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Meharg DP, Naanyu V, Rambaldini B, Clarke MJ, Lacey C, Jebasingh F, Lopez-Jaramillo P, Gould GS, Aceves B, Alison JA, Chaiton M, Chen J, Gonzalez-Salazar F, Goodyear-Smith F, Gwynne KG, Lee KS, MacKay D, Maple-Brown L, Mishara BL, Nigenda G, Ramani-Chander A, Sherwood SG, Thomas N, Thrift AG, Anderson M. The Global Alliance for Chronic Diseases researchers' statement on non-communicable disease research with Indigenous peoples. Lancet Glob Health 2023; 11:e324-e326. [PMID: 36796972 DOI: 10.1016/s2214-109x(23)00039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023]
Affiliation(s)
- David P Meharg
- Sydney School of Health Sciences, University of Sydney, Sydney 2006, NSW, Australia; Faculty of Medicine and Health, and Poche Centre for Indigenous Health, University of Sydney, Sydney 2006, NSW, Australia.
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Marilyn J Clarke
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Cameron Lacey
- Māori Indigenous Health Innovation, University of Otago, Christchurch, New Zealand
| | - Felix Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Gillian S Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Benjamin Aceves
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jennifer A Alison
- Sydney School of Health Sciences, University of Sydney, Sydney 2006, NSW, Australia; Allied Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Jun Chen
- Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Francisco Gonzalez-Salazar
- Cytogenetics Department, Northeast Biomedical Research Center, Mexican Institute of Social Security, Monterrey, Mexico
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Kylie S Lee
- The Edith Collins Centre, Sydney Local Health District, Sydney, NSW, Australia; National Drug Research Institute and enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Burnet Institute, Melbourne, VIC, Australia; Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney 2006, NSW, Australia
| | - Diana MacKay
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia; Department of Endocrinology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia; Department of Endocrinology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Brian L Mishara
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Anusha Ramani-Chander
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Stephen G Sherwood
- Fundación EkoRural, Quito, Ecuador and Wageningen University, Wageningen, Netherlands
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Michael Anderson
- Waakebiness Institute for Indigenous Health, University of Toronto, Toronto, ON, Canada
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MacKay D, Freeman N, Boyle JA, Campbell S, McLean A, Peiris D, Corpus S, Connors C, Moore E, Wenitong M, Silver B, McIntyre HD, Shaw JE, Brown A, Kirkham R, Maple-Brown L. Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation. Int J Gynaecol Obstet 2021; 155:179-194. [PMID: 34331708 DOI: 10.1002/ijgo.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve prenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia. METHODS A qualitative evaluation, underpinned by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid-intervention. Semi-structured interviews were conducted with the participants, who included clinicians, regional policymakers and managers, and study implementation staff. RESULTS Interviewees (n = 45) reported that the early phase of the intervention had resulted in the establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management, including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor-intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy. CONCLUSION The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including the development of a communication and engagement strategy.
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Affiliation(s)
- Diana MacKay
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Natasha Freeman
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sandra Campbell
- College of Nursing and Midwifery, Charles Darwin University, Cairns, Queensland, Australia
| | - Anna McLean
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Diabetes and Endocrinology, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - David Peiris
- Centre for Health Systems Science, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Sumaria Corpus
- Danila Dilba Health Service, Darwin, Northern Territory, Australia
| | - Christine Connors
- Population & Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Mark Wenitong
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Silver
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - H David McIntyre
- Clinical Unit, Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Shaw
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Renae Kirkham
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Louise Maple-Brown
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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New RH, Hare MJL, MacKay D, Kasireddy V, Ellis E, Thomas ME, Chitturi S. Profound Hypocalcemia Following Thyroidectomy for Graves’ Disease. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Introduction: While transient parathyroid insufficiency is not an uncommon complication of thyroidectomy, severe and prolonged hypocalcemia attributed to a combination of post-surgical hypoparathyroidism, hungry bone syndrome (HBS) and hypovitaminosis D is unusual.
Clinical Case: A 17-year-old female from a remote community in Australia with Graves’ disease, complicated by exophthalmos and atrial flutter, underwent total thyroidectomy due to challenges with medication adherence leading to persistent thyrotoxicosis. FT4 was >150 pmol/L (normal 10–20 pmol/L) almost two years after diagnosis. Pre-operatively, she received Lugol’s iodine, carbimazole and beta-blockade. The operation was uncomplicated and three parathyroid glands were preserved. Within six hours of thyroidectomy, she developed symptomatic hypocalcemia with corrected calcium 1.9 mmol/L (7.6 mg/dL) (normal 2.2–2.65 mmol/L). PTH level was 0.8 pmol/L (normal 1.4–9.0 pmol/L). Magnesium and phosphate levels were initially normal but hyperphosphatemia developed the following day. 25-OH vitamin D was low (29 nmol/L, normal 50–150 nmol/L) and was corrected with high dose cholecalciferol.
Despite use of continuous intravenous calcium gluconate in addition to oral calcium carbonate, as well as both intravenous and oral calcitriol and magnesium, urinary calcium excretion remained undetectable. Teriparatide 20 mcg BD was commenced on post-operative day 14 with no demonstrable improvement in serum calcium. Less than 48 hours after cessation of parenteral calcium on day 18 post-operation, corrected calcium and ionised calcium declined to 1.47 mmol/L (5.9 mg/dL) and 0.46 mmol/L (normal 1.15–1.33 mmol/L) respectively, prompting recommencement of calcium infusion.
Her remarkably high requirement for calcium replacement with negligible urinary calcium excretion for at least one month in spite of parenteral calcium infusion for a total of three weeks’ duration is highly suggestive of HBS which became evident due to post-surgical hypoparathyroidism. She had elevated ALP (618 U/L, normal 35–140 U/L) and increased bone resorption marker (N-telopeptide/creatinine 262 nmol BCE/mmol, normal <100 nmol BCE/mmol), with osteopenia at lumbar spine (Z-score -1.7) and femur (Z-score -1.3). Additionally, vitamin D deficiency is likely to have contributed to the severity of hypocalcemia.
60 days after surgery, she was still requiring calcium carbonate 2500 mg QID (4 g/day elemental calcium) and calcitriol 1 mcg TDS. Her phosphate level had normalised and ALP gradually declined to 241 U/L.
Clinical Lesson: This case highlights the importance of attaining euthyroid status as early as possible pre-operatively to allow near-complete reversal of thyrotoxicosis-induced osteodystrophy, as indicated by normalisation of serum ALP, and ensuring vitamin D levels are replete prior to thyroidectomy for Graves’ disease.
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Affiliation(s)
- Ru H New
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - Matthew J L Hare
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - Diana MacKay
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - Vidya Kasireddy
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - Elna Ellis
- Department of Endocrinology, Alice Springs Hospital, Northern Territory, Australia
| | - Mahiban E Thomas
- Department of Maxillofacial Surgery, Royal Darwin Hospital, Northern Territory, Australia
| | - Sridhar Chitturi
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
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Eva N, Rocca M, MacKay D. Aha Moments and Continued Confusion: An Analysis of Threshold Concepts through Student Reflections in the ACRL Framework. C&RL 2021. [DOI: 10.5860/crl.82.2.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wood A, MacKay D, Fitzsimmons D, Derkenne R, Kirkham R, Boyle JA, Connors C, Whitbread C, Welsh A, Brown A, Shaw JE, Maple-Brown L. Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia. Int J Environ Res Public Health 2020; 17:ijerph17030720. [PMID: 31979123 PMCID: PMC7037226 DOI: 10.3390/ijerph17030720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/24/2023]
Abstract
Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as “discussed” (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.
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Affiliation(s)
- Anna Wood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
| | - Diana MacKay
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
| | - Dana Fitzsimmons
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Ruth Derkenne
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Renae Kirkham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
| | - Jacqueline A. Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | | | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
| | - Alison Welsh
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Alex Brown
- South Australia Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA 5005, Australia
| | - Jonathan E. Shaw
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia;
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
- Correspondence:
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6
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Kirkham R, MacKay D, Barzi F, Whitbread C, Kirkwood M, Graham S, Van Dokkum P, McIntyre HD, Shaw JE, Brown A, O'Dea K, Connors C, Oats J, Zimmet P, Boyle J, Maple-Brown L. Improving postpartum screening after diabetes in pregnancy: Results of a pilot study in remote Australia. Aust N Z J Obstet Gynaecol 2018; 59:430-435. [PMID: 30276799 DOI: 10.1111/ajo.12894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/27/2018] [Accepted: 08/07/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The postpartum period is a critical time to improve health outcomes for Aboriginal women, particularly for those who have chronic conditions. AIMS To assess enhanced support methods (for women following diabetes in pregnancy (DIP)) to improve completion rates of recommended postpartum health checks. MATERIALS AND METHODS Fifty-three Aboriginal women in the Northern Territory (NT) were contacted in the postpartum period to encourage medical check-ups. Messages were delivered through phone (call or text messages) or other methods (Facebook or email). The primary outcome was postpartum blood glucose testing (oral glucose tolerance testing (OGTT), random or fasting glucose and HbA1c). RESULTS Establishing contact with women was difficult. Of 137 messages sent to 52 women, 22 responded (42%). Phone was the most common contact method with successful contact made from 16 of 119 (13%) attempts. Rates of postpartum OGTT completion were higher in the group successfully contacted (32% vs 7%). However, for any postpartum glucose testing (including OGTT and HbA1c) rates were 25 of 42 (60%) and neither success in making contact nor the contact method was associated with higher rates. CONCLUSIONS The small sample size limits our conclusions; however, results highlight that engaging remote women postpartum is difficult. While rates of postpartum OGTT completion differed according to successful contacts, rates of any postpartum blood glucose testing did not. Further research is needed to explore feasible intervention methods to improve postpartum screening after a pregnancy complicated by diabetes.
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Affiliation(s)
- Renae Kirkham
- Menzies School of Health Research, Darwin, Australia
| | | | | | - Cherie Whitbread
- Menzies School of Health Research, Darwin, Australia.,Royal Darwin Hospital, Darwin, Australia
| | | | - Sian Graham
- Menzies School of Health Research, Darwin, Australia
| | - Paula Van Dokkum
- Baker IDI Heart and Diabetes Institute, Alice Springs, Australia.,Alice Springs Hospital, Alice Springs, Australia
| | - H David McIntyre
- Mater Medical Research Institute, Brisbane, Australia.,Obstetric Medicine, University of Queensland, Brisbane, Australia
| | - Jonathan E Shaw
- Clinical and Population Health Research, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kerin O'Dea
- Population Health Research, University of South Australia, Adelaide, Australia
| | - Christine Connors
- Darwin Region & Strategic Primary Health Care Branch, Top End Health Service, Northern Territory Department of Health, Darwin, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Darwin, Australia.,Royal Darwin Hospital, Darwin, Australia
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MacKay D, Nordenström A, Falhammar H. Bilateral Adrenalectomy in Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2018; 103:1767-1778. [PMID: 29554355 DOI: 10.1210/jc.2018-00217] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/09/2018] [Indexed: 02/04/2023]
Abstract
CONTEXT Management of congenital adrenal hyperplasia (CAH) involves suppression of the hypothalamic-pituitary-adrenal axis using supraphysiological doses of exogenous glucocorticoids. This can pose a challenge, with Cushing syndrome a frequent complication of adequate suppression. Bilateral adrenalectomy, with subsequent replacement of glucocorticoids and mineralocorticoids at physiological doses, has been proposed as an alternative therapeutic strategy. OBJECTIVE To review the outcomes after bilateral adrenalectomy for CAH. DATA SOURCES A systematic search of PubMed/MEDLINE and Web of Science, identifying relevant reports published up to 10 January 2018. STUDY SELECTION Case reports or case series were included if they reported individual patient data from patients with CAH who had undergone bilateral adrenalectomy. DATA EXTRACTION Information regarding the following was extracted: first author, country, sex, age at adrenalectomy, year of adrenalectomy, diagnosis, molecular abnormality, pre- and postoperative biochemistry, pre- and postoperative medications, pre- and postoperative body mass index, indication for adrenalectomy, surgical technique, gross and microscopic adrenal characteristics, follow-up duration, and short- and long-term postoperative outcomes. DATA SYNTHESIS We identified 48 cases of bilateral adrenalectomy for CAH, with patients aged from 4 months to 56 years at surgery. The most common indication for surgery was the inability to control hyperandrogenism/virilization and/or Cushing syndrome (n = 30; 62%). Most patients (n = 34; 71%) reported symptomatic improvement postoperatively, with some cases of short-term (n = 5; 10%) and long-term (n = 13; 27%) adverse outcomes. CONCLUSIONS Bilateral adrenalectomy for CAH appears to be a reasonable therapeutic option for carefully selected patients who have had unsatisfactory outcomes with conventional medical management.
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Affiliation(s)
- Diana MacKay
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Menzies School of Health Research, Darwin, Northern Territory, Australia
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Hastie CE, Smith GCS, MacKay D, Pell JP. 109 Maternal risk of ischaemic heart disease following elective and spontaneous preterm delivery: retrospective cohort study of 750 350 singleton pregnancies. Heart 2010. [DOI: 10.1136/hrt.2010.196089.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rweyemamu M, Roeder P, MacKay D, Sumption K, Brownlie J, Leforban Y. Planning for the progressive control of foot-and-mouth disease worldwide. Transbound Emerg Dis 2008; 55:73-87. [PMID: 18397510 DOI: 10.1111/j.1865-1682.2007.01016.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the wake of on-going successful programmes for global eradication of rinderpest and the current effort to contain the spread of avian influenza, the progressive world-wide control of FMD must be regarded as a major contribution to the international public good. FMD is the single most animal disease constraint to international trade in animal products. Its control is relevant, on the one hand, to protecting the livestock industries of industrialised countries and, on the other, to the livelihoods and income generation of developing countries, where, as a general rule, FMD continues to be endemic. The strategy that is advocated in this paper is one that is based on progressive risk reduction of FMD in the context of progressive market access of livestock commodities from developing countries. It is suggested that FMD control should be linked to improvement in livelihoods of livestock dependent communities in the FMD endemic settings. It is expected that this in turn will lead to increasing demand for effective national veterinary services and disease surveillance. This strategy has also taken lessons from the global rinderpest eradication programme and regional FMD control programmes in Europe and South America. The strategy that is advocated for the progressive control of FMD in the endemic settings is based on a seven stage process within a horizon of about 30 years, namely: (1) Assessing and defining national FMD status; (2) instituting vaccination and movement control; (3) suppressing virus transmission to achieve absence of clinical disease; (4) achieving freedom from FMD with vaccination in accordance with the OIE standards; (5) achieving freedom from FMD without vaccination in accordance with the OIE standards; (6) extending FMD free zones; and (7) maintaining FMD Freedom. Concomitant with progressive FMD control, there needs be the encouragement of such risk reduction measures as in-country commodity processing in order to encourage regulated trade in livestock commodities without unduly increasing the risk of disease spread. Finally, the progressive control of FMD should also be seen as part of reducing the overall, world-wide threat of infectious diseases to human health and economic development.
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Affiliation(s)
- M Rweyemamu
- Royal Veterinary College, Department of Pathology and Infectious Diseases, University of London and Woking, Surrey GU21 2LQ, UK.
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Roghani R, Grunfeld R, Hazard S, Hancey J, Natoli N, Ehrlich P, MacKay D, Miraliakbari R. P144. J Surg Res 2007. [DOI: 10.1016/j.jss.2006.12.375] [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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Mudher A, Shepherd D, Newman TA, Mildren P, Jukes JP, Squire A, Mears A, Drummond JA, Berg S, MacKay D, Asuni AA, Bhat R, Lovestone S. GSK-3beta inhibition reverses axonal transport defects and behavioural phenotypes in Drosophila. Mol Psychiatry 2004; 9:522-30. [PMID: 14993907 DOI: 10.1038/sj.mp.4001483] [Citation(s) in RCA: 211] [Impact Index Per Article: 10.6] [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] [Indexed: 12/19/2022]
Abstract
The tauopathies are a group of disorders characterised by aggregation of the microtubule-associated protein tau and include Alzheimer's disease (AD) and the fronto-temporal dementias (FTD). We have used Drosophila to analyse how tau abnormalities cause neurodegeneration. By selectively co-expressing wild-type human tau (0N3R isoform) and a GFP vesicle marker in motorneurons, we examined the consequences of tau overexpression on axonal transport in vivo. The results show that overexpression of tau disrupts axonal transport causing vesicle aggregation and this is associated with loss of locomotor function. All these effects occur without neuron death. Co-expression of constitutively active glycogen-synthase kinase-3beta (GSK-3beta) enhances and two GSK-3beta inhibitors, lithium and AR-A014418, reverse both the axon transport and locomotor phenotypes, suggesting that the pathological effects of tau are phosphorylation dependent. These data show that tau abnormalities significantly disrupt neuronal function, in a phosphorylation-dependent manner, before the classical pathological hallmarks are evident and also suggest that the inhibition of GSK-3beta might have potential therapeutic benefits in tauopathies.
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Affiliation(s)
- A Mudher
- Department of Neuroscience and Old Age Psychiatry, Institute of Psychiatry, Kings College London, De Crespigny Park, London, UK
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MacKay D. Hemorrhoids and varicose veins: a review of treatment options. Altern Med Rev 2001; 6:126-40. [PMID: 11302778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Hemorrhoids and varicose veins are common conditions seen by general practitioners. Both conditions have several treatment modalities for the physician to choose from. Varicose veins are treated with mechanical compression stockings. There are several over-the-counter topical agents available for hemorrhoids. Conservative therapies for both conditions include diet, lifestyle changes, and hydrotherapy which require a high degree of patient compliance to be effective. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation. Injection sclerotherapy is the non-surgical treatment for primary varicose veins. Non-surgical modalities require physicians to be specially trained, own specialized equipment, and assume associated risks. If a non-surgical approach fails, the patient is often referred to a surgeon. The costly and uncomfortable nature of treatment options often lead a patient to postpone evaluation until aggressive intervention is necessary. Oral dietary supplementation is an attractive addition to the traditional treatment of hemorrhoids and varicose veins. The loss of vascular integrity is associated with the pathogenesis of both hemorrhoids and varicose veins. Several botanical extracts have been shown to improve microcirculation, capillary flow, and vascular tone, and to strengthen the connective tissue of the perivascular amorphous substrate. Oral supplementation with Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent time-consuming, painful, and expensive complications of varicose veins and hemorrhoids.
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Affiliation(s)
- D MacKay
- Thorne Research, 4616 SE 30th, Portland, OR 97202, USA.
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Abstract
Using a stereological method, the optical disector, we examined three inbred strains of mice (NZB/BINJ, DBA/2, and C57BL/6J) for morphological differences in volume, neuronal number, and density of the pyramidal cell and dentate gyrus granule cell layers of the hippocampus. We found significant differences in volume and neuronal number for both regions between the three strains at 9 weeks of age, but only modest differences in neuronal density. The left dentate volume was 90% larger in the NZB strain and 70% greater in the DBA strain (P<0.0001), and the left pyramidal cell layer was 144% larger in the NZB strain and 150% larger in the DBA strain, than in the B6 strain (P<0.0001). Neuron number in the left dentate was 81% greater in NZB and 37% greater in DBA (P<0.001), and in the left pyramidal cell layer 118% greater in the NZB and 92% greater in the DBA (P<0.01). Differences in neuronal density of the left dentate were not significant (P = 0.060, ns). For the left pyramidal cell layer, neuronal density was 14% greater in B6 and 34% greater in NZB than the DBA strain (P = 0.016). No significant differences were found in left-right laterality, or according to sex. We found that strain accounted for 60% of the variance in hippocampal volume and 44% of neuron number. These differences thus mainly reflect genetic variation in hippocampal volume and may have important implications for brain evolution, behaviour, and human diseases where hippocampal degeneration is involved.
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Affiliation(s)
- I Abusaad
- Department of Neuropathology, The Institute of Psychiatry, London, United Kingdom
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Gostick NK, Mayhew SR, Mukerji D, Bradley I, Ganvir P, Shepherd F, Davis A, MacKay D, Hopwood AM. A randomised comparative trial of nicardipine versus amiloride and hydrochlorothiazide in mild to moderate hypertension. A report from the General Practitioner Hypertension Study Group. J Hum Hypertens 1989; 3:141-4. [PMID: 2668525] [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: 01/02/2023]
Abstract
In 1984 the General Practitioner Hypertension Study Group undertook a rescreening of their patient population, looking for patients who still had untreated mild to moderate essential hypertension. Suitable patients were entered into a clinical trial comparing the safety and efficacy of nicardipine (a calcium antagonist) and amiloride + hydrochlorothiazide (HCTZ) (moduretic). The study included one year of long-term follow-up. Both drugs significantly lowered BP in both the short and long term. Numbers and percentages of patients from each group reporting adverse experiences were similar in the short term, but in the long term the frequency of adverse event reporting was much lower with nicardipine treatment than with amiloride + HCTZ treatment (2/10 versus 9/17). Treatment with amiloride + HCTZ led to elevations in serum levels of cholesterol, uric acid and urea, which were maintained at one year, whilst no abnormalities in blood biochemistry were seen in patients treated with nicardipine. In conclusion we have found that nicardipine compares very favourably with amiloride + HCTZ in the treatment of mild to moderate hypertensive patients.
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Affiliation(s)
- N K Gostick
- Medical Department, Syntex Pharmaceuticals Limited, Maidenhead, Berkshire, UK
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Bauer FE, Venetikou M, MacKay D, Ginsberg L, Burrin J, Bloom SR. Galanin: A novel modulator of pituitary and pancreatic hormone secretion in man. ACTA ACUST UNITED AC 1986. [DOI: 10.1016/0167-0115(86)90089-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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Blanche C, MacKay D, Lee ME. A new overpressure safety valve for use in the venting line during cardiopulmonary bypass. Mt Sinai J Med 1986; 53:239-40. [PMID: 3487718] [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: 01/06/2023]
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MacKay D. Volume discounts: incentives for group purchasing. Dimens Health Serv 1985; 62:30. [PMID: 4076632] [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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Georges M, MacKay D, Fraser-Reid B. A synthesis of methyl 4,6-dideoxy-3-C-methyl-4-(N-methylacetamido)-alpha-D-altropyr anoside, the 3-epimer of (methyl N-acetylsibirosaminide). Carbohydr Res 1984; 130:115-24. [PMID: 6478458 DOI: 10.1016/0008-6215(84)85274-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The oxirane ring of 1,6:3,4-dianhydro-beta-D-talopyranose reacted at C-4 with methylamine, and the product, further processed gave a 3-deoxy-C-3-methylene derivative. Iodonium ion-induced cyclisation led to an iodooxazolidinone, and deiodination, followed by hydrolysis and N-acetylation, to the title compound.
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Howard A, Adams G, Church LJ, MacKay D. Made-to-measure C.P.R. Dimens Health Serv 1982; 59:9. [PMID: 7075900] [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: 01/23/2023]
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MacKay D, McKirdy HC. Proceedings: Effect of vasopressin and of adenosine triphosphate on the flat preparation of rabbit rectum. Br J Pharmacol 1972; 44:366P-367P. [PMID: 4668627 PMCID: PMC1666087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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