: 10.1186/s12890-024-03038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Excessive use of short-acting β2 agonists (SABA) in patients with asthma continues to be a notable concern due to its link to higher mortality rates. Global relevance of SABA overuse in asthma management cannot be understated, it poses significant health risk to patients with asthma and imposes burden on healthcare systems. This study, as part of global SABINA progamme, aimed to describe the prescribing patterns and clinical outcomes associated with SABA use in the Chinese population. METHODS Retrospective cohort study was conducted using anonymized electronic healthcare records of Clinical Data Analysis and Reporting System (CDARS) from Hong Kong Hospital Authority (HA). Patients newly diagnosed with asthma between 2011 and 2018 and aged ≥12 years were included, stratified by SABA use (≤2, 3-6, 7-10, or ≥11 canisters/year) during one-year baseline period since asthma diagnosis date. Patients were followed up from one-year post-index until earliest censoring of events: outcome occurrence and end of study period (31 December 2020). Cox proportional regression and negative binomial regression were used to estimate the mortality risk and frequency of hospital admissions associated with SABA use respectively, after adjusting for age, sex, Charlson Comorbidity Index (CCI), and inhaled corticosteroid (ICS) dose. Outcomes include all-cause, asthma-related, and respiratory-related mortality, frequency of hospital admissions for any cause, and frequency of hospital admissions due to asthma. RESULTS 17,782 patients with asthma (mean age 46.7 years, 40.8% male) were included and 59.1% of patients were overusing SABA (≥ 3 canisters per year). Each patient was prescribed a median of 5.61 SABA canisters/year. SABA overuse during baseline period was associated with higher all-cause mortality risk compared to patients with ≤2 canisters/year. Association was dose-dependent, highest risk in those used ≥11 canisters/year (adjusted hazard ratio: 1.42, 95% CI: 1.13, 1.79) and 3-6 canisters/year (adjusted hazard ratio: 1.22, 95% CI: 1.00, 1.50). Higher SABA prescription volume associated with increased frequency of hospital admissions with greatest risk observed in 7-10 canisters/year subgroup (adjusted rate ratio: 4.81, 95% CI: 3.66, 6.37). CONCLUSIONS SABA overuse is prevalent and is associated with increased all-cause mortality risk and frequency of hospital admissions among the patients with asthma in Hong Kong.
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Affiliation(s)
- Lydia Wy Fung
- formerly, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- formerly, Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Vincent Kc Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Christine Kwan
- Sau Po Centre of Ageing, The University of Hong Kong, Hong Kong SAR, China
- formerly, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- formerly, Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - W C Kwok
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - David Cl Lam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Melbourne, Victoria, Australia
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ian Ck Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
- Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK
- Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong SAR, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China.
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China.
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Kwan C, Chen YH, Killoran JH, Ferrone ML, Marcus KJ, Tanguturi S, Balboni TA, Spektor A, Huynh MA. Outcomes of Stereotactic Body Radiation Therapy (SBRT) for Femur Oligometastases. Int J Radiat Oncol Biol Phys 2023; 117:e122. [PMID: 37784673 DOI: 10.1016/j.ijrobp.2023.06.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiation therapy (SBRT) is increasingly used for oligometastatic bone disease, but there is limited data regarding the clinical outcomes of utilizing SBRT in treatment for femur metastases, which was excluded from SABR-COMET. We aimed to identify patient or treatment factors associated with clinical outcomes among patients treated with SBRT to femur metastases for oligometastatic disease control or re-irradiation. MATERIALS/METHODS We identified 50 patients with 56 femur lesions consecutively treated with SBRT at a single institution May 2017-June 2022. The Kaplan-Meier method was used to characterize time-to-event endpoints and Cox proportional hazards models were performed to evaluate the associations between baseline factors and clinical outcomes. Local control was defined as the absence of regional tumor progression at treated area or need for surgical fixation post radiation. RESULTS Most patients had ECOG 0-1 (90%), prostate (50%) or breast/lung (16%) cancer, and 1-3 lesions (100%), including 30 proximal and 5 distal. 55% of lesions received concurrent systemic therapy, including ADT (n = 18) or immunotherapy (n = 6). Median PTV volume was 54.7cc (range, 6.6 to 387cc). PTV V100(%) was 99% (range 71.5-100). Fractionation included 18-20 Gy/1F, 27-30 Gy/3F, 25-40 Gy/5F, and 50 Gy/10F. 43% of lesions had Mirel's score ≥ 7 and 91% of lesions did not have extraosseous bone extension on diagnostic CT and/or MRI. Acute toxicities included grade 1 fatigue (14.3%), pain flare (7.1%), and decreased blood counts (1.8%). Late toxicities included fracture (1.8%) at 1.5 years and 2 patients with radiation-induced osteonecrosis (3.6%) from dose of 40 Gy in 5F and 30 Gy in 5F (after prior 30 Gy/10F). One patient (n = 2%) required fixation post-radiation due to progression of disease or symptoms. With median follow up 19.4 months, 1 and 2-year rates of local control were 84% and 69%, progression-free survival were 55% and 27%, and overall survival were 91% and 74%. CONCLUSION There was no significant association between patient or treatment characteristics and local control outcomes. Femur SBRT for oligometastatic disease control in well-selected patients was associated with good outcomes with minimal rates of acute and late toxicity. Further prospective study is warranted.
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Affiliation(s)
- C Kwan
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Y H Chen
- Harvard Medical School, Boston, MA; Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - J H Killoran
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - M L Ferrone
- Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - K J Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - S Tanguturi
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - T A Balboni
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - A Spektor
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - M A Huynh
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
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Fung LWY, Zhao J, Yan VKC, Blais JE, Chan JCH, Li STH, Shami JJP, Kwan C, Wei Y, Wong CKH, Li X, Chui CSL, Wan EYF, Lai FTT, Tse S, Cowling BJ, Wong ICK, Chan EW. COVID-19 Vaccination Preferences of University Students and Staff in Hong Kong. JAMA Netw Open 2022; 5:e2212681. [PMID: 35579895 PMCID: PMC9115609 DOI: 10.1001/jamanetworkopen.2022.12681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Importance COVID-19 has required universities to rapidly develop vaccination policies for students and staff, yet little is known about the preferences of these individuals toward vaccination. Objective To quantify student and staff preferences for COVID-19 vaccination at a university in Hong Kong. Design, Setting, and Participants A cross-sectional online survey study was conducted from July 20 to September 21, 2021, before the announcement of a campus-wide vaccine mandate. A survey of 42 451 eligible university students and staff used discrete-choice experiment methods to quantify 7 attributes of COVID-19 vaccination: risk of a mild or moderate adverse event after vaccination, risk of a severe adverse event after vaccination, efficacy against COVID-19 infection, efficacy against severe manifestation of COVID-19 infection, duration of protection after vaccination, incentive for completing vaccination, and out-of-pocket costs. Main Outcomes and Measures A mixed logit regression model was used to estimate the preferences of attributes for COVID-19 vaccines and marginal willingness to pay (mWTP) adjusted for background characteristics, role, vaccination, and COVID-19 infection status of family or friends, adverse event status after vaccination among family and friends of participants, and scenario block. Results Among 42 451 eligible university students and staff invited, 3423 individuals completed the survey (mean [SD] age, 27.1 [9.9] years; 2053 [60.0%] women). Participants included 2506 students (73.2%) and 917 staff (26.8%), with a response rate of 8.1%. Quarantine-free travel was preferred (β = 0.86; 95% CI, 0.72-0.99; mWTP: $235.9; 95% CI, $190.3-$294.2), followed by efficacy against any COVID-19 infection (β = 0.30; 95% CI, 0.29-0.32; mWTP: $84.1; 95% CI, $71.8-$100.8), against severe manifestation of COVID-19 infection (β = 0.25; 95% CI, 0.24-0.27; mWTP: $69.7; 95% CI, $465-$653), and risk of severe adverse events following vaccination (β = -0.24; 95% CI, -0.27 to -0.21; mWTP: -$66.8; 95% CI, -$81.5 to -$55.3). Participants were less concerned about protection duration (β = 0.17; 95% CI, 0.15-0.18; mWTP: $46.0; 95% CI, $38.6-$56.2) and risk of mild to moderate adverse events (β = -0.12; 95% CI, -0.13 to -0.10; mWTP: -$32.7; 95% CI, -$41.2 to -$26.4). Conclusions and Relevance Preference of all attributes were significant and were considered important by the participants for vaccine decision-making. Insights drawn could assist policy makers in future vaccination decisions, such as campus vaccine mandate and requirement of a third dose.
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Affiliation(s)
- Lydia W. Y. Fung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Jiaxi Zhao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Digital and Data Innovation, AstraZeneca Global R&D (China) Co Ltd, Shanghai, China
| | - Vincent K. C. Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Joseph E. Blais
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jacky C. H. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Silvia T. H. Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jessica J. P. Shami
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Christine Kwan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Yue Wei
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos K. H. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Celine S. L. Chui
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Y. F. Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco T. T. Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Benjamin J. Cowling
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Research Department of Practice and Policy, University College London, London, United Kingdom
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
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Gani L, Lau E, Luk A, Sobrepena L, Tran QK, Kesavadev J, Jia W, Yu W, Tsang CC, Mukhopadhyay M, Jha S, Sheu W, Ho YK, Nguyen TK, Ozaki R, So WY, Kwan C, Fu AWC, Mirasol R, Phatak SR, Kumar KMP, Aravind S, Janakiraman H, Chan JCN. Cross-sectional survey of biosimilar insulin utilization in Asia: The Joint Asia Diabetes Evaluation Program. J Diabetes Investig 2018; 9:1312-1322. [PMID: 29575724 PMCID: PMC6215931 DOI: 10.1111/jdi.12843] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/26/2018] [Accepted: 03/14/2018] [Indexed: 12/01/2022] Open
Abstract
Aims/Introduction Biosimilar insulin can reduce treatment costs, although the extent of its use is largely unknown. We examined biosimilar insulin use and its associations with the quality of glycemic control using the Joint Asia Diabetes Evaluation register. Materials and Methods We carried out a cross‐sectional analysis in 81,531 patients with type 1 and type 2 diabetes enrolled into the Joint Asia Diabetes Evaluation Program from 2007 to 2014. All insulin related terms are extracted from the Joint Asia Diabetes Evaluation portal, and compared clinical profiles between biosimilar and originator insulin users. Multivariate analysis was performed to assess the association of biosimilar insulin compared with originator insulin with dosage, glycated hemoglobin and hypoglycemia events. Results Amongst 81,531 patients, 20.5% (n = 16,738) were insulin‐treated. In four countries with high use of biosimilar insulin, 4.7% (n = 719) of insulin users (n = 10,197) were treated with biosimilar insulin (India n = 507, 70.3%; the Philippines n = 90, 12.5%; China n = 62, 8.6%; Vietnam n = 60, 8.3%). Biosimilar insulin users were younger and had higher body mass index, glycated hemoglobin, insulin dosage and more frequent hypoglycemia than originator insulin users. These associations were non‐significant after adjustment for confounders. Only age, college education, diabetes education, lipid control, physical activity and history of cardiovascular complications were independently associated with these quality measures. Conclusions Biosimilar insulin use is not uncommon in Asia. Data exclusion due to incomplete capturing of brand names suggests possibly higher use. The multiple determinants of the quality of glycemic control call for establishment of prospective cohorts and diabetes registers to monitor the safety and efficacy of different brands of biosimilar insulin and their impacts on clinical outcomes.
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Affiliation(s)
- Linsey Gani
- Changi General Hospital, Singapore.,Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Eric Lau
- Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Andrea Luk
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | | | | | - Jothydev Kesavadev
- Jothydev's Diabetes and Research Center, Thiruvananthapuram, Kerala, India
| | - Weiping Jia
- Shanghai Sixth People's Hospital, Shanghai, China
| | - Weinan Yu
- Huaian Second People's Hospital, Jiangsu, China
| | | | | | - Sujeet Jha
- Max Super Specialty Hospital, New Delhi, Delhi, India
| | - Wayne Sheu
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yoon Kun Ho
- The Catholic University of Korea, Seoul, Korea
| | | | - Risa Ozaki
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Wing Yee So
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Christine Kwan
- Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Amy W C Fu
- Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong
| | | | | | | | | | | | - Juliana C N Chan
- Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong.,Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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Lin A, Kwan C, Armstrong J, Sippel J, Thomas L, Atherton J, Prasad S. Minimum Left Atrial Volume Shows a Better Correlation with Invasively and Non-Invasively Measured LV Filling Pressures than Maximal Left Atrial Volume in Patients with Myocardial Infarction. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.514] [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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Kwan C, Chan HHW, Chan AKC. Heterogeneity of information regarding inhibitors in the product monographs of antihaemophilic factors in North America. Haemophilia 2015; 21:e448-51. [PMID: 26193776 DOI: 10.1111/hae.12742] [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] [Accepted: 05/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- C Kwan
- McMaster University, Hamilton, ON, Canada.,Thrombosis & Atherosclerosis Research Institute (TAARI), McMaster University, Hamilton, ON, Canada
| | - H H W Chan
- Thrombosis & Atherosclerosis Research Institute (TAARI), McMaster University, Hamilton, ON, Canada.,Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - A K C Chan
- Thrombosis & Atherosclerosis Research Institute (TAARI), McMaster University, Hamilton, ON, Canada.,Division of Hematology-Oncology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Lin A, Kwan C, Guppy-Coles K, Dooris M, Thomas L, Dahiya A, Atherton J, Prasad S. Impact of infarct size on left ventricular diastolic function following acute myocardial infarction. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.089] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Leong MY, Gudi M, Chang TE, Kwan C. A rare microscopic finding in an early abortion specimen. J Postgrad Med 2014; 60:214-6. [PMID: 24823535 DOI: 10.4103/0022-3859.132375] [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: 11/04/2022] Open
Affiliation(s)
- M Y Leong
- Department of Pathology and Laboratory Medicine, KandangKerbau Women's and Children's Hospital, Singapore
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Pugh C, Cohen E, Kwan C, Cannon-Bowers J. Investigating the Importance of Taskwork in Team-Based Assessments. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.860] [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: 10/25/2022]
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Cohen E, Maag A, Kwan C, Laufer S, Pugh C. Assessing Inter-station and Cross-task Validity Evidence for Sensor-based Performance Measures. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.432] [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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Mok C, Kwan C, Chan K, Lee K, Tam L. AB0453 Retention rate of the anti-TNF biologics in the treatment of rheumatic diseases and predictive factors for drug withdrawal: Data from the hong kong biologics registry. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.453] [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: 11/04/2022]
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Kwan C, Bell R, Koenig T, Bischofberger A, Horadagoda N, Perkins NR, Jeffcott LB, Dart AJ. Effects of intra-articular sodium pentosan polysulfate and glucosamine on the cytology, total protein concentration and viscosity of synovial fluid in horses. Aust Vet J 2012; 90:315-20. [DOI: 10.1111/j.1751-0813.2012.00959.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Kwan
- Research and Clinical Training Unit; University Veterinary Teaching Hospital, University of Sydney; Camden; NSW; Australia
| | - R Bell
- Research and Clinical Training Unit; University Veterinary Teaching Hospital, University of Sydney; Camden; NSW; Australia
| | - T Koenig
- Research and Clinical Training Unit; University Veterinary Teaching Hospital, University of Sydney; Camden; NSW; Australia
| | - A Bischofberger
- Research and Clinical Training Unit; University Veterinary Teaching Hospital, University of Sydney; Camden; NSW; Australia
| | - N Horadagoda
- Research and Clinical Training Unit; University Veterinary Teaching Hospital, University of Sydney; Camden; NSW; Australia
| | - NR Perkins
- Ausvet Animal Health Services; Toowoomba; Queensland; Australia
| | - LB Jeffcott
- Research and Clinical Training Unit; University Veterinary Teaching Hospital, University of Sydney; Camden; NSW; Australia
| | - AJ Dart
- Research and Clinical Training Unit; University Veterinary Teaching Hospital, University of Sydney; Camden; NSW; Australia
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Fan X, Kwan C, Riall TS, Sellin J. A gastric ulcer at the anastomosis site perforated into the liver 3 years after Roux-en-Y gastric bypass surgery. Gastrointest Endosc 2008; 68:769; discussion 769. [PMID: 18555244 DOI: 10.1016/j.gie.2008.02.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 02/29/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Xinqing Fan
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
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Tan LHC, Tan PH, Tan SY, Ventura R, Yip GWC, Zhou YC, Do E, Koay ESC, Kwan C, Poh BK, Peh S. Inflammatory myofibroblastic tumour of the bladder may express anaplastic lymphoma kinase by translocation-dependent and translocation-independent mechanisms: a report of two cases. Histopathology 2007; 50:278-82. [PMID: 17222259 DOI: 10.1111/j.1365-2559.2007.02575.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kwan C, Steers E, Rieder M, Matsui D. Perspective of canadian pediatricians on barriers to drug investigation in children in Canada. Clin Pharmacol Ther 2003. [DOI: 10.1016/s0009-9236(03)90393-6b] [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: 11/26/2022]
Affiliation(s)
- C. Kwan
- University of Western Ontario London Canada
| | - E. Steers
- University of Western Ontario London Canada
| | | | - D. Matsui
- University of Western Ontario London Canada
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Kwan C, Steers E, Rieder MJ, Matsui D. Barriers to Drug Investigation in Children in Canada: Perspectives from Academic and Community Practice. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.45ab] [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: 11/14/2022] Open
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Abstract
A 34-year-old lady developed a constellation of dermatitis, fever, lymphadenopathy and hepatitis, beginning on the 17th day of a course of oral sulphasalazine for sero-negative rheumatoid arthritis. Cervical and inguinal lymph node biopsies showed the features of severe necrotising lymphadenitis, associated with erythrophagocytosis and prominent eosinophilic infiltrates, without viral inclusion bodies, suggestive of an adverse drug reaction.A week later, fulminant drug-induced hepatitis, associated with the presence of anti-nuclear autoantibodies (but not with other markers of autoimmunity), and accompanied by multi-organ failure and sepsis, supervened. She subsequently died some 5 weeks after the commencement of her drug therapy.Post-mortem examination showed evidence of massive hepatocellular necrosis, acute hypersensitivity myocarditis, focal acute tubulo-interstitial nephritis and extensive bone marrow necrosis, with no evidence of malignancy. It is thought that the clinico-pathological features and chronology of this case bore the hallmarks of the so-called "3-week sulphasalazine syndrome", a rare, but often fatal, immunoallergic reaction to sulphasalazine.
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Affiliation(s)
- G Lau
- Department of Forensic Medicine, Institute of Science and Forensic Medicine, Outram Road, Singapore 169608, Singapore
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Burri BJ, Neidlinger TR, Lo AO, Kwan C, Wong MR. Supercritical fluid extraction and reversed-phase liquid chromatography methods for vitamin A and beta-carotene heterogeneous distribution of vitamin A in the liver. J Chromatogr A 1997; 762:201-6. [PMID: 9098978 DOI: 10.1016/s0021-9673(96)00705-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We developed supercritical fluid procedures for extracting vitamin A and beta-carotene from vitamin supplements and calf liver tissue. The SF extracts could be injected onto an HPLC column without further pretreatment. Samples were analysed by RP-HPLC using diode array detection or by spectrophotometry. Recoveries were very good. SF extracts from a vitamin preparation of uniform composition had an R.S.D. of 4%. Extracts from calf liver supplements were predictably more heterogeneous. The SF extraction method is less labor intensive then traditional liquid-liquid procedures for extracting vitamin A and carotenoids from tissues.
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Affiliation(s)
- B J Burri
- Western Human Nutrition Research Center, USDA/ARS/PWA, San Francisco, CA 94129, USA
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Loh LE, Ho KH, Thoo A, Kwan C. Hemangioma of the ethmoidal sinuses. Singapore Med J 1994; 35:211-4. [PMID: 7939825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A report of a rare case of hemangioma of the ethmoidal sinuses with erosion of bony orbital wall and anterior cranial fossa. An outline of the management is presented.
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Affiliation(s)
- L E Loh
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
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Andy C, Kwan C. A note on the finite-sample distribution of lagrange multiplier tests for univariate time series models. COMMUN STAT-SIMUL C 1993. [DOI: 10.1080/03610919308813146] [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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Chua EC, Ang CL, Yeo KT, Kwan C. Choroidal melanoma: a report of three cases. Ann Acad Med Singap 1991; 20:812-6. [PMID: 1803978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Choroidal melanoma is extremely rare in our population. We report three cases with varied presentations. Two patients presented late with secondary lens induced and neovascular glaucoma, and one patient had early presentation of metamorphosia. We would like to emphasise the importance of an ultrasound scan before any intraocular surgery where the view of the fundus is obscured by an opaque ocular media. A proper ultrasound diagnosis avoids unnecessary surgery which could cause tumour dissemination. Two cases were enucleated and one was managed conservatively.
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Abstract
Prior work has indicated that the polycistronic lacZYA mRNA of Escherichia coli is cleaved during decay at approximately intergenic sites (L. W. Lim and D. Kennell, J. Mol. Biol. 135: 369-390, 1979). In this work, we characterized the products by using probes specific for the different cistrons. This analysis indicated that six lac mRNA species are present in the following order of decreasing abundance: lacZ, -A, -ZYA, -ZY, -YA, and -Y. Very little lacYA and lacY mRNAs were present, whereas in cells induced to steady state, there was 10 times more lacZ than lacZYA mRNA. The lacZ mRNA appeared as a discrete species extending to a site in the lacZ-Y intergenic space (ca. residue 3150). This site is just distal to a potential rho-independent termination sequence. We examined the function of this sequence to determine whether it contributes to the distribution of the mRNAs. Although the termination sequence was shown to function in vitro, when it was recloned into an expression vector, no termination was seen in vivo. Moreover, direct examination of the kinetics of lac messenger synthesis revealed that after initiation, most transcription continued to the end of the operon. We conclude that during normal growth, the operon is transcribed in its entirety and that the individual lac mRNAs are formed by cleavage. These results confirm earlier work implying that the lac operon is transcribed in its entirety but are in conflict with several recent reports suggesting that internal termination occurs. Our findings indicate that the natural polarity of the operon (lacZ is expressed sixfold more strongly than lacA) is based on posttranslational effects and not on polarity of transcription.
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Affiliation(s)
- G J Murakawa
- Department of Microbiology and Molecular Genetics, University of California, Los Angeles 90024-1489
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Abstract
To determine if there are any unique features of nursing home-acquired pneumonia we carried out a case-control study wherein each patient admitted with nursing home-acquired pneumonia was age- and sex-matched with a patient with community-acquired pneumonia. There were 36 men and 38 women in the nursing home group. The mean age of both groups was 74 years. The mortality rate for nursing home-acquired pneumonia it was 40.5%, whereas for community-acquired pneumonia it was 28% (P = NS). Patients with nursing home-acquired pneumonia had a significantly higher incidence of dementia and cerebrovascular accidents, and patients with community-acquired pneumonia were more likely to be smokers and to have chronic obstructive pulmonary disease. Aspiration pneumonia was more common among patients with nursing home-acquired pneumonia (P less than .001), and Hemophilus influenza pneumonia more common among the patients with community-acquired infection (P less than .01). Sputum for culture could be obtained in only 31 and 39% of the patients--contributory to the high rates of pneumonia of unknown etiology 63.5 and 56.1% for the nursing home group and the control subjects, respectively. Patients with nursing home-acquired pneumonia received cloxacillin and aminoglycosides more frequently than patients with community-acquired pneumonia (P less than .05), and patients with community-acquired pneumonia received erythromycin more frequently than patients with nursing home-acquired pneumonia (P less than .05). Complications were common during the hospital stay of these patients--the most frequent being congestive heart failure, urinary tract infection, renal failure, and respiratory failure.
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Abstract
The authors studied 138 patients, 57 of whom were younger than 65 years of age and 81 who were 65 years of age and older, with community-acquired pneumonia to determine whether or not such pneumonia is different in the elderly and to define how such patients are investigated and treated. Pneumonia in the elderly was characterized by a higher mortality, 30 v 10%; more likely to be of unknown etiology, 54 v 30%; and more likely to show radiographic progression after the patient had been admitted to the hospital, 48 v 11%. In addition, elderly patients were more likely to be afebrile when admitted, 57 v 26%. Twenty-seven etiologic categories were present in 77 patients in whom a cause for the pneumonia was established. Streptococcus pneumoniae accounted for 9.4% of the pneumonia overall and for 27% of the pneumonia among patients who had sputum cultures performed before antibiotic therapy. The diagnostic yield was 11.6% for blood cultures, 38.2% for sputum cultures, 2.3% for throat washing, and 22.1% for serological studies. Twenty-seven percent of patients were receiving antibiotics of the time of admission to the hospital. Most (79%) received more than one antibiotic after admission. This study indicates that community-acquired pneumonia is a serious illness and that an algorithm approach to diagnosis and treatment of such pneumonia is necessary.
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Marrie TJ, Van Buren J, Fraser J, Haldane EV, Faulkner RS, Williams JC, Kwan C. Seroepidemiology of Q fever among domestic animals in Nova Scotia. Am J Public Health 1985; 75:763-6. [PMID: 3890569 PMCID: PMC1646304 DOI: 10.2105/ajph.75.7.763] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We used the indirect microimmunofluorescence test to determine the presence of antibodies in sheep, cattle, goat, cat, and dog sera to phase I and II Coxiella burnetii antigens in Nova Scotia. Only 6.7 per cent of the 329 sheep tested had antibodies to phase II antigen and none had antibodies to phase I. Of 29 goats tested, 7 per cent and 3.5 per cent had antibodies to phase II and phase I antigens, respectively. In contrast, 23.8 per cent of the 214 cattle tested had antibodies to phase II antigen, and 24.2 per cent had antibodies to phase I antigen; 24.1 per cent of 216 cats tested had antibodies to phase II antigen and 6 per cent had antibodies to phase I antigen. None of the 447 dogs tested had antibodies detected. We conclude that cattle and cats may be reservoirs for human Q fever in Nova Scotia.
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Marrie TJ, Haldane EV, Faulkner RS, Kwan C, Grant B, Cook F. The importance of Coxiella burnetii as a cause of pneumonia in Nova Scotia. Can J Public Health 1985; 76:233-6. [PMID: 4052906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Marrie TJ, Van Buren J, Faulkner RS, Haldane EV, Williams JC, Kwan C. Seroepidemiology of Q fever in Nova Scotia and Prince Edward Island. Can J Microbiol 1984; 30:129-34. [PMID: 6713300 DOI: 10.1139/m84-021] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The prevalence of Coxiella burnetti infection (Q fever) was determined among Nova Scotia (N.S.) and Prince Edward Island (P.E.I.) blood donors by using the complement fixation and microimmunofluorescence (IF) test. The complement fixation and IF antibody tests measured antibody prevalence for the phase II or phase I and II antigens, respectively. Complement-fixing antibodies to phase II antigen were detected in 4.1% of 997 N.S. and 5.0% of 219 P.E.I. blood donors. Anti-phase II antibodies were detected by microimmunofluorescence in 11.8 and 14.6% of the blood donors in the two provinces, respectively. Anti-phase I antibodies were detected among 2.8% of the N.S. blood donors and 6.3% of the P.E.I. blood donors. Comparison of rates of anti-phase II IF by counties in N.S. revealed that there was at least one county where infection by C. burnetti is hyperendemic. Rates of antibody prevalence were similar in all three areas of P.E.I. examined. We conclude that "Q fever" is endemic in N.S. and P.E.I. and that the microimmunofluorescence test is more suitable than the complement fixation test for seroepidemiologic studies.
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Abstract
The status of the erythrocyte insulin receptor was investigated prior to and during storage at 4C in acid-citrate dextrose (ACD) solution. The receptors on cells that were obtained from both resting and exercised fasting subjects and stored for up to three days in ACD were unchanged as evaluated by both maximal specific hormone binding and the concentration of insulin required to one half maximally inhibit specific binding. These findings indicate, therefore, that the binding of insulin to its receptor on erythrocytes can be assayed in samples of stored blood and that this assay reflects the status of the receptor at the time of sampling.
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Abstract
Our objectives in this study were to elucidate various aspects of the epidemiology of Staphylococcus saprophyticus. This organism was isolated from the midstream urine specimens of 7.5% of 145 college women with frequency and urgency of urination and dysuria, but from only 0.07% of 14,835 urine specimens from adult inpatients at the Victoria General Hospital. It was found to be part of the urethral flora of only 2% of healthy women. Other staphylococci which formed part of the urethral flora of 100 healthy women included S. epidermidis (59 women), S. hominis (15 women), S. haemolyticus (13 women), S. warneri (9 women), and S. aureus (6 women). Finally, we determined that resistance to the 5-micrograms novobiocin disk has a 93% positive predictive accuracy as a presumptive test for S. saprophyticus.
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Abstract
The activity of eight antimicrobial agents was determined against 115 isolates of Staphylococcus saprophyticus. All were susceptible to ampicillin, cephalexin, and trimethoprim-sulfamethoxazole and resistant to nalidixic acid and novobiocin. A bimodal pattern of susceptibility to erythromycin was observed: 80% were inhibited by 0.25 microgram/ml, whereas 13% required greater than or equal to 128 micrograms/ml. The following urethral staphylococci were susceptible to ampicillin, cephalexin, and nitrofurantoin but resistant to nalidixic acid: S. epidermidis, S. hominis, S. haemolyticus, S. warneri, S. simulans, and S. cohnii.
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Longo D, Cherrick H, Kwan C, Apirion D. Escherichia coli strains with modified RNase II activity: isolation and properties. Mol Gen Genet 1971; 110:54-60. [PMID: 4927442 DOI: 10.1007/bf00276046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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