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Manouchehri K, Zahabi S, Davidson J, Wilson CA, Lawlor C, Graham ME. Knowledge and attitudes surrounding breastfeeding in pediatric otolaryngology: A survey study. Int J Pediatr Otorhinolaryngol 2024; 176:111774. [PMID: 37979254 DOI: 10.1016/j.ijporl.2023.111774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE This survey study seeks to understand the knowledge and attitudes of pediatric otolaryngologists around breastfeeding to potentially inform future educational efforts. METHODS This cross-sectional survey recruited 59 pediatric otolaryngologists from an international WhatsApp group comprising 213 members over a four-week period. Demographics, knowledge, attitudes, and experiences with breastfeeding were investigated using Likert scales. Descriptive statistics and correlational analyses were conducted. Statistical significance was set at p < 0.05. RESULTS The majority of participants were women (59%) and had children (86%). Most participants and/or their partners breastfed for 4-12 months (67%). Previous breastfeeding education was limited in both medical school (20%) and residency (15%). Most agreed that otolaryngologists should be knowledgeable about breastfeeding (83%), however men respondents felt significantly less comfortable counselling (p < 0.003), addressing difficulties (p < 0.044), and suggesting means to change milk supply (p < 0.007). Knowledge gaps were identified with assessing aspiration risk and airway anomalies. Breastfeeding experience did not significantly influence attitudes and comfort around breastfeeding, or the knowledge of participants. CONCLUSION While attitudes towards breastfeeding amongst pediatric otolaryngologists are very positive, degrees of comfort and knowledge are more limited, especially amongst men otolaryngologists. Future research should consider exploring the efficacy of educational efforts in Otolaryngology for improving the support offered to breastfeeding dyads.
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Affiliation(s)
- Kimya Manouchehri
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sarah Zahabi
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Victoria Hospital, Western University, London, ON, Canada
| | - Jacob Davidson
- Division of Pediatric Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Victoria Hospital, Western University, London, ON, Canada
| | - Claire A Wilson
- Division of Pediatric Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Victoria Hospital, Western University, London, ON, Canada
| | - Claire Lawlor
- Department of Otolaryngology - Head and Neck Surgery, Children's National Health System, Washington, DC, USA
| | - M Elise Graham
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Victoria Hospital, Western University, London, ON, Canada.
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Meisner JW, Izadi S, Kamran A, Shieh HF, Smithers CJ, Bennett J, Demehri FR, Mohammed S, Lawlor C, Choi SS, Zendejas B. Screening for Vocal Fold Movement Impairment in Children Undergoing Esophageal and Airway Surgery. Laryngoscope 2023; 133:3564-3570. [PMID: 36892035 DOI: 10.1002/lary.30646] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/04/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Children undergoing cervical and/or thoracic operations are at risk for recurrent laryngeal nerve injury, resulting in vocal fold movement impairment (VFMI). Screening for VFMI is often reserved for symptomatic patients. OBJECTIVE Identify the prevalence of VFMI in screened preoperative patients prior to an at-risk operation to evaluate the value of screening all patients at-risk for VFMI, regardless of symptoms. METHODS A single center, retrospective review of all patients undergoing a preoperative flexible nasolaryngoscopy between 2017 and 2021, examining the presence of VFMI and associated symptoms. RESULTS We evaluated 297 patients with a median (IQR) age of 18 (7.8, 56.3) months and a weight of 11.3 (7.8, 17.7) kilograms. Most had a history of esophageal atresia (EA, 60%), and a prior at-risk cervical or thoracic operation (73%). Overall, 72 (24%) patients presented with VFMI (51% left, 26% right, and 22% bilateral). Of patients with VFMI, 47% did not exhibit the classic symptoms (stridor, dysphonia, and aspiration) of VFMI. Dysphonia was the most prevalent classic VFMI symptom, yet only present in 18 (25%) patients. Patients presenting with a history of at-risk surgery (OR 2.3, 95%CI 1.1, 4.8, p = 0.03), presence of a tracheostomy (OR 3.1, 95%CI 1.0, 10.0, p = 0.04), or presence of a surgical feeding tube (OR 3.1, 95%CI 1.6, 6.2, p = 0.001) were more likely to present with VFMI. CONCLUSION Routine screening for VFMI should be considered in all at-risk patients, regardless of symptoms or prior operations, particularly in those with a history of an at-risk surgery, presence of tracheostomy, or a surgical feeding tube. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3564-3570, 2023.
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Affiliation(s)
- Jay W Meisner
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Shawn Izadi
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Ali Kamran
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Hester F Shieh
- Department of Surgery, Johns Hopkins All Childrens, St Petersburg, Florida, U.S.A
| | - C Jason Smithers
- Department of Surgery, Johns Hopkins All Childrens, St Petersburg, Florida, U.S.A
| | - John Bennett
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Claire Lawlor
- Department of Ear, Nose and Throat Surgery, Children's National, Washington, District of Columbia, U.S.A
| | - Sukgi S Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
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Brennan MM, Herlihy A, Kelly S, Lawlor C, Heavey L. Treat Climate Change like the Public Health Emergency it is. Ir Med J 2023; 116:4. [PMID: 36916733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Blumenthal D, Leonard JA, Habib A, Behzadpour H, Lawlor C, Preciado D. Decannulation in Trisomy 21 patients undergoing laryngotracheal reconstruction. Int J Pediatr Otorhinolaryngol 2023; 164:111407. [PMID: 36525699 DOI: 10.1016/j.ijporl.2022.111407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Down Syndrome (DS) patients are more susceptible to either congenital or acquired subglottic stenosis (SGS). This often creates a multilevel airway obstruction and can lead to tracheostomy dependence early in life. As a result, they may require Laryngotracheal Reconstruction (LTR) to achieve decannulation. The primary objective of this study was to assess decannulation rates, time to decannulation and potential barriers to decannulation in DS patients undergoing LTR. METHODS We performed a retrospective chart review from 2008 to 2021 of 193 children who underwent LTR for treatment for laryngotracheal stenosis at a stand-alone tertiary children's hospital. The relationship between clinical data and decannulation status was evaluated using multivariable logistic regression and Fisher exact tests. Time to decannulation analysis was performed using Kaplan Meier analysis and evaluated with log-rank and Cox proportional hazards regression. RESULTS We determined that DS patients carry an inherit risk for decannulation failure compared to the general population (OR: 6.112, P = . 044, CI 1.046-35.730). Of the 8 patients with DS only three were decannulated. Overall, patients with Trisomy 21 had a significantly increased time to decannulation when compared to all LTR patients (P = .008, Log-rank). We found that these patients are more likely to have both suprastomal collapse (P = .0004, Fischer's Exact) and Tracheomalacia (P = .034, Fischer's Exact) compared to all other LTR patients. While post-operative tracheomalacia did not significantly affect decannulation failure (P = .056, Fischer's Exact) it did significantly prolong decannulation in all LTR patients (P = .018, Log-rank). CONCLUSION Trisomy 21 patients are at an increased risk for decannulation failure. Our study illustrates that these poor outcomes are likely a result of conditions more commonly found in this cohort including: narrow tracheal caliber, tracheomalacia and hypotonia.
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Affiliation(s)
- Daniel Blumenthal
- Department of Otolaryngology and Head and Neck Surgery Residency, Medstar Georgetown University Hospital, Washington, DC, USA
| | - James A Leonard
- Department of Otolaryngology and Head and Neck Surgery Residency, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Andy Habib
- Georgetown University School of Medicine, USA
| | - Hengameh Behzadpour
- Department of Pediatric Otolaryngology, Children's National Medical Center, USA
| | - Claire Lawlor
- Department of Pediatric Otolaryngology, Children's National Medical Center, USA; George Washington University School of Medicine, USA
| | - Diego Preciado
- Department of Pediatric Otolaryngology, Children's National Medical Center, USA; George Washington University School of Medicine, USA.
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Spyreli E, McGowan L, Heery E, Kelly A, Croker H, Lawlor C, O'Neill R, Kelleher CC, McCarthy M, Wall P, Heinen MM. Public beliefs about the consequences of living with obesity in the Republic of Ireland and Northern Ireland. BMC Public Health 2022; 22:1910. [PMID: 36229815 PMCID: PMC9559245 DOI: 10.1186/s12889-022-14280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to capture public beliefs about living with obesity, examine how these beliefs have changed over time and to explore whether certain characteristics were associated with them in a nationally representative sample of adults from the Republic of Ireland (RoI) and Northern Ireland (NI). Methods A cross-sectional survey employed a random quota sampling approach to recruit a nationally representative sample of 1046 adults across NI and RoI. Telephone interviews captured information on demographics; health behaviours & attitudes; and beliefs about the consequences of obesity (measured using the Obesity Beliefs Scale). Univariable analyses compared beliefs about the consequences of living with obesity between participants with a self-reported healthy weight and those living with overweight or obesity, and non-responders (those for whom weight status could not be ascertained due to missing data). Multiple linear regression examined associations between obesity-related beliefs and socio-demographics, self-rated health and perceived ability to change health behaviours. Multiple linear regression also compared changes in obesity-related beliefs between 2013 and 2020 in the RoI. Results Higher endorsement of the negative outcomes of obesity was significantly associated with living with a healthy weight, higher self-rated health, dietary quality and perceived ability to improve diet and physical activity. Those who lived with overweight, with obesity and non-responders were less likely to endorse the negative consequences of obesity. Those living with obesity and non-responders were also more likely to support there is an increased cost and effort in maintaining a healthy weight. Comparison with survey data from 2013 showed that currently, there is a greater endorsement of the health benefits of maintaining a healthy weight (p < 0001), but also of the increased costs associated with it (p < 0001). Conclusion Beliefs about the consequences of maintaining a healthy body weight are associated with individuals’ weight, self-rated health, diet and perceived ease of adoption of dietary and exercise-related improvements. Beliefs about the health risks of obesity and perceived greater costs associated with maintaining a healthy weight appear to have strengthened over time. Present findings are pertinent to researchers and policy makers involved in the design and framing of interventions to address obesity. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-14280-9.
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Affiliation(s)
- Eleni Spyreli
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK.
| | - L McGowan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - E Heery
- Library and Research Service, Oireachtas, Houses of the Oireachtas Service, Dublin, Ireland
| | - A Kelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - H Croker
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - C Lawlor
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
| | - R O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - C C Kelleher
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
| | - M McCarthy
- Cork University Business School, University College Cork, Cork, Ireland
| | - P Wall
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
| | - M M Heinen
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
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Baldassari CM, Lam DJ, Ishman SL, Chernobilsky B, Friedman NR, Giordano T, Lawlor C, Mitchell RB, Nardone H, Ruda J, Zalzal H, Deneal A, Dhepyasuwan N, Rosenfeld RM. Expert Consensus Statement: Pediatric Drug-Induced Sleep Endoscopy. Otolaryngol Head Neck Surg 2021; 165:578-591. [PMID: 33400611 DOI: 10.1177/0194599820985000] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 12/16/2022]
Abstract
OBJECTIVE To develop an expert consensus statement on pediatric drug-induced sleep endoscopy (DISE) that clarifies controversies and offers opportunities for quality improvement. Pediatric DISE was defined as flexible endoscopy to examine the upper airway of a child with obstructive sleep apnea who is sedated and asleep. METHODS Development group members with expertise in pediatric DISE followed established guidelines for developing consensus statements. A search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements regarding DISE in children 0 to 18 years old. Topics with significant practice variation and those that would improve the quality of patient care were prioritized. RESULTS The development group identified 59 candidate consensus statements, based on 50 initial proposed topics, that focused on addressing the following high-yield topics: (1) indications and utility, (2) protocol, (3) optimal sedation, (4) grading and interpretation, (5) complications and safety, and (6) outcomes for DISE-directed surgery. After 2 iterations of the Delphi survey and removal of duplicative statements, 26 statements met the criteria for consensus; 11 statements were designated as no consensus. Several areas, such as the role of DISE at the time of adenotonsillectomy, were identified as needing further research. CONCLUSION Expert consensus was achieved for 26 statements pertaining to indications, protocol, and outcomes for pediatric DISE. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to pediatric DISE.
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Affiliation(s)
- Cristina M Baldassari
- Eastern Virginia Medical School / Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Derek J Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center / University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Norman R Friedman
- Children's Hospital Colorado / University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Terri Giordano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Claire Lawlor
- Children's National Medical Center / George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Heather Nardone
- Nemours / Alfred I. duPont Hospital for Children, New Castle County, Delaware, USA
| | - James Ruda
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Habib Zalzal
- West Virginia University, Morgantown, West Virginia, USA
| | - Adrienne Deneal
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Affiliation(s)
- Claire Lawlor
- Children's National Medical Center, Department of Otolaryngology. Washington, DC
- George Washington University School of Medicine and Health Sciences. Washington, DC
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Lawlor C, Kawai K, Tracy L, Sobin L, Kenna M. Women in Otolaryngology: Experiences of Being Female in the Specialty. Laryngoscope 2020; 131:E380-E387. [PMID: 32702136 DOI: 10.1002/lary.28917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES A broad survey of women otolaryngologists on the current state of the field, including opportunities for advancement, support of family leave, and prevalence of harassment, has not been performed since 1998. An update on the experiences of female otolaryngologists is vital to continue to advance the specialty. STUDY DESIGN Anonymous web-based survey. METHODS Survey of members of the Women in Otolaryngology (WIO) section of the American Academy of Otolaryngology-Head and Neck Surgery (all members of the AAO-HNS that identify as female are automatically members of this section). Distributed via AAO-HNS. RESULTS Five hundred thirty-five responses out of 2303 total WIO members (response rate of 23.2%). Respondents ranged in age from 25 to >65 years. Respondents reported that in the residency programs they attended, 29% of residents, 13% of faculty, and 7% of department leaders were women. Forty-four percent disagreed that their department leaders and 39% disagreed that their male co-residents were supportive of women starting families in training. Younger respondents were more likely to feel that their department leaders were supportive of female residents, maternity leave, etc. Harassment in the current work environment did not differ by age; 53% reported harassment-free, 31% subtle undertones, 8% noticeable tones, 2% significant harassment. Harassment in the workplace varied by region; the greatest level of harassment was in the Midwest. CONCLUSIONS Women otolaryngologists continue to experience harassment in the workplace. It is encouraging that younger otolaryngologists feel more supported by their departments in both their careers and their personal lives. This survey highlights critical areas for continued growth within our specialty. LEVEL OF EVIDENCE IV Laryngoscope, 131:E380-E387, 2021.
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Affiliation(s)
- Claire Lawlor
- Department of Otolaryngology, Children's National Medical Center, Washington, District of Columbia, U.S.A.,George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, U.S.A
| | - Kosuke Kawai
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lauren Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Lindsay Sobin
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts, Worcester, Massachusetts, U.S.A
| | - Margaret Kenna
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
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Lawlor C, Balakrishnan K, Bottero S, Boudewyns A, Campisi P, Carter J, Cheng A, Cocciaglia A, DeAlarcon A, Derkay C, Fayoux P, Hart C, Hartnick C, LeBoulanger N, Moreddu E, Muntz H, Nicollas R, Peer S, Pransky S, Rahbar R, Russell J, Rutter M, Seedat R, Sidell D, Smith R, Soma M, Strychowsky J, Thompson D, Triglia JM, Trozzi M, Wyatt M, Zalzal G, Zur KB, Nuss R. International Pediatric Otolaryngology Group (IPOG): Juvenile-onset recurrent respiratory papillomatosis consensus recommendations. Int J Pediatr Otorhinolaryngol 2020; 128:109697. [PMID: 31698245 DOI: 10.1016/j.ijporl.2019.109697] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop consensus recommendations for the evaluation and management of juvenile-onset recurrent respiratory papillomatosis (JORRP) in pediatric patients. METHODS Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. RESULTS Consensus recommendations including diagnostic considerations, surgical management, systemic adjuvant therapies, postoperative management, surveillance, and voice evaluation. These recommendations are based on the collective opinion of the IPOG members and are targeted for otolaryngologists, primary care providers, pulmonologists, infectious disease specialists, and any other health care providers that manage patients with JORRP. CONCLUSIONS Pediatric JORRP consensus recommendations are aimed at improving care and outcomes in this patient population.
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Affiliation(s)
- Claire Lawlor
- Department of Otolaryngology, Children's National Health System, Washington, DC, United States.
| | | | - Sergio Bottero
- Department Pediatric Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paolo Campisi
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - John Carter
- Department of Otolaryngology, Ochsner Health System, New Orleans, LA, United States
| | - Alan Cheng
- Department of Pediatric Otolaryngology, The Sydney Children's Hospital Network-Westmead Campus, The University of Sydney, Sydney, NSW, Australia
| | - Alejandro Cocciaglia
- Servicio de Endoscopía Respiratoria, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alessandro DeAlarcon
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Craig Derkay
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Sentara Norfolk General Hospital, Norfolk, VA, United States
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Jeanne de Flandre Hospital-CHU Lille, Lille, France
| | - Catherine Hart
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Christopher Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Nicolas LeBoulanger
- Department of Otorhinolaryngology, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Eric Moreddu
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Harlan Muntz
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Richard Nicollas
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Shazia Peer
- Department of Otorhinolaryngology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Seth Pransky
- Pediatric Specialty Partners, San Diego, CA, United States
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| | - John Russell
- Department of Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Michael Rutter
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Riaz Seedat
- Department of Otorhinolaryngology, Universitas Academic Hospital, Bloemfontein, South Africa
| | - Douglas Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, United States
| | - Richard Smith
- Department of Otolaryngology -Head and Neck Surgery, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, United States
| | - Marlene Soma
- Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Julie Strychowsky
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, Western University, London, ON, Canada
| | - Dana Thompson
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, And Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Jean-Michel Triglia
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Marilena Trozzi
- Department Pediatric Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Michelle Wyatt
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Washington, DC, United States
| | - Karen B Zur
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Roger Nuss
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
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Lawlor C, Smithers CJ, Hamilton T, Baird C, Rahbar R, Choi S, Jennings R. Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy. Laryngoscope 2019; 130:E65-E74. [PMID: 30908672 DOI: 10.1002/lary.27938] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 02/09/2019] [Accepted: 02/27/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Combined anterior and posterior tracheobronchopexy is a novel surgical approach for the management of severe tracheobronchomalacia (TBM). We present our institutional experience with this procedure. Our objective was to determine the utility and safety of anterior and posterior tracheopexy in the treatment of severe TBM. STUDY DESIGN Retrospective chart review. METHODS All patients who underwent anterior and posterior tracheopexy from January 2013 to July 2017 were retrospectively reviewed. Charts were reviewed for indications, preoperative work-up, tracheobronchomalacia classification and severity, procedure, associated syndromes, synchronous upper aerodigestive tract lesions, and aberrant thoracic vessels. Main outcomes measured included improvement in respiratory symptoms, successful extubation and/or decannulation, vocal fold immobility, and new tracheotomy placement. RESULTS Twenty-five patients underwent anterior and posterior tracheopexy at a mean age of 15.8 months (range, 2-209 months; mean, 31 months if 2 outliers of 206 and 209 months included). Mean length of follow-up was 26.8 months (range, 13-52 months). Indications for surgery included apneic events, ventilator dependence, need for positive pressure ventilation, tracheotomy dependence secondary to TBM, recurrent pneumonia, and exercise intolerance. Many patients had other underlying syndromes and synchronous upper aerodigestive tract lesions (8 VACTERL, 2 CHARGE, 1 trisomy 21, 1 Feingold syndrome, 17 esophageal atresia/tracheoesophageal fistula, 20 cardiac/great vessel anomalies, 1 subglottic stenosis, 1 laryngomalacia, 7 laryngeal cleft). At preoperative bronchoscopy, 21 of 25 patients had >90% collapse of at least one segment of their trachea, and the remaining four had 70% to 90% collapse. Following anterior and posterior tracheopexy, one patient developed new bilateral vocal-fold immobility; one patient with a preoperative left cord paralysis had a new right vocal-fold immobility. Postoperatively, most patients had significant improvement in their respiratory symptoms (21 of 25, 84%) at most recent follow-up. Three patients with preexisting tracheotomy were decannulated; two patients still had a tracheotomy at last follow-up. Two patients required new tracheotomy for bilateral vocal-fold immobility. CONCLUSIONS Combined anterior and posterior tracheopexy is a promising new technique for the surgical management of severe TBM. Further experience and longer follow-up are needed to validate this contemporary approach and to minimize the risk of recurrent laryngeal nerve injury. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E65-E74, 2020.
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Affiliation(s)
- Claire Lawlor
- Department of Otolaryngology, Children's National Medical Center, Washington, DC
| | | | - Thomas Hamilton
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Christopher Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Reza Rahbar
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Russell Jennings
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
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Choi S, Lawlor C, Rahbar R, Jennings R. Diagnosis, Classification, and Management of Pediatric Tracheobronchomalacia. JAMA Otolaryngol Head Neck Surg 2019; 145:265-275. [DOI: 10.1001/jamaoto.2018.3276] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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]
Affiliation(s)
- Sukgi Choi
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
| | - Claire Lawlor
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
| | - Russell Jennings
- Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
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Gogia M, Lawlor C, Shengelia N, Stvilia K, Raymond HF. Hidden populations: discovering the differences between the known and the unknown drug using populations in the Republic of Georgia. Harm Reduct J 2019; 16:15. [PMID: 30755222 PMCID: PMC6373035 DOI: 10.1186/s12954-019-0287-5] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background The HIV epidemic in Georgia is increasing. Data shows that compared to previous years, Georgia has increasingly more HIV-infected individuals than previous assessments. Select client groups remain hard to reach by harm reduction programs. The need for innovative strategies to involve these individuals is imperative. Methods The following study examines demographics and risk factors of participants, previously known and not known to harm reduction services, for HIV and other infectious disease in towns across Georgia in 2015 and compares risk among different groups, while also assessing the rationale for implementing Peer-Driven Interventions in Georgian Harm Reduction activities. Important differences in demographics and risk profile are thought to exist between those exposed, and those unexposed, to harm reduction activity. Results Important and striking differences between previously known and unknown participants, including demographic background and risk profile and behaviours exist in the drug using community. These differences can potentially explain some of the rise of HIV prevalence in Georgia. Conclusion Significant differences exist between known and unknown drug users in Georgia, the differences between which are crucial for planning future and holistic harm reduction activities in Georgia, regionally and globally. The research advocates for smarter harm reduction activity, adds to the global evidence for the utility of Peer-Driven Intervention, and encourages sustained global effort for reduction of blood-borne disease burden globally.
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Affiliation(s)
- M Gogia
- The Georgian Harm Reduction Network, Tbilisi, Georgia.
| | - C Lawlor
- The Georgian Harm Reduction Network, Tbilisi, Georgia
| | - N Shengelia
- Curatio International Foundation, Tbilisi, Georgia
| | - K Stvilia
- The National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | - H F Raymond
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
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Abstract
Osteochondromas, the most common benign bone tumors, are cartilaginous neoplasms of unknown origin with rare malignant potential. Osteochondromas rarely occur in the head and neck, and diagnosis relies on a combination of clinical, radiological, and histological criteria. Excision is often curative. We describe the first reported case of hyoid osteochondroma in an adolescent male with multiple osteochondroma, discuss its surgical management, and perform a review of the salient literature. Osteochondroma represents a rare diagnosis to include in the differential of any midline neck mass.
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Affiliation(s)
- Blake S Raggio
- 1 Tulane University Medical Center, New Orleans, LA, USA
| | - Samuel Ficenec
- 1 Tulane University Medical Center, New Orleans, LA, USA
| | | | - Claire Lawlor
- 1 Tulane University Medical Center, New Orleans, LA, USA
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Kelly G, Hughes R, McGarry T, van den Born M, Adamzik K, Fitzgerald R, Lawlor C, Tobin AM, Sweeney CM, Kirby B. Dysregulated cytokine expression in lesional and nonlesional skin in hidradenitis suppurativa. Br J Dermatol 2015; 173:1431-9. [PMID: 26282467 DOI: 10.1111/bjd.14075] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a dearth of information on the precise pathogenesis of hidradenitis suppurativa (HS), but immune dysregulation is implicated. OBJECTIVES To determine the nature of the immune response in HS. METHODS Skin biopsies - lesional, perilesional (2 cm away) and uninvolved (10 cm away) - were obtained from patients with HS and healthy controls. The expression of various cytokines was determined by enzyme-linked immunosorbent assay, flow cytometry and real-time polymerase chain reaction. RESULTS The expression of the inflammatory cytokines interleukin (IL)-17, IL-1β and tumour necrosis factor-α was enhanced in lesional skin of patients with HS. In addition, IL17A and IL1B mRNA were enhanced in clinically normal perilesional skin. CD4(+) T cells produced IL-17 in HS, while CD11c(+) CD1a(-) CD14(+) cells were sources of IL-1β. Activated caspase-1 was detected in HS skin and was associated with enhanced expression of NLRP3 and IL18. Inhibition of caspase-1 decreased IL-1β and IL-18 production, suggesting that the caspase-1 pathway participates in IL-1β and IL-18 expression in HS. Abnormal cytokine expression was detected in perilesional and uninvolved skin, which may suggest that subclinical inflammation is present in HS skin prior to the formation of an active lesion. CONCLUSIONS This study demonstrates that CD4(+) T cells produce IL-17 in HS and that the IL-17 pathway may be important in HS pathogenesis. CD11c(+) CD1a(-) CD14(+) cells are a source of IL-1β in HS, the production of which was shown to be mediated, in part, via a caspase-1-dependent pathway. These results suggest that IL-17 and the caspase-1-associated cytokines IL-1β and IL-18 may play a role in the pathogenesis of HS.
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Affiliation(s)
- G Kelly
- Dermatology Research, Education and Research Centre, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
| | - R Hughes
- Dermatology Research, Education and Research Centre, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
| | - T McGarry
- Department of Rheumatology, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland.,The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - M van den Born
- Dermatology Research, Education and Research Centre, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
| | - K Adamzik
- Department of Dermatology, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
| | - R Fitzgerald
- Department of Dermatology, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - C Lawlor
- Department of Plastic Surgery, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
| | - A M Tobin
- Department of Dermatology, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - C M Sweeney
- Dermatology Research, Education and Research Centre, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
| | - B Kirby
- Department of Dermatology, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
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Howard L, Flach C, Leese M, Byford S, Killaspy H, Cole L, Lawlor C, Betts J, Sharac J, Cutting P, McNicholas S, Johnson S. Effectiveness and cost-effectiveness of admissions to women's crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial. Br J Psychiatry 2014; 53:s32-40. [PMID: 20679277 DOI: 10.1192/bjp.bp.110.081083] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 11/23/2022]
Abstract
BACKGROUND Women's crisis houses have been developed in the UK as a less stigmatising and less institutional alternative to traditional psychiatric wards. AIMS To examine the effectiveness and cost-effectiveness of women's crisis houses by first examining the feasibility of a pilot patient-preference randomised controlled trial (PP-RCT) design (ISRCTN20804014). METHOD We used a PP-RCT study design to investigate women presenting in crisis needing informal admission. The four study arms were the patient preference arms of women's crisis house or hospital admission, and randomised arms of women's crisis house or hospital admission. RESULTS Forty-one women entered the randomised arms of the trial (crisis house n = 19, wards n = 22) and 61 entered the patient-preference arms (crisis house n = 37, ward n = 24). There was no significant difference in outcomes (symptoms, functioning, perceived coercion, stigma, unmet needs or quality of life) or costs for any of the groups (randomised or preference arms), but women who obtained their preferred intervention were more satisfied with treatment. CONCLUSIONS Although the sample sizes were too small to allow definite conclusions, the results suggest that when services are able to provide interventions preferred by patients, those patients are more likely to be satisfied with treatment. This pilot study provides some evidence that women's crisis houses are as effective as traditional psychiatric wards, and may be more cost-effective.
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Affiliation(s)
- L Howard
- Health Service and Population Research Department, Institute of Psychiatry, Box PO29, De Crespigny Park, London SE5 8AF, UK.
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Carter JM, Lawlor C, Guarisco JL. The efficacy of mitomycin and stenting in choanal atresia repair: a 20 year experience. Int J Pediatr Otorhinolaryngol 2014; 78:307-11. [PMID: 24367937 DOI: 10.1016/j.ijporl.2013.11.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 10/10/2013] [Revised: 11/16/2013] [Accepted: 11/21/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the efficacy of topical mitomycin and stenting in patients that have undergone endoscopic repair of choanal atresia. METHODS Retrospective review of 37 endoscopic operations on pediatric patients for choanal atresia. RESULTS Twenty-six sides were operated on in 17 patients; 37 total operations were performed. All 17 patients were repaired endoscopically with 1 patient requiring transpalatal revision surgery. Eight patients (47%) had a unilateral atresia and 9 (53%) were bilateral. Eleven total sides (42%) were treated initially with mitomycin. Eighteen percent of those sides required post-operative dilation vs. 40% of the sides not treated with mitomycin (p=0.39) and no patient in the mitomycin group required revision surgery compared to 20% of patients not treated with mitomycin (p=0.24). Significantly fewer sides in the mitomycin group (9%) developed granulation vs. those treated without (53%) (p=0.03). The average number of procedures performed (1.18 vs. 2.53; p=0.002) was significantly fewer in those patients treated with mitomycin vs. not. A greater amount of sides in the stent group developed granulation tissue (50% vs.0%; p=0.023). The average number of procedures performed was significantly greater in those patients treated with a stent (2.33 vs. 1.12; p=0.008). The average time spent in the hospital was significantly shorter (7.09 vs. 2.33 days; p=0.02) in those patients treated without stenting. CONCLUSION Topical mitomycin is efficacious as an adjuvant therapy as it was associated with the formation of less granulation tissue, a lower rate of restenosis and fewer surgeries. Stenting was associated with significantly more procedures, greater formation of granulation tissue and longer overall hospital stays. However, consideration should be given toward stent placement in all neonates for the prevention of post-operative airway obstruction. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- John M Carter
- Tulane University Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, New Orleans, LA 70112, United States.
| | - Claire Lawlor
- Tulane University Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, New Orleans, LA 70112, United States.
| | - J Lindhe Guarisco
- Ochsner Medical Center - Department of Otolaryngology - Head & Neck Surgery, 1514 Jefferson Hwy, Jefferson, LA 70121, United States.
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Fowler V, Robinson L, Bankowski B, Cox S, Parida S, Lawlor C, Gibson D, O'Brien F, Ellefsen B, Hannaman D, Takamatsu HH, Barnett PV. A DNA vaccination regime including protein boost and electroporation protects cattle against foot-and-mouth disease. Antiviral Res 2012; 94:25-34. [PMID: 22330893 DOI: 10.1016/j.antiviral.2012.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/27/2012] [Accepted: 02/02/2012] [Indexed: 11/21/2022]
Abstract
Protection against foot-and-mouth disease (FMD) using DNA technology has been documented for sheep and pigs but not for the highly susceptible species of cattle. Twenty-five Holstein Friesian cross-bred cattle were vaccinated twice, 21 days apart, with a DNA vaccine containing the capsid coding region (P1) along with the non-structural proteins 2A, 3C and 3D (pcDNA3.1/P1-2A3C3D) of O(1) Kaufbeuren alone or coated onto PLG (d,l-lactide-co-glycolide) microparticles. In some pcDNA3.1/P1-2A3C3D was also combined with an adjuvant plasmid expressing bovine granulocyte macrophage colony stimulating factor (GM-CSF). DNA vaccinations were administered intramuscularly with, or without, the use of electroporation and at 42 days post primary vaccination cattle received a protein boost of 146S FMD virus (FMDV) antigen and non-structural protein 3D. For comparison, four cattle were vaccinated with a conventional FMD vaccine and two more included as unvaccinated controls. Apart from those immunised with PLG microparticles all cattle were challenged with 10(5) TCID(50) cattle adapted O(1) Lausanne FMDV virus at day 93 post primary vaccination. All DNA vaccinated cattle regardless of regime developed good humoral and cell mediated responses prior to challenge. The best overall virus neutralising antibody, IFN-γ and clinical protection (75%) were seen in the cattle whereby the DNA was delivered by electroporation. In contrast, only 25% of cattle vaccinated with the DNA vaccine without electroporation were clinically protected. The addition of GM-CSF in combination with electroporation further improved the efficacy of the vaccine, as demonstrated from the reduction of clinical disease and virus excretions in nasal swabs. We thus demonstrate for the first time that cattle can be clinically protected against FMDV challenge following a DNA prime-protein boost strategy, and particularly when DNA vaccine is combined with GM-CSF and delivered by electroporation.
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Affiliation(s)
- V Fowler
- Institute for Animal Health, Pirbright Laboratory, Surrey, UK.
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Lawlor C, O'Sullivan MP, Rice B, Dillon P, Gallagher PJ, O'Leary S, Shoyele S, Keane J, Cryan SA. Therapeutic aerosol bioengineering of targeted, inhalable microparticle formulations to treat Mycobacterium tuberculosis (MTb). J Mater Sci Mater Med 2012; 23:89-98. [PMID: 22183789 DOI: 10.1007/s10856-011-4511-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 11/30/2011] [Indexed: 05/31/2023]
Abstract
Therapeutic aerosol bioengineering (TAB) of Mycobacterium tuberculosis (MTb) therapies using inhalable microparticles offers a unique opportunity to target drugs to the site of infection in the alveolar macrophages, thereby increasing dosing in the lungs and limiting systemic exposure to often toxic drugs. Previous work by us used sophisticated, high content analysis to design the optimal poly(lactide-co-glycolic) acid (PLGA) microparticle for delivery of drugs to alveolar macrophages. Herein, we applied this technology to three different anti-MTb drugs. These formulations were then tested for encapsulation efficiency, drug-release, in vitro killing against MTb and aerosol performance. Methods for encapsulating each of the drugs in the PLGA microparticles were successfully developed and found to be capable of controlling the release of the drug for up to 4 days. The efficacy of each of the encapsulated anti-MTb drugs was maintained and in some cases enhanced post-encapsulation. A method of processing these drug-loaded microparticles for inhalation using standard dry powder inhaler devices was successfully developed that enabled a very high respirable dose of the drug to be delivered from a simple dry powder inhaler device. Overall, TAB offers unique opportunities to more effectively treat MTb with many potential clinical and economic benefits resulting.
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Affiliation(s)
- C Lawlor
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Seoighe D, Dempsey M, Lawlor C, O’Dwyer A. Factitious disorder as a differential diagnosis for recurrent skin graft failure. J Plast Reconstr Aesthet Surg 2011; 64:e89-91. [DOI: 10.1016/j.bjps.2010.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 11/02/2010] [Accepted: 11/05/2010] [Indexed: 11/27/2022]
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Lawlor C, O'Sullivan M, O’Leary S, Bowie R, Keane J, Gallagher P, Cryan S. A study of the interaction of novel, coated microparticles with alveolar macrophages and their application in tuberculosis treatment via inhalation. Drug Discov Today 2010. [DOI: 10.1016/j.drudis.2010.09.422] [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: 10/18/2022]
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Frimpong K, Wzorek J, Lawlor C, Spencer K, Mitzel T. Use of N-methylformamide as a solvent in indium-promoted Barbier reactions en route to enediyne and epoxy diyne formation: comparison of rate and stereoselectivity in C-C bond-forming reactions with water. J Org Chem 2010; 74:5861-70. [PMID: 19634900 PMCID: PMC2976581 DOI: 10.1021/jo900763u] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 11/30/2022]
Abstract
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Indium-promoted coupling reactions between propargyl aldehydes (1) and α-chloropropargylphenyl sulfide are reported. Although water has been shown to accelerate indium metal promoted reactions, the reverse pattern was observed in this series. Use of N-methylformamide (NMF), which has not previously been a solvent known for use in indium-promoted reactions, afforded an acceleration of these Barbier-style reactions compared to water. Indium-promoted reactions in this study also showed excellent regiocontrol and good stereocontrol, allowing for easy entry into the formation of epoxydiyne and enediyne skeletal structures. This paper also describes use of the Barbier Coupled product (2) as a new, and easy, entry into the formation of enediyne and epoxydiyne skeletal structures.
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Affiliation(s)
- Kwame Frimpong
- Department of Chemistry, Trinity College, 300 Summit Street, Hartford, Connecticut 06106, USA
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Savage DB, Nolan JV, Godwin IR, Mayer DG, Aoetpah A, Nguyen T, Baillie ND, Rheinberger TE, Lawlor C. Water and feed intake responses of sheep to drinking water temperature in hot conditions. ACTA ACUST UNITED AC 2008. [DOI: 10.1071/ea08056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
When live-export sheep from Australia arrive in the Middle East during the northern summer months, they may be offered drinking water at temperatures exceeding 40°C. There is little published research to indicate whether drinking water temperature is important in managing heat stress in sheep or its effect on their health and welfare. Three studies were conducted with Merino wethers in climate-controlled rooms to investigate: (i) responses to drinking water temperatures of 20°C, 30°C and 40°C in a cool (20°C) and hot (40°C) environment, (ii) preferences for drinking water temperature at 20°C or 30°C when in a hot or cool environment and (iii) effects of water restriction when offered hot water (40°C) in a hot environment. Sheep assigned to the hot room had significantly higher respiration rates than those assigned to the cool room. In the cool environment, water intakes were the same when water temperatures were 20°C, 30°C or 40°C; however, when the sheep were given a choice between drinking water at 20°C and 30°C, they preferred (P < 0.05) to drink water at 20°C. In the hot environment, water intake increased as drinking water temperature increased, and sheep preferred to drink water at 30°C rather than 20°C. When the availability of 40°C drinking water was restricted (to ~10% of liveweight) in the hot environment, sheep had higher respiration rates than those offered unlimited water.
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Alam M, Moynagh M, Lawlor C. Cement burns: the dublin national burns unit experience. J Burns Wounds 2007; 7:e4. [PMID: 18091981 PMCID: PMC2064966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Cement burns account for relatively few admissions to a burn unit; however, these burns deserve separate consideration because of special features of diagnosis and management. Cement burns, even though potentially disabling, have rarely been reported in literature. METHODS A retrospective review was performed of all patients admitted with cement burns injuries to the national burns unit at the St James's Hospital in Dublin, Ireland, over a 10-year period for the years 1996-2005. RESULTS A total of 46 patients with cement burns were admitted. The majority of patients were aged 16-74 years (mean age = 32 years). Eighty-seven percent of injuries occurred in an industrial and 13% in a domestic setting. The upper and lower extremities were involved in all the patients, and the mean total body surface area affected was 6.5%. The mean length of hospital stay was 21 days with a range of 1-40 days. Thirty-eight (82%) were surgically managed involving debridement and split-thickness skin graft (SSG) and four (9%) were conservatively managed. A further four did not have data available. CONCLUSION Widespread inexperience in dealing with this group of cement burns patients and delays in referral to burns unit highlights the potential for greater levels of general awareness and knowledge in both prevention and treatment of these burns. As well, early debridement and split-thickness skin grafting at diagnosis constitutes the best means of reducing the high socioeconomic costs and allows for early return to work.
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Affiliation(s)
- Munir Alam
- St James's Hospital, Dublin 8, Ireland,Correspondence:
| | | | - C. Lawlor
- St James's Hospital, Dublin 8, Ireland
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Murphy SM, Davidson C, Kennedy AM, Eadie PA, Lawlor C. Backyard burning. J Plast Reconstr Aesthet Surg 2007; 61:180-2. [PMID: 17502168 DOI: 10.1016/j.bjps.2006.11.033] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Revised: 10/27/2006] [Accepted: 11/22/2006] [Indexed: 11/27/2022]
Abstract
This study was undertaken to determine whether changes had occurred in the numbers of burns that could be related to backyard burning subsequent to the introduction of the council tax throughout Eire for the collection of household refuse. Numbers of patients admitted to our unit who had sustained burns by burning rubbish were recorded prospectively over a period of 12 months. A random control group was taken as three years prior to this and results found by retrospective chart review. Between January and November 2005, 168 patients were admitted to the National Burns Unit, St James's Hospital Dublin, Ireland. Nineteen of these patients sustained flame burns from backyard burning. One hundred and seventy patients were admitted in the comparative period of 2002; Seven of these from backyard burning. The total number of inpatient days for these patients in 2005 (255) was significantly more than in 2002 (68) (p=0.024). The numbers in our study show a marked increase in the number of patients sustaining burns in this manner, and appear to correlate with the introduction of bin charges by a number of county councils around the country last year. This study demonstrates that the introduction of legislation can have an unforeseen adverse affect on the population if not introduced in correlation with appropriate public education. While the introduction of waste charges represents a very necessary move forward in waste disposal in Ireland, public awareness campaigns should be implemented to prevent further such injuries from occurring.
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Affiliation(s)
- S M Murphy
- National Burns Unit, St James's Hospital, James's Street, Dublin 8, Ireland.
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Möllmann H, Wagner M, Krishnaswami S, Dimova H, Tang Y, Falcoz C, Daley-Yates PT, Krieg M, Stöckmann R, Barth J, Lawlor C, Möllmann AC, Derendorf H, Hochhaus G. Single-dose and steady-state pharmacokinetic and pharmacodynamic evaluation of therapeutically clinically equivalent doses of inhaled fluticasone propionate and budesonide, given as Diskus or Turbohaler dry-powder inhalers to healthy subjects. J Clin Pharmacol 2001; 41:1329-38. [PMID: 11762560 DOI: 10.1177/00912700122012913] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Direct comparisons of the pharmacokinetic (PK) and systemic pharmacodynamic (PD) properties of inhaled corticosteroids after single and multiple dosing in the same subjects are scarce. The objective of this study was to compare thePK/PDproperties of clinically equivalent, single, and multiple doses of dry-powder formulations of inhaled fluticasone propionate (FP 200 and 500 microg via Diskus) and budesonide (BUD, 400 and 1,000 microg via Turbohaler). Fourteen healthy subjects completed a double-blind, double-dummy, randomized, placebo-controlled, five-way crossover study consisting of a single dose administered at 8 a.m. on day 1 followed by 4 days of twice-daily dosing at 8 a.m. and 8 p.m. on days 2 to 5. Serum concentrations of FP and BUD were measured using validated liquid chromatography/ mass spectrometry assays. The 24-hour cumulative cortisol suppression (CCS) in serum was monitored as the pharmacodynamic surrogate marker. Peak serum concentrations following single and multiple dosing were observed 10 to 30 minutes after inhalation for BUD and 30 to 90 minutes afterinhalation of FP with no influence of dose ordosingregimen. After a single dose of 1000 microg BUD and 500 microg FP the median estimates of terminal half-life and mean residence time were 3.5 and 3.9 hours for BUD and 10.1 and 12.0 hours for FP, respectively. Using previously reported intravenous data, the mean absorption times (MAT) were calculated to be around 2 hours and 7 hours for BUD and FP respectively. On average, the area under the curve (A UC) at steady state (day 5) was up to 30% higher for BUD compared to that over a 12-hour period following the first dose on day 1, whereas A UC estimates were 50% to 80% higherforFP at steady state, indicating accumulation. However, the steady-state Cmax values were seven to eight times and AUC values three to four times higher for BUD than for FP. Comparison of active treatment data with placebo showed that CCS after a single dose was not pronounced for any of the doses/drugs studied. On day 5, both doses of BUD caused statistically significant suppression (CCS of 19% for the 400 microg dose and 36% for the 1,000 microg dose). For FP only the high dose had a statistically significant effect on serum cortisol (CCS of 14% for the 200 microg dose and 27% for the 500 microg dose). Compared to BUD, FP has slower pulmonary absorption and slower elimination kinetics. However, following inhalation of therapeutically equipotent, multiple twice-daily doses in healthy subjects, the systemic effects of FP delivered via Diskus on AUC24 serum cortisol were relatively low and similar to those of BUD delivered via Turbohaler.
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Affiliation(s)
- H Möllmann
- Medical Clinic Bergmannsheil, University of Bochum, Germany
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MacDonald TJ, Brown KM, LaFleur B, Peterson K, Lawlor C, Chen Y, Packer RJ, Cogen P, Stephan DA. Expression profiling of medulloblastoma: PDGFRA and the RAS/MAPK pathway as therapeutic targets for metastatic disease. Nat Genet 2001; 29:143-52. [PMID: 11544480 DOI: 10.1038/ng731] [Citation(s) in RCA: 310] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Little is known about the genetic regulation of medulloblastoma dissemination, but metastatic medulloblastoma is highly associated with poor outcome. We obtained expression profiles of 23 primary medulloblastomas clinically designated as either metastatic (M+) or non-metastatic (M0) and identified 85 genes whose expression differed significantly between classes. Using a class prediction algorithm based on these genes and a leave-one-out approach, we assigned sample class to these tumors (M+ or M0) with 72% accuracy and to four additional independent tumors with 100% accuracy. We also assigned the metastatic medulloblastoma cell line Daoy to the metastatic class. Notably, platelet-derived growth factor receptor alpha (PDGFRA) and members of the downstream RAS/mitogen-activated protein kinase (MAPK) signal transduction pathway are upregulated in M+ tumors. Immunohistochemical validation on an independent set of tumors shows significant overexpression of PDGFRA in M+ tumors compared to M0 tumors. Using in vitro assays, we show that platelet-derived growth factor alpha (PDGFA) enhances medulloblastoma migration and increases downstream MAP2K1 (MEK1), MAP2K2 (MEK2), MAPK1 (p42 MAPK) and MAPK3 (p44 MAPK) phosphorylation in a dose-dependent manner. Neutralizing antibodies to PDGFRA blocks MAP2K1, MAP2K2 and MAPK1/3 phosphorylation, whereas U0126, a highly specific inhibitor of MAP2K1 and MAP2K2, also blocks MAPK1/3. Both inhibit migration and prevent PDGFA-stimulated migration. These results provide the first insight into the genetic regulation of medulloblastoma metastasis and are the first to suggest a role for PDGFRA and the RAS/MAPK signaling pathway in medulloblastoma metastasis. Inhibitors of PDGFRA and RAS proteins should therefore be considered for investigation as possible novel therapeutic strategies against medulloblastoma.
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Affiliation(s)
- T J MacDonald
- Center for Cancer and Transplantation Biology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, USA.
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Lawlor C, Suzuki A. The disease of the self: representing consumption, 1700-1830. Bull Hist Med 2000; 74:458-494. [PMID: 11016095 DOI: 10.1353/bhm.2000.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- C Lawlor
- University of Newcastle-upon-Tyne, U.K.
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Lawlor C. Sterne, Edward Baynard, and the history of cold bathing: medical Shandeism. Notes Queries 1999; 46:22-25. [PMID: 11623732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- C Lawlor
- Thomas Reid Institute, University of Aberdeen
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Lawler M, Locasciulli A, Bacigalupo A, Humphries P, Ljungman P, McCann SR, Nolan N, McDermott EW, Reynolds JR, McCann A, Rafferty R, Sweeney P, Carney D, O’Higgins NJ, Duffy MJ, Gardiner C, Reen DJ, O’Connell MA, Kelleher D, Hall N, O’Neill LAJ, Long A, McCarthy JV, Fernandes RS, Cotter TG, Ryan E, Kitching A, MacMathuna P, Mulligan E, Merriman R, Dervan P, Kelly P, Gorey TF, Lennon JR, Crowe J, Bennett MA, Kay EW, Curran B, O’Donoghue DP, Leader M, Croke DT, O’Connor JM, McKelvey-Martin VJ, McKenna PG, O’Riordan JM, Tobin A, O’Mahoney M, Keogh FM, O’Riordan J, McNamara C, McEneaney P, Daly PA, Farrell M, Young S, Gibbons D, McCarthy P, Mulcahy H, Parfrey NA, Sheahan K, Lambkin H, Mothersill C, Chin D, Sheehan K, Kelehan P, Parfrey N, Morrin M, Khan F, Delaney P, Rowan DM, Orminston WJ, Donnellan PP, Khalid A, Kerin M, O’Hanlon DM, Kent P, Given HF, Kennedy SM, McGeoch G, Spurr NK, Barrett J, O’Sullivan G, Collins JK, Willcocks T, Kennedy S, Dolan J, Gallagher W, McDermott E, O’Higgins N, Hagan R, McManus R, Ormiston W, Daly P, Sheils O, McDermott M, O’Briain DS, Maher D, Costello P, Flanagan F, Stack J, Ennis J, Grimes H, Yanni A, Harrison M, Lowry WS, Russell SEH, Atkinson RJ, White P, Hickey I, Bell DW, Biggart D, Doyle J, Staunton MJ, Gaffney EF, Dervan PA, McCabe MM, Fennelly JJ, Carney DN, O’Reilly M, McMahon JN, Moriarty M, Hurson B, O’Neill AJ, Magee H, O’Loughlin J, Dervan PA, Cremin P, Orminston W, McCarthy J, Redmond P, Duggan S, Rea S, Bouchier-Hayes D, O’Donnell J, Duggan C, Crown J, Bermingham D, Nugent A, Fleming C, Crosby P, Wolff S, McCarthy D, Walsh CB, Cassidy M, Husain S, Kay E, Thornhilll M, Whelan D, Barry D, Turner M, Prenderville W, Murphy F, Prendiville W, Gibson G, O’Grady T, Carmody M, Donohoe J, Walshe J, Murphy GM, O’Donoghue J, Kerin K, Ahern S, Molloy K, Goulden N, Pamphilon DH, O’Connell M, Power C, Leroux A, Perricaudet M, Walls D, Britton F, Brennan L, Barnett YA, Madden B, Wakelin LPG, Loughrey HC, Corley P, Redmond HP, Watson RWG, Keogh I, O’Hanlon D, Walsh S, Callaghan J, McNamara M, Benedict-Smith A, Barnes C, Neylon D, Fenton M, Searcey M, Topham CM, Wakelin LG, Howarth NM, Purohit A, Reed MJ, Potter BVL, Hatton WJ, McKerr G, Harvey D, Carson J, Hannigan BM, McCarthy PJ, McClean S, Hill BT, Costelloe C, Denny WA, Fingleton B, McDonnell S, Butler M, Corbally N, Dervan PA, Stephens JF, Martin G, McGirl A, Lawlor E, Gardiner N, Lynch S, Arce MD, O’Brien F, Duggan A, O’Herlihy S, Shanahan F, O’Keeffe G, McCann S, Sweeney K, Neill AO, Pamphilon D, Sheridan M, Reid I, Seymour CB, Walshe T, Hennessy TP, O’Mahony A, O’Connell’ J, Lawlor C, Nolan S, Morrisey D, Pedlow PJ, Walsh M, Lowry SW, McAleer JJA, McKeown SR, Afrasiabi M, Lappin TRJ, Joiner B, Hirst KV, Hirst DG, Sweeney E, VanderSpek J, Murphy J, Foss F. Irish Association for Cancer Research. Ir J Med Sci 1995. [DOI: 10.1007/bf02967834] [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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Abstract
In a double-blind, randomized, parallel-group study, five groups of 10 healthy men received single 5-minute infusions of 8 mg, 4 mg, 1 mg, 0.25 mg, or 0.1 mg ondansetron (as hydrochloride dihydrate) 30 minutes before oral administration of 30 ml syrup of ipecacuanha. Emetic episodes and nausea (100 mm visual analog scale) were assessed over an 8-hour period. There were no emetic episodes after 8 or 4 mg ondansetron. Seven, nine, and 10 subjects vomited after 1 mg, 0.25 mg and 0.1 mg ondansetron, respectively, with median times to onset of 62, 31, and 37 minutes. Median peak nausea scores were 0 mm for both 8 and 4 mg ondansetron and 30, 53, and 26 mm for 1, 0.25, and 0.1 mg ondansetron. Adverse events were mild. This model showed a close correlation with clinically effective doses of ondansetron. It may be successfully and safely used to assess the antiemetic potential of 5-HT3-receptor antagonists in healthy subjects.
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Affiliation(s)
- N Minton
- Clinical Pharmacology Division, Glaxo Group Research Ltd., Greenford, Middlesex, England
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