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de Hora M, Heather N, Webster D, Albert B, Hofman P. The use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives. Front Endocrinol (Lausanne) 2023; 14:1226284. [PMID: 37850096 PMCID: PMC10578435 DOI: 10.3389/fendo.2023.1226284] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
Newborn screening for congenital adrenal hyperplasia using 17-hydroxyprogesterone by immunoassay remains controversial despite screening been available for almost 40 years. Screening is confounded by poor immunoassay specificity, fetal adrenal physiology, stress, and illness which can result in a large number of false positive screening tests. Screening programmes apply higher screening thresholds based on co-variates such as birthweight or gestational age but the false positive rate using immunoassay remains high. Mass spectrometry was first applied to newborn screening for congenital adrenal hyperplasia over 15 years ago. Elevated 17-hydroxprogesterone by immunoassay can be retested with a specific liquid chromatography tandem mass spectrometry assay that may include additional steroid markers. Laboratories register with quality assurance programme providers to ensure accurate steroid measurements. This has led to improvements in screening but there are additional costs and added laboratory workload. The search for novel steroid markers may inform further improvements to screening. Studies have shown that 11-oxygenated androgens are elevated in untreated patients and that the adrenal steroidogenesis backdoor pathway is more active in babies with congenital adrenal hyperplasia. There is continual interest in 21-deoxycortisol, a specific marker of 21-hydroxylase deficiency. The measurement of androgenic steroids and their precursors by liquid chromatography tandem mass spectrometry in bloodspots may inform improvements for screening, diagnosis, and treatment monitoring. In this review, we describe how liquid chromatography tandem mass spectrometry has improved newborn screening for congenital adrenal hyperplasia and explore how future developments may inform further improvements to screening and diagnosis.
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Affiliation(s)
- Mark de Hora
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Natasha Heather
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Dianne Webster
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Benjamin Albert
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul Hofman
- Clinical Research Unit, Liggins Institute, University of Auckland, Auckland, New Zealand
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Bernhardt I, Glamuzina E, Ryder B, Knoll D, Heather N, De Hora M, Webster D, Wilson C. The risk of classical galactosaemia in newborns with borderline galactose metabolites on newborn screening. JIMD Rep 2023; 64:180-186. [PMID: 36873086 PMCID: PMC9981414 DOI: 10.1002/jmd2.12339] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Newborn screening (NBS) for classical galactosaemia (CG) facilitates early diagnosis and treatment to prevent life-threatening complications, but remains controversial, and screening protocols vary widely between programmes. False-negatives associated with first-tier screening of total galactose metabolites (TGAL) are infrequently reported; however, newborns with TGAL below the screening threshold have not been systematically studied. Following the diagnosis of CG in two siblings missed by NBS, a retrospective cohort study of infants with TGAL just below the cut-off (1.5 mmol/L blood) was conducted. Children born in New Zealand (NZ) from 2011 to 2019, with TGAL 1.0-1.49 mmol/L on NBS were identified from the national metabolic screening programme (NMSP) database, and clinical coding data and medical records were reviewed. GALT sequencing was performed if CG could not be excluded following review of medical records. 328 infants with TGAL 1.0-1.49 mmol/L on NBS were identified, of whom 35 had ICD-10 codes relevant to CG including vomiting, poor feeding, weight loss, failure to thrive, jaundice, hepatitis, Escherichia coli urinary tract infection, sepsis, intracranial hypertension and death. CG could be excluded in 34/35, due to documentation of clinical improvement with continued dietary galactose intake, or a clear alternative aetiology. GALT sequencing in the remaining individual confirmed Duarte-variant galactosaemia (DG). In conclusion, undiagnosed CG appears to be rare in those with TGAL 1.0-1.49 mmol/L on NBS; however, our recent experience with missed cases is nevertheless concerning. Further work is required to establish the optimum screening strategy, to maximize the early detection of CG without excess false-positives.
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Affiliation(s)
- Isaac Bernhardt
- National Metabolic Service, Auckland City Hospital and Starship Children's HospitalAucklandNew Zealand
| | - Emma Glamuzina
- National Metabolic Service, Auckland City Hospital and Starship Children's HospitalAucklandNew Zealand
| | - Bryony Ryder
- National Metabolic Service, Auckland City Hospital and Starship Children's HospitalAucklandNew Zealand
| | - Detlef Knoll
- Chemical Pathology (Section New Born Screening), Auckland City HospitalAucklandNew Zealand
| | - Natasha Heather
- Newborn Metabolic Screening Unit, Auckland City HospitalAucklandNew Zealand
| | - Mark De Hora
- Chemical Pathology (Section New Born Screening), Auckland City HospitalAucklandNew Zealand
| | - Dianne Webster
- Newborn Metabolic Screening Unit, Auckland City HospitalAucklandNew Zealand
| | - Callum Wilson
- National Metabolic Service, Auckland City Hospital and Starship Children's HospitalAucklandNew Zealand
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Mathews DM, Peart JM, Sim RG, O’Sullivan S, Derraik JGB, Heather NL, Webster D, Johnson NP, Hofman PL. The impact of prolonged, maternal iodine exposure in early gestation on neonatal thyroid function. Front Endocrinol (Lausanne) 2023; 14:1080330. [PMID: 36798662 PMCID: PMC9927197 DOI: 10.3389/fendo.2023.1080330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
CONTEXT Hysterosalpingography (HSG) using oil-soluble contrast medium (OSCM) improves pregnancy rates but results in severe and persistent iodine excess, potentially impacting the fetus and neonate. OBJECTIVE To determine the incidence of thyroid dysfunction in newborns conceived within six months of OSCM HSG. DESIGN Offspring study of a prospective cohort of women who underwent OSCM HSG. SETTING Auckland region, New Zealand (2020-2022). PARTICIPANTS Offspring from the SELFI (Safety and Efficacy of Lipiodol in Fertility Investigations) study cohort (n=57). MEASUREMENTS All newborns had a dried blood spot card for TSH measurement 48 hours after birth as part of New Zealand's Newborn Metabolic Screening Programme. Forty-one neonates also had a heel prick serum sample at one week to measure thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Maternal urine iodine concentration (UIC) and TSH in the six months after OSCM HSG were retrieved from the SELFI study for analyses. PRIMARY OUTCOME Incidence of hypothyroidism in the neonatal period. RESULTS There was no evidence of primary hypothyroidism on newborn screening (TSH 2-10 mIU/L). All neonates tested at one week had normal serum TSH, FT4, and FT3 levels. However, increasing maternal peak UIC levels during pregnancy were associated with lower TSH levels (p= 0.006), although also associated with lower FT4 levels (p=0.032). CONCLUSIONS While pre-conceptional OSCM HSG in women did not result in neonatal hypothyroidism, gestational iodine excess was associated with a paradoxical lowering of neonatal TSH levels despite lower FT4 levels. These changes likely reflect alterations in deiodinase activity in the fetal hypothalamic-pituitary axis from iodine excess. TRIAL REGISTRATION https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000738921, identifier 12620000738921.
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Affiliation(s)
- Divya M. Mathews
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children’s Hospital, Te Whatu Ora – Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
- *Correspondence: Divya M. Mathews,
| | | | | | - Susannah O’Sullivan
- Endocrinology, Greenlane Clinical Centre, Te Whatu Ora – Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - José G. B. Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Natasha L. Heather
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Metabolic Screening Programme, Lab Plus, Te Whatu Ora – Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Dianne Webster
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Metabolic Screening Programme, Lab Plus, Te Whatu Ora – Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Neil P. Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Repromed Auckland, Auckland, New Zealand
| | - Paul L. Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children’s Hospital, Te Whatu Ora – Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
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Huynh T, Greaves R, Mawad N, Greed L, Wotton T, Wiley V, Ranieri E, Rankin W, Ungerer J, Price R, Webster D, Heather N. Fifty years of newborn screening for congenital hypothyroidism: current status in Australasia and the case for harmonisation. Clin Chem Lab Med 2022; 60:1551-1561. [PMID: 35998658 DOI: 10.1515/cclm-2022-0403] [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] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Since its implementation 50 years ago in Quebec, Canada, newborn screening for congenital hypothyroidism has become one of the most successful public health measures worldwide. Screening programmes across Australia and New Zealand are characterised by significant commonalities in screening algorithms, and a high degree of regional cooperation in harmonisation efforts. We aimed to conduct a comprehensive survey of current performance and practices related to the total testing process for congenital hypothyroidism screening and provide recommendations for harmonisation priorities within our region. METHODS A survey was conducted involving the six newborn screening laboratories which provide complete geographic coverage across Australasia. Approximately 360,000 newborns are screened annually. Survey questions incorporated pre-analytical, analytical, and post-analytical aspects of the screening programmes and an extensive 5-year (2016-2020) retrospective analysis of individual programme performance data. Responses from individual screening programmes were collated. RESULTS The uptake of newborn screening was over 98% for the six major jurisdictions. All programmes have adopted a single-tier thyroid stimulating hormone (TSH) strategy using the Perkin Elmer GSP instrument. Significant similarities exist between programmes for recommended age of collection and recollection protocols for low birthweight newborns. The process for the determination of TSH cutoffs varies between programmes. TSH lower cut-offs for borderline-positive and positive notifications between 12-15 and 12-25 mIU/L blood, respectively. Recall rates vary between 0.08 and 0.20%. The case definition for congenital hypothyroidism generally includes biochemical and radiological parameters in addition to the commencement of thyroxine. All programmes reported collecting biochemical and clinical data on infants with positive screening tests, and positive predictive values vary between 23.6 and 77.3%. Variation in reported incidence (1:1,300-2,000) cannot be entirely explained by cutoff or recall rate (although one programme reporting fewer cases includes only permanent disease). CONCLUSIONS Despite similarities between newborn screening algorithms for congenital hypothyroidism across Australia and New Zealand, differences in reported programme performance provide the basis for further harmonisation. Surveillance of a large population offers the potential for the ongoing development of evidence-based screening guidelines.
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Affiliation(s)
- Tony Huynh
- Department of Endocrinology & Diabetes, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Department of Chemical Pathology, Mater Pathology, South Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Ronda Greaves
- Department of Biochemical Genetics, Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Nazha Mawad
- Department of Biochemical Genetics, Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Lawrence Greed
- Western Australia Newborn Screening Programme, PathWest, WA, Australia
| | - Tiffany Wotton
- NSW Newborn Screening Programme, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Veronica Wiley
- NSW Newborn Screening Programme, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Enzo Ranieri
- Department of Biochemical Genetics, SA Pathology, Adelaide, SA, Australia
| | - Wayne Rankin
- Department of Chemical Pathology, SA Pathology, Adelaide, SA, Australia
| | - Jacobus Ungerer
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Chemical Pathology, Pathology Queensland, Herston, QLD, Australia
| | - Ricky Price
- Newborn Screening Unit, Pathology Queensland, Herston, QLD, Australia
| | - Dianne Webster
- National Newborn Metabolic Screening programme, Specialist Chemical Pathology, LabPlus, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Natasha Heather
- National Newborn Metabolic Screening programme, Specialist Chemical Pathology, LabPlus, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Heather N, Morgan L, Knoll D, Shore K, de Hora M, Webster D. Introduction of a Protocol for Structured Follow-Up and Texting of Inadequate and Borderline-Positive Newborn Metabolic Screening Results. Int J Neonatal Screen 2022; 8:ijns8020030. [PMID: 35645284 PMCID: PMC9149934 DOI: 10.3390/ijns8020030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
A national protocol for structured follow-up and texting of repeat newborn bloodspot screening (NBS) sample requests was introduced. Repeat samples are needed where the initial sample is inadequate or the result borderline-positive. This protocol aimed to improve the timeliness and completeness of receipt of repeat NBS samples. Under the structured protocol, all repeat sample requests were phoned or texted to the lead maternity carer (LMC), in addition to the standard written report issued. Weekly text reminders were sent until 4 weeks or the sample was received. National data were monitored following implementation of the protocol. The proportion of repeat samples received within 10 days of request improved after the introduction of the protocol, from 35.0% in 2013 to 81.4% in 2020 (p < 0.001). The proportion of requests lost to follow-up decreased, from 4.1% in 2013 to 1.3% in 2020 (p < 0.001). A structured NBS follow-up protocol that included SMS text messaging led to an earlier and more complete receipt of repeat samples. This is likely due to practitioners receiving the request more quickly, as well as the laboratory adopting a consistent approach to repeated reminders. SMS text messages are a useful adjunctive method for screening programmes to communicate with health care providers.
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Affiliation(s)
- Natasha Heather
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland 1148, New Zealand; (L.M.); (D.K.); (K.S.); (M.d.H.); (D.W.)
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
- Correspondence:
| | - Lisa Morgan
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland 1148, New Zealand; (L.M.); (D.K.); (K.S.); (M.d.H.); (D.W.)
| | - Detlef Knoll
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland 1148, New Zealand; (L.M.); (D.K.); (K.S.); (M.d.H.); (D.W.)
| | - Keith Shore
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland 1148, New Zealand; (L.M.); (D.K.); (K.S.); (M.d.H.); (D.W.)
| | - Mark de Hora
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland 1148, New Zealand; (L.M.); (D.K.); (K.S.); (M.d.H.); (D.W.)
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Dianne Webster
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland 1148, New Zealand; (L.M.); (D.K.); (K.S.); (M.d.H.); (D.W.)
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
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Shamputa IC, Nguyen DTK, Burdo T, Dao G, Gharbiya L, Burns M, MacKenzie H, Barker K, Webster D. Canadian immigrants´ awareness and perceptions of TB infection and TB. Int J Tuberc Lung Dis 2022; 26:454-456. [PMID: 35505486 DOI: 10.5588/ijtld.21.0629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- I C Shamputa
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - D T K Nguyen
- Ministry of Health, Government of New Brunswick, Saint John, NB, Canada, Faculty of Business, University of New Brunswick, Saint John, NB, Canada
| | - T Burdo
- MD Program, Dalhousie University New Brunswick, Saint John, NB, Canada
| | - G Dao
- MD Program, Dalhousie University New Brunswick, Saint John, NB, Canada
| | - L Gharbiya
- Saint John Newcomer Centre, Newcomer Settlement, Saint John, NB, Canada
| | - M Burns
- Newcomer Connection, The YMCA of Greater Saint John, Saint John, NB, Canada
| | - H MacKenzie
- Division of Microbiology, Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, NB, Canada
| | - K Barker
- Ministry of Health, Government of New Brunswick, Saint John, NB, Canada
| | - D Webster
- Division of Microbiology, Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, NB, Canada, Faculty of Medicine, Dalhousie University New Brunswick, Saint John, NB, Canada, Division of Infectious Diseases, Department of Medicine, Saint John Regional Hospital, Saint John, NB, Canada
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Bernhardt I, Glamuzina E, Dowsett LK, Webster D, Knoll D, Carpenter K, Bennett MJ, Maeda M, Wilson C. Genotype–phenotype correlations in
CPT1A
deficiency detected by newborn screening in Pacific populations. JIMD Rep 2022; 63:322-329. [PMID: 35822099 PMCID: PMC9259392 DOI: 10.1002/jmd2.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
Carnitine palmitoyltransferase 1A (CPT1A) deficiency is a long chain fatty acid oxidation disorder, typically presenting with hypoketotic hypoglycaemia and liver dysfunction during fasting and intercurrent illness. Classical CPT1A deficiency is a rare disease, although a milder ‘Arctic variant' (p.P479L) is common in the Inuit population. Since the introduction of expanded metabolic screening (EMS), the newborn screening programmes of Hawai'i and New Zealand (NZ) have detected a significant increase in the incidence of CPT1A deficiency. We report 22 individuals of Micronesian descent (12 in NZ and 10 in Hawai'i), homozygous for a CPT1A c.100T>C (p.S34P) variant detected by EMS or ascertained following diagnosis of a family member. No individuals with the Micronesian variant presented clinically with metabolic decompensation prior to diagnosis or during follow‐up. Three asymptomatic homozygous adults were detected following the diagnosis of their children by EMS. CPT1A activity in cultured skin fibroblasts showed residual enzyme activity of 26% of normal controls. Secondly, we report three individuals from two unrelated Niuean families who presented clinically with symptoms of classic CPT1A deficiency, prior to the introduction of EMS. All were found to be homozygous for a CPT1A c.2122A>C (p.S708R) variant. CPT1A activity in fibroblasts of all three individuals was severely reduced at 4% of normal controls. Migration pressure, in part due to climate change may lead to increased frequency of presentation of Pacific peoples to regional metabolic services around the world. Knowledge of genotype–phenotype correlations in these populations will therefore inform counselling and treatment of those detected by newborn screening.
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Affiliation(s)
- Isaac Bernhardt
- National Metabolic Service Auckland City Hospital and Starship Children's Hospital Auckland New Zealand
| | - Emma Glamuzina
- National Metabolic Service Auckland City Hospital and Starship Children's Hospital Auckland New Zealand
| | - Leah K. Dowsett
- Department of Pediatrics University of Hawai'i John A. Burns School of Medicine Honolulu Hawai'i USA
- Hawai'i Community Genetics Honolulu Hawai'i USA
| | - Dianne Webster
- Newborn Metabolic Screening Unit Auckland City Hospital Auckland New Zealand
| | - Detlef Knoll
- Chemical Pathology (Section New Born Screening) Auckland City Hospital Auckland New Zealand
| | | | - Michael J. Bennett
- Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Michelle Maeda
- Hawai'i Community Genetics Honolulu Hawai'i USA
- State of Hawai'i Department of Health Children with Special Health Needs Program Honolulu Hawai'i USA
| | - Callum Wilson
- National Metabolic Service Auckland City Hospital and Starship Children's Hospital Auckland New Zealand
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Mathews DM, Peart JM, Johnson NP, Sim RG, Heather NL, Webster D, O'Sullivan S, Hofman PL. Hysterosalpingography with Oil-Soluble Contrast Medium Does Not Increase Newborn Hypothyroidism. Int J Endocrinol 2022; 2022:4532714. [PMID: 35242184 PMCID: PMC8888087 DOI: 10.1155/2022/4532714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/29/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Hysterosalpingography (HSG) with oil-soluble contrast medium (OSCM) improves pregnancy rates in women with idiopathic infertility. However, OSCM has high iodine content and slow clearance resulting in potential iodine excess. If pregnancy occurs, this could impact fetal thyroid gland development and function. We aim to determine the effect of a preconceptional OSCM HSG on the thyroid function of the neonate. Design and Patients. This was a retrospective analysis of newborn TSH data for a cohort of neonates conceived within six months of an OSCM HSG in the Auckland region, New Zealand, from the years 2000 to 2019. Thyroid-stimulating hormone (TSH) levels of these newborns were obtained from newborn screening, which is routinely performed for all children at 48-72 hours of life. The primary outcome was the incidence of permanent or transient congenital hypothyroidism in this cohort. RESULTS Of 146 babies included, all had normal TSH levels with values ranging from 1 to 7 mIU/L on the whole blood analysis of a capillary heel sample using the Perkin-Elmer AutoDelfia assay. Conception during the first 3 cycles following an OSCM HSG was 76%; however, TSH levels in this group were not higher than those conceived in later cycles. CONCLUSION Preconceptional OSCM HSG did not increase the risk of congenital hypothyroidism in the New Zealand scenario.
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Affiliation(s)
- Divya M. Mathews
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Paediatric Endocrinology, Starship Children's Hospital, Auckland, New Zealand
| | | | - Neil P. Johnson
- Repromed Auckland, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Natasha L. Heather
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland, New Zealand
| | - Dianne Webster
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland, New Zealand
| | - Susannah O'Sullivan
- Endocrinology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Paul L. Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Paediatric Endocrinology, Starship Children's Hospital, Auckland, New Zealand
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de Hora MR, Heather NL, Webster D, Albert BB, Hofman PL. Birth Weight- or Gestational Age-adjusted Second-tier LCMSMS Cutoffs Improve Newborn Screening for CAH in New Zealand. J Clin Endocrinol Metab 2021; 106:e3390-e3399. [PMID: 34058748 DOI: 10.1210/clinem/dgab383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The positive predictive value of newborn screening for congenital adrenal hyperplasia (CAH) in New Zealand is approximately 10%. The use of a second tier liquid chromatography-tandem mass spectrometry bloodspot steroid profile test with birth weight- or gestational age-adjusted screening cutoffs may result in further screening improvements. METHODS Three years of newborn screening data with additional second-tier steroid metabolites was evaluated (n = 167 672 births). Data from babies with a negative screening test and confirmed CAH cases were compared. First- and second-tier steroid measurements were correlated with both birth weight and gestational age. Analysis of variance was used to determine birth weight and gestational age groups. Screening cutoffs were determined and applied retrospectively to model screening performance. RESULTS First-tier immunoassay data correlated better with gestational age than with birth weight, but there was no difference with second-tier steroid measurements. Four distinct birth weight and gestational age groups were established for 17-hydroxyprogesterone and a steroid ratio measurement. Application of 97.5th percentile second-tier birth weight- or gestational age-adjusted cutoffs would result in 10 positive tests over the period of the study with 8 true-positive screens and 2 false-positive tests. The positive predictive value of screening would be increased from 10.8% to 80%. CONCLUSIONS The use of either birth weight- or gestational age-adjusted cutoffs for second-tier screening tests can significantly reduce the false positive rate of newborn screening for CAH in New Zealand without loss in screening sensitivity.
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Affiliation(s)
- Mark R de Hora
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Natasha L Heather
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Dianne Webster
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Paul L Hofman
- Clinical Research Unit, Liggins Institute, University of Auckland, Auckland, New Zealand
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de Hora MR, Heather NL, Patel T, Bresnahan LG, Webster D, Hofman PL. Implementing steroid profiling by liquid chromatography-tandem mass spectrometry improves newborn screening for congenital adrenal hyperplasia in New Zealand. Clin Endocrinol (Oxf) 2021; 94:904-912. [PMID: 33471388 DOI: 10.1111/cen.14422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/17/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the impact of a liquid chromatography-tandem mass spectrometry (LCMSMS) second-tier test on newborn screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH) in New Zealand. DESIGN In a prospective study, a LCMSMS method to measure 17-hydroxyprogesterone (17OHP) was adapted to measure four additional steroids. Steroid concentrations were collected on all second-tier CAH screening tests while protocols remained unchanged. Steroid ratio parameters with recommended or published screening cuts-offs were evaluated for their impact on newborn screening performance. MEASUREMENTS Precision, accuracy, linearity and recovery of the second-tier LCMSMS method were evaluated. Second-tier specimens were divided in 3 groups; newborn screening bloodspots from neonates with confirmed CAH (n = 7) and 2 groups specimens from neonates with a birthweight (BW) ≤1500 g (n = 795) and with a BW > 1500 g (n = 806) with a negative newborn screening test. Six protocols using four steroid ratio parameters were evaluated. The sensitivity, specificity, false positive rate and positive predictive value of screening was calculated for each protocol. RESULTS The LCMSMS method was sufficiently accurate and precise to be used as a second-tier test for CAH. Screening sensitivity remained at 100% for each protocol apart from (17OHP + androstenedione)/cortisol when the highest cut-off of 3.75 was applied. The false positive rate was significantly improved when (17OHP + androstenedione)/cortisol and (17OHP + 21-deoxycortisol)/cortisol were evaluated with cut-offs of 2.5 and 1.5 respectively (P < .01) and both with a positive predictive value of 64%. CONCLUSIONS A second-tier LCMSMS newborn screening test for CAH offers significant improvements to screening specificity without any other changes to screening protocols.
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Affiliation(s)
- Mark R de Hora
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Natasha L Heather
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Tejal Patel
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Lauren G Bresnahan
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Dianne Webster
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Paul L Hofman
- Clinical Research Unit, Liggins Institute, University of Auckland, Auckland, New Zealand
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11
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West R, Hong J, Derraik JGB, Webster D, Heather NL, Hofman PL. Newborn Screening TSH Values Less Than 15 mIU/L Are Not Associated With Long-term Hypothyroidism or Cognitive Impairment. J Clin Endocrinol Metab 2020; 105:5864811. [PMID: 32598474 DOI: 10.1210/clinem/dgaa415] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/09/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is unclear whether newborns with mild thyrotropin elevation (mTSHe) are at risk of neurocognitive impairment. We assessed whether mTSHe at birth persists during childhood and compared neurocognitive functioning to siblings. METHODS This study encompassed children born in the Auckland region (New Zealand) with a newborn screen TSH level of 8 to 14 mIU/L blood, age 6.9 to 12.6 years at assessment, and their siblings. Thyroid function tests (serum TSH and free thyroxine) and neurocognitive assessments were performed, including IQ via the Wechsler Intelligence Scale for Children, fourth edition. RESULTS Ninety-six mTSHe individuals were studied, including 67 children recruited with 75 sibling controls. Mean mTSHe newborn TSH level was 10.1 mIU/L blood and 2.4 mIU/L at assessment (range, 0.8-7.0 mIU/L, serum). Although higher newborn TSH levels in the mTSHe group correlated with lower full-scale IQ scores (r = 0.25; P = .040), they were not associated with the magnitude of the IQ difference within sibling pairs (P = .56). Cognitive scores were similar for mTSHe and controls (full-scale IQ 107 vs 109; P = .36), with a minor isolated difference in motor coordination scores. CONCLUSIONS Our data do not suggest long-term negative effects of neonatal mild TSH elevation. TSH elevation below the screen threshold appears largely transient, and midchildhood neurocognitive performance of these children was similar to their siblings. We propose that associations between neonatal mild TSH elevation and IQ are due to familial confounders. We caution against the practice of reducing screening CH cutoffs to levels at which the diagnosis may not offer long-term benefit for those detected.
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Affiliation(s)
- Rachel West
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Joyce Hong
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Dianne Webster
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland, New Zealand
| | - Natasha L Heather
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
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12
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Nichols MK, Andrew MK, Ye L, Hatchette TF, Ambrose A, Boivin G, Bowie W, Dos Santos G, Elsherif M, Green K, Haguinet F, Katz K, Leblanc J, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Powis J, Richardson D, Semret M, Sharma R, Shinde V, Smyth D, Trottier S, Valiquette L, Webster D, McNeil SA. The Impact of Prior Season Vaccination on Subsequent Influenza Vaccine Effectiveness to Prevent Influenza-related Hospitalizations Over 4 Influenza Seasons in Canada. Clin Infect Dis 2020; 69:970-979. [PMID: 30508064 DOI: 10.1093/cid/ciy1009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent studies have demonstrated the possibility of negative associations between prior influenza vaccines and subsequent influenza vaccine effectiveness (VE), depending on season and strain. We investigated this association over 4 consecutive influenza seasons (2011-2012 through 2014-2015) in Canada. METHODS Using a matched test-negative design, laboratory-confirmed influenza cases and matched test-negative controls admitted to hospitals were enrolled. Patients were stratified into 4 groups according to influenza vaccine history (not vaccinated current and prior season [referent], vaccinated prior season only, vaccinated current season only, and vaccinated both current and prior season). Conditional logistic regression was used to estimate VE; prior vaccine impact was assessed each season for overall effect and effect stratified by age (<65 years, ≥65 years) and type/subtype (A/H1N1, A/H3N2, influenza B). RESULTS Overall, mainly nonsignificant associations were observed. Trends of nonsignificant decreased VE among patients repeatedly vaccinated in both prior and current season relative to the current season only were observed in the A/H3N2-dominant seasons of 2012-2013 and 2014-2015. Conversely, in 2011-2012, during which B viruses circulated, and in 2013-2014, when A/H1N1 circulated, being vaccinated in both seasons tended to result in a high VE in the current season against the dominant circulating subtype. CONCLUSIONS Prior vaccine impact on subsequent VE among Canadian inpatients was mainly nonsignificant. Even in circumstances where we observed a trend of negative impact, being repeatedly vaccinated was still more effective than not receiving the current season's vaccine. These findings favor continuation of annual influenza vaccination recommendations, particularly in older adults. CLINICAL TRIALS REGISTRATION NCT01517191.
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Affiliation(s)
- M K Nichols
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - M K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - L Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - T F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - A Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - G Boivin
- Centre Hospitalier Universitaire de Québec, Québec City, Canada
| | - W Bowie
- University of British Columbia, Vancouver, Canada
| | - G Dos Santos
- Business and Decision Life Sciences, Bruxelles, Belgium.,Present affiliation: GSK, Wavre, Belgium
| | - M Elsherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - K Green
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - K Katz
- North York General Hospital, Toronto
| | - J Leblanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - M Loeb
- McMaster University, Hamilton
| | - D MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | | | | | - A McGeer
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J Powis
- Michael Garron Hospital, Toronto
| | | | - M Semret
- McGill University, Montreal, Québec
| | - R Sharma
- GSK, Mississauga, Ontario, Canada
| | - V Shinde
- GSK, King of Prussia, Pennsylvania.,Present affiliation: Novavax Vaccines, Washington, D.C
| | - D Smyth
- The Moncton Hospital, New Brunswick
| | - S Trottier
- Centre Hospitalier Universitaire de Québec, Québec City, Canada
| | | | - D Webster
- Saint John Hospital Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - S A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
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13
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Cormack BE, Jiang Y, Harding JE, Crowther CA, Lynn A, Nair A, Hewson M, Meyer M, Broadbent R, Webster D, Glamuzina E, Ryder B, Bloomfield FH. Plasma ammonia concentrations in extremely low birthweight infants in the first week after birth: secondary analysis from the ProVIDe randomized clinical trial. Pediatr Res 2020; 88:250-256. [PMID: 31896121 PMCID: PMC7384986 DOI: 10.1038/s41390-019-0730-z] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/20/2019] [Accepted: 12/09/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Little is known about normative ammonia concentrations in extremely low birthweight (ELBW) babies and whether these vary with birth characteristics. We aimed to determine ammonia concentrations in ELBW babies in the first week after birth and relationships with neonatal characteristics and protein intake. METHODS Arterial blood samples for the measurement of plasma ammonia concentration were collected within 7 days of birth from ProVIDe trial participants in six New Zealand neonatal intensive care units. RESULTS Three hundred and twenty-two babies were included. Median (range) gestational age was 25.7 (22.7-31.6) weeks. Median (interquartile range (IQR)) ammonia concentration was 102 (80-131) µg/dL. There were no statistically significant associations between ammonia concentrations and birthweight or sex. Ammonia concentrations were weakly correlated with mean total (Spearman's rs = 0.11, P = 0.047) and intravenous (rs = 0.13, P = 0.02) protein intake from birth, gestational age at birth (rs = -0.13, P = 0.02) and postnatal age (rs = -0.13, P = 0.02). CONCLUSIONS Plasma ammonia concentrations in ELBW babies are similar to those of larger and more mature babies and only weakly correlated with protein intake. Currently, recommended thresholds for investigation of hyperammonaemia are appropriate for ELBW babies. Protein intake should not be limited by concerns about potential hyperammonaemia.
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Affiliation(s)
- Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Adrienne Lynn
- Neonatal Intensive Care Unit, Christchurch Women's Hospital, Christchurch, New Zealand
| | - Arun Nair
- Newborn Intensive Care Unit, Waikato Hospital, Hamilton, New Zealand
| | - Michael Hewson
- Neonatal Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | - Mike Meyer
- Neonatal Unit, Middlemore Hospital, Auckland, New Zealand
| | - Roland Broadbent
- Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Dianne Webster
- LabPlus, Auckland District Health Board, Auckland, New Zealand
| | - Emma Glamuzina
- National Adult and Paediatric Metabolic Service, Auckland, New Zealand
| | - Bryony Ryder
- National Adult and Paediatric Metabolic Service, Auckland, New Zealand
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.
- Newborn Services, Auckland City Hospital, Auckland, New Zealand.
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14
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Heather N, Webster D. It All Depends What You Count-The Importance of Definitions in Evaluation of CF Screening Performance. Int J Neonatal Screen 2020; 6:47. [PMID: 33073037 PMCID: PMC7423005 DOI: 10.3390/ijns6020047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 01/17/2023] Open
Abstract
Screening metrics are essential to both quality assessment and improvement, but are highly dependent on the way positive tests and cases are counted. In cystic fibrosis (CF) screening, key factors include how mild cases of late-presenting CF and CF screen positive, inconclusive diagnosis (CFSPID) are counted, whether those at prior increased risk of CF are excluded from the screened population, and which aspects of the screening pathway are considered. This paper draws on the New Zealand experience of almost forty years of newborn screening for CF. We demonstrate how different definitions impact the calculation of screening sensitivity. We suggest that, to enable meaningful comparison, CF screening reports should clarify what steps in the screening pathway are included in the assessment, as well as the algorithm used and screening target.
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Affiliation(s)
- Natasha Heather
- National Newborn Metabolic Screening programme, LabPlus, Auckland City Hospital, Auckland 1148, New Zealand;
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand
| | - Dianne Webster
- National Newborn Metabolic Screening programme, LabPlus, Auckland City Hospital, Auckland 1148, New Zealand;
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand
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15
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de Hora MR, Heather NL, Patel T, Bresnahan LG, Webster D, Hofman PL. Measurement of 17-Hydroxyprogesterone by LCMSMS Improves Newborn Screening for CAH Due to 21-Hydroxylase Deficiency in New Zealand. Int J Neonatal Screen 2020; 6:6. [PMID: 33073005 PMCID: PMC7422986 DOI: 10.3390/ijns6010006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/24/2020] [Indexed: 11/26/2022] Open
Abstract
The positive predictive value of newborn screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency was <2% in New Zealand. This is despite a bloodspot second-tier immunoassay method for 17-hydroxyprogesterone measurement with an additional solvent extract step to reduce the number of false positive screening tests. We developed a liquid chromatography tandem mass spectrometry (LCMSMS) method to measure 17-hydroxyprogesterone in bloodspots to replace our current second-tier immunoassay method. The method was assessed using reference material and residual samples with a positive newborn screening result. Correlation with the second-tier immunoassay was determined and the method was implemented. Newborn screening performance was assessed by comparing screening metrics 2 years before and 2 years after LCMSMS implementation. Screening data analysis demonstrated the number of false positive screening tests was reduced from 172 to 40 in the 2 years after LCMSMS implementation. The positive predictive value of screening significantly increased from 1.71% to 11.1% (X2 test, p < 0.0001). LCMSMS analysis of 17OHP as a second-tier test significantly improves screening specificity for CAH due to 21-hydroxylase deficiency in New Zealand.
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Affiliation(s)
- Mark R de Hora
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland 1023, New Zealand; (N.L.H.); (T.P.); (L.G.B.); (D.W.)
| | - Natasha L Heather
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland 1023, New Zealand; (N.L.H.); (T.P.); (L.G.B.); (D.W.)
| | - Tejal Patel
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland 1023, New Zealand; (N.L.H.); (T.P.); (L.G.B.); (D.W.)
| | - Lauren G Bresnahan
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland 1023, New Zealand; (N.L.H.); (T.P.); (L.G.B.); (D.W.)
| | - Dianne Webster
- Newborn Screening, Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland 1023, New Zealand; (N.L.H.); (T.P.); (L.G.B.); (D.W.)
| | - Paul L Hofman
- Clinical Research Unit, Liggins Institute, University of Auckland, Auckland 1010, New Zealand;
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16
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LeBlanc JJ, ElSherif M, Mulpuru S, Warhuus M, Ambrose A, Andrew M, Boivin G, Bowie W, Chit A, Dos Santos G, Green K, Halperin SA, Hatchette TF, Ibarguchi B, Johnstone J, Katz K, Langley JM, Lagacé-Wiens P, Loeb M, Lund A, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Poirier A, Powis J, Richardson D, Semret M, Shinde V, Smyth D, Trottier S, Valiquette L, Webster D, Ye L, McNeil S. Validation of the Seegene RV15 multiplex PCR for the detection of influenza A subtypes and influenza B lineages during national influenza surveillance in hospitalized adults. J Med Microbiol 2020; 69:256-264. [PMID: 31264957 PMCID: PMC7431100 DOI: 10.1099/jmm.0.001032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/16/2019] [Indexed: 01/04/2023] Open
Abstract
Background. The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network (CIRN SOS) has been performing active influenza surveillance since 2009 (ClinicalTrials.gov identifier: NCT01517191). Influenza A and B viruses are identified and characterized using real-time reverse-transcriptase polymerase chain reaction (RT-PCR), and multiplex testing has been performed on a subset of patients to identify other respiratory virus aetiologies. Since both methods can identify influenza A and B, a direct comparison was performed.Methods. Validated real-time RT-PCRs from the World Health Organization (WHO) to identify influenza A and B viruses, characterize influenza A viruses into the H1N1 or H3N2 subtypes and describe influenza B viruses belonging to the Yamagata or Victoria lineages. In a subset of patients, the Seeplex RV15 One-Step ACE Detection assay (RV15) kit was also used for the detection of other respiratory viruses.Results. In total, 1111 nasopharyngeal swabs were tested by RV15 and real-time RT-PCRs for influenza A and B identification and characterization. For influenza A, RV15 showed 98.0 % sensitivity, 100 % specificity and 99.7 % accuracy. The performance characteristics of RV15 were similar for influenza A subtypes H1N1 and H3N2. For influenza B, RV15 had 99.2 % sensitivity, 100 % specificity and 99.8 % accuracy, with similar assay performance being shown for both the Yamagata and Victoria lineages.Conclusions. Overall, the detection of circulating subtypes of influenza A and lineages of influenza B by RV15 was similar to detection by real-time RT-PCR. Multiplex testing with RV15 allows for a more comprehensive respiratory virus surveillance in hospitalized adults, without significantly compromising the reliability of influenza A or B virus detection.
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Affiliation(s)
- J. J. LeBlanc
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - M. ElSherif
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - S. Mulpuru
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - M. Warhuus
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - A. Ambrose
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - M. Andrew
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - G. Boivin
- Centre Hospitalier Universitaire de Québec, QC, Canada
| | - W. Bowie
- University of British Columbia, Vancouver, BC, Canada
| | - A. Chit
- Sanofi Pasteur, Swiftwater, PA, USA
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - G. Dos Santos
- Business & Decision Life Sciences (on behalf of GSK), Bruxelles, Belgium
- Present address: GSK, Wavre, Belgium
| | - K. Green
- Mount Sinai Hospital, Toronto, ON, Canada
| | - S. A. Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - T. F. Hatchette
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - B. Ibarguchi
- GSK, Mississauga, ON, Canada
- Present address: Bayer, Inc., Mississauga, Ontario, Canada
| | - J. Johnstone
- Public Health Ontario and University of Toronto, Toronto, ON, Canada
| | - K. Katz
- North York General Hospital, Toronto, ON, Canada
| | - J. M. Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - M. Loeb
- Public Health Ontario and University of Toronto, Toronto, ON, Canada
| | - A. Lund
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - D. MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - A. McCarthy
- Ottawa Hospital General, Ottawa, Ontario, Canada
| | - J. E. McElhaney
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - A. McGeer
- Mount Sinai Hospital, Toronto, ON, Canada
| | - A. Poirier
- Centre Intégré Universitaire de Santé et Services Sociaux, Quebec, QC, Canada
| | - J. Powis
- Toronto East General Hospital, Toronto, ON, Canada
| | | | - M. Semret
- McGill University, Montreal, QC, Canada
| | - V. Shinde
- GSK, King of Prussia, PA, USA
- Present address: Novavax Vaccines, Washington, DC, USA
| | - D. Smyth
- The Moncton Hospital, Moncton, NB, Canada
| | - S. Trottier
- Centre Hospitalier Universitaire de Québec, QC, Canada
| | | | | | - L. Ye
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - S. A. McNeil
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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17
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Heather NL, Derraik JGB, Webster D, Hofman PL. The impact of demographic factors on newborn TSH levels and congenital hypothyroidism screening. Clin Endocrinol (Oxf) 2019; 91:456-463. [PMID: 31162702 DOI: 10.1111/cen.14044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/09/2019] [Accepted: 05/30/2019] [Indexed: 01/06/2023]
Abstract
CONTEXT Optimal newborn screening thyroid-stimulating hormone (TSH) cut-offs are contentious. Analysis of demographic factors that impact screen TSH levels may help explain international variance and provide guidance to screening programmes. OBJECTIVE To determine the influence of demographic factors on newborn screening TSH levels and screening performance parameters. DESIGN AND SETTING National, retrospective population study using blood spot TSH cards from the New Zealand newborn screening programme in 2010-2015. PATIENTS 325 685 blood spot cards. MAIN OUTCOME MEASURES Likelihood of exceeding specific TSH thresholds (TSH ≥5, ≥10 and ≥15 mIU/L) and group-specific screening performance parameters. RESULTS The likelihood of high TSH levels differed between ethnic groups. Pacific Island infants were more than twice as likely to have high-normal TSH levels (≥5 and ≥10 mIU/L) and nearly twice as likely to have a positive screen (≥15 mIU/L) as New Zealand Europeans. Māori or Chinese ethnicity, male sex, younger gestational age and greater socio-economic deprivation scores were also associated with high-normal TSH levels. At a TSH threshold ≥15 mIU/L, screening sensitivity was lowest (88.89% vs 95.83% overall) and PPV greatest (88.89% vs 62.84%) amongst Asian infants. Early samples were more than three times as likely to reach the screen-positive threshold and more likely to yield a false-positive result (PPV 20.00% vs 68.87%, P = 0.004). CONCLUSIONS Newborn TSH levels are impacted by a number of demographic variables, particularly ethnicity and age at sample collection. Screening performance may be improved through the use of targeted thresholds.
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Affiliation(s)
- Natasha L Heather
- LabPlus, Auckland District Health Board, Newborn Metabolic Screening Programme, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Dianne Webster
- LabPlus, Auckland District Health Board, Newborn Metabolic Screening Programme, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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18
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Abstract
The International Society for Neonatal Screening (ISNS) has met regularly at both international meetings and those of the various chapters[...]
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Affiliation(s)
- Veronica Wiley
- The NSW Newborn Screening, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Dianne Webster
- Newborn Metabolic Screening Programme, LabPlus, Auckland City Hospital, Auckland 1140, New Zealand
| | - Gerard Loeber
- ISNS office, 3721 CK Bilthoven, The Netherlands
- Correspondence:
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Ogden NH, Bouchard C, Badcock J, Drebot MA, Elias SP, Hatchette TF, Koffi JK, Leighton PA, Lindsay LR, Lubelczyk CB, Peregrine AS, Smith RP, Webster D. What is the real number of Lyme disease cases in Canada? BMC Public Health 2019; 19:849. [PMID: 31253135 PMCID: PMC6599318 DOI: 10.1186/s12889-019-7219-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/20/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lyme disease is emerging in Canada due to expansion of the range of the tick vector Ixodes scapularis from the United States. National surveillance for human Lyme disease cases began in Canada in 2009. Reported numbers of cases increased from 144 cases in 2009 to 2025 in 2017. It has been claimed that few (< 10%) Lyme disease cases are reported associated with i) supposed under-diagnosis resulting from perceived inadequacies of serological testing for Lyme disease, ii) expectation that incidence in Canadian provinces and neighbouring US states should be similar, and iii) analysis of serological responses of dogs to the agent of Lyme disease, Borrelia burgdorferi. We argue that performance of serological testing for Lyme disease is well studied, and variations in test performance at different disease stages are accounted for in clinical diagnosis of Lyme disease, and in surveillance case definitions. Extensive surveillance for tick vectors has taken place in Canada providing a clear picture of the emergence of risk in the Canadian environment. This surveillance shows that the geographic scope of I. scapularis populations and Lyme disease risk is limited but increasing in Canada. The reported incidence of Lyme disease in Canada is consistent with this pattern of environmental risk, and the differences in Lyme disease incidence between US states and neighbouring Canadian provinces are consistent with geographic differences in environmental risk. Data on serological responses in dogs from Canada and the US are consistent with known differences in environmental risk, and in numbers of reported Lyme disease cases, between the US and Canada. CONCLUSION The high level of consistency in data from human case and tick surveillance, and data on serological responses in dogs, suggests that a high degree of under-reporting in Canada is unlikely. We speculate that approximately one third of cases are reported in regions of emergence of Lyme disease, although prospective studies are needed to fully quantify under-reporting. In the meantime, surveillance continues to identify and track the ongoing emergence of Lyme disease, and the risk to the public, in Canada.
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Affiliation(s)
- N. H. Ogden
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St. Hyacinthe, Canada
| | - C. Bouchard
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St. Hyacinthe, Canada
| | - J. Badcock
- Office of the Chief Medical Officer of Health, New Brunswick Department of Health, Fredericton, Canada
| | - M. A. Drebot
- Zoonotic Diseases and Special Pathogens Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - S. P. Elias
- Maine Medical Center Research Institute, Scarborough, ME USA
| | - T. F. Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, NS Canada
| | - J. K. Koffi
- Policy Integration and Zoonoses Division, Centre for Food-Borne, Environmental and Zoonotic Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - P. A. Leighton
- Département de pathologie et microbiologie, and Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada
| | - L. R. Lindsay
- Zoonotic Diseases and Special Pathogens Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - C. B. Lubelczyk
- Maine Medical Center Research Institute, Scarborough, ME USA
| | - A. S. Peregrine
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - R. P. Smith
- Maine Medical Center Research Institute, Scarborough, ME USA
| | - D. Webster
- Department of Medicine, Division of Infectious Diseases, Faculty of Medicine, Saint John Regional Hospital, Dalhousie University, Saint John, New Brunswick Canada
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Abstract
When screening for carnitine uptake disorder (CUD), the New Zealand (NZ) newborn screening (NBS) service identified infants as screen-positive if they had initial and repeat free carnitine (C0) levels of less than 5.0 μmol/L. Since 2006, the NBS service has identified two infants with biochemical and genetic features consistent with neonatal CUD and nine mothers with features consistent with maternal CUD. A review of the literature suggests that these nine women reflect less than half the true prevalence and that CUD is relatively common. However, the NZ results (two infants) suggest a very low sensitivity and positive predictive value of NBS. While patients presenting with significant disease due to CUD are well described, the majority of adults with CUD are asymptomatic. Nonetheless, treatment with high-dose oral L-carnitine is recommended. Compliance with oral L-carnitine is likely to be poor long term. This may represent a specific risk as treatment could repress the usual compensatory mechanisms seen in CUD, such that a sudden discontinuation of treatment may be dangerous. L-carnitine is metabolized to trimethylamine-N-oxide (TMAO) and treated patients have extremely high plasma TMAO levels. TMAO is an independent risk factor for atherosclerosis and, thus, caution should be exercised regarding long-term treatment with high-dose carnitine of asymptomatic patients who may have a biochemical profile without disease. Due to these concerns, the NZ Newborn Metabolic Screening Programme (NMSP) initiated a review via a series of advisory and governance committees and decided to discontinue screening for CUD.
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Affiliation(s)
- Callum Wilson
- National Metabolic Service, Starship Children's Hospital, P.O. Box 92024, Auckland 1142, New Zealand
| | - Detlef Knoll
- Newborn Metabolic Screening Unit, Auckland City Hospital, Auckland, New Zealand
| | - Mark de Hora
- Newborn Metabolic Screening Programme, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Campbell Kyle
- LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Emma Glamuzina
- National Metabolic Service, Starship Children's Hospital, P.O. Box 92024, Auckland 1142, New Zealand
| | - Dianne Webster
- Newborn Metabolic Screening Programme, LabPlus, Auckland City Hospital, Auckland, New Zealand
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21
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Webster D, Jolley D. Keep them on the field: Simple load management for injury prevention in sub-elite Australian Rules football. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.044] [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: 10/28/2022]
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Sieniewicz B, Behar J, Gould J, Claridge S, Porter B, Betts TR, Webster D, James S, Turley A, Rinaldi CA. P329Optimal site selection during biventircualar endocardial pacing improves acute haemodynamic response and chronic remodeling: A multi-centre UK study. Europace 2018. [DOI: 10.1093/europace/euy015.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Sieniewicz
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Behar
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Gould
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Claridge
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - T R Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - D Webster
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - S James
- James Cook University Hospital, Middlesborough, United Kingdom
| | - A Turley
- James Cook University Hospital, Middlesborough, United Kingdom
| | - C A Rinaldi
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
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23
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Sieniewicz B, Behar J, Gould J, Porter B, Betts TR, Webster D, James S, Turley A, Rinaldi CA. P1134Safety and efficacy of optimal site selection during biventircualar endocardial pacing: A multi-centre UK study. Europace 2018. [DOI: 10.1093/europace/euy015.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Sieniewicz
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Behar
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Gould
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - T R Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - D Webster
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - S James
- James Cook University Hospital, Middlesborough, United Kingdom
| | - A Turley
- James Cook University Hospital, Middlesborough, United Kingdom
| | - C A Rinaldi
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
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24
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Gander S, Webster D, Smyth D, materniak S. A337 RESULTS OF PILOT HEPATITIS C SCREENING PROGRAM IN INFANTS BORN TO HIGH RISK MOTHERS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.338] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Gander
- Paediatrics, Horizon Health, Saint John, NB, Canada
| | - D Webster
- Centre for Research, Education and Clinical Care of At-Risk Populations (RECAP), Saint John, NB, Canada
| | - D Smyth
- Centre for Research, Education and Clinical Care of At-Risk Populations (RECAP), Saint John, NB, Canada
| | - S materniak
- Centre for Research, Education and Clinical Care of At-Risk Populations (RECAP), Saint John, NB, Canada
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Feld J, Conway B, Bruneau J, Cooper C, Cox J, Deshaies L, Fraser C, Macphail G, Powis J, Steingart C, Stewart K, Thomas R, Webster D, Drolet M, Mcgovern M, Trepanier J. A27 CHARACTERIZATION OF HCV INFECTED PWID IN THE SETTING OF CLINICAL CARE IN CANADA (CAPICA): FINAL RESULTS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Feld
- Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - B Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | - J Bruneau
- CHUM:Hopital St-Luc, Montreal, QC, Canada
| | - C Cooper
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - J Cox
- McGill University Health Center, Montreal, QC, Canada
| | - L Deshaies
- Clinique Médicale Lauberivière, Quebec, QC, Canada
| | - C Fraser
- Cool Aid Community Health Center, Victoria, BC, Canada
| | - G Macphail
- Calgary Urban Project Society (CUPS), Calgary, AB, Canada
| | - J Powis
- Toronto Community Hep C Program, Toronto, ON, Canada
| | | | - K Stewart
- Saskatoon Infectious Disease Care Network, Saskatoon, SK, Canada
| | - R Thomas
- Clinique Médicale l’Actuel, Montreal, QC, Canada
| | - D Webster
- Dalhousie University, Saint John, NB, Canada
| | - M Drolet
- Merck Canada, Kirkland, QC, Canada
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26
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Borgia S, Elkhashab M, Ghali P, Kaita K, Lee S, Shafran S, Tam E, Trottier B, Webster D, Pinsonnault C, Ackad N. A188 REAL-LIFE MANAGEMENT OF CHRONIC HEPATITIS C VIRUS INFECTION IN CANADA: DESCRIPTION OF PATIENT PROFILE, PROGNOSTIC FACTORS AND TREATMENT STRATEGIES. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.189] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Borgia
- Osler Hepatitis Centre, Brampton, ON, Canada
| | | | - P Ghali
- McGill University Health Centre, Montreal, QC, Canada
| | - K Kaita
- University of Manitoba, Winnipeg, MB, Canada
| | - S Lee
- University of Calgary, Calgary, AB, Canada
| | - S Shafran
- University of Alberta, Edmonton, AB, Canada
| | - E Tam
- Lair Centre, Vancouver, BC, Canada
| | - B Trottier
- Clinique Medicale L’Actuel, Montreal, QC, Canada
| | - D Webster
- St John Regional Hospital, St John, NB, Canada
| | - C Pinsonnault
- Medical, Abbvie Corporation, Saint-Laurent, QC, Canada
| | - N Ackad
- Medical Affairs, Abbvie Corporation, Montreal, QC, Canada
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27
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Elkhashab M, Ghesquiere W, Lee S, Shafran S, Webster D, Tam E, Pinsonnault C, Ackad N. A223 MOSAIC: AN INTERNATIONAL MULTICENTRE PROSPECTIVE OBSERVATIONAL STUDY TO EVALUATE THE EPIDEMIOLOGY, HUMANISTIC AND ECONOMIC OUTCOMES OF TREATMENT FOR CHRONIC HEPATITIS C VIRUS (HCV). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.224] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - W Ghesquiere
- Medicine, Vancouver Island Health Authority, Victoria, BC, Canada
| | - S Lee
- University of Calgary, Calgary, AB, Canada
| | - S Shafran
- University of Alberta, Edmonton, AB, Canada
| | - D Webster
- Dalhousie University, Halifax, NS, Canada
| | - E Tam
- LAIR centre, Vancouver, BC, Canada
| | - C Pinsonnault
- Medical, Abbvie Corporation, Saint-Laurent, QC, Canada
| | - N Ackad
- Medical Affairs, Abbvie Corporation, Montreal, QC, Canada
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28
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Daly A, Pinto A, Evans S, Almeida M, Assoun M, Belanger-Quintana A, Bernabei S, Bollhalder S, Cassiman D, Champion H, Chan H, Dalmau J, de Boer F, de Laet C, de Meyer A, Desloovere A, Dianin A, Dixon M, Dokoupil K, Dubois S, Eyskens F, Faria A, Fasan I, Favre E, Feillet F, Fekete A, Gallo G, Gingell C, Gribben J, Kaalund Hansen K, Ter Horst N, Jankowski C, Janssen-Regelink R, Jones I, Jouault C, Kahrs G, Kok I, Kowalik A, Laguerre C, Le Verge S, Lilje R, Maddalon C, Mayr D, Meyer U, Micciche A, Och U, Robert M, Rocha J, Rogozinski H, Rohde C, Ross K, Saruggia I, Schlune A, Singleton K, Sjoqvist E, Skeath R, Stolen L, Terry A, Timmer C, Tomlinson L, Tooke A, Vande Kerckhove K, van Dam E, van den Hurk T, van der Ploeg L, van Driessche M, van Rijn M, van Wegberg A, Vasconcelos C, Vestergaard H, Vitoria I, Webster D, White F, White L, Zweers H, MacDonald A. Dietary practices in propionic acidemia: A European survey. Mol Genet Metab Rep 2017; 13:83-89. [PMID: 29021961 PMCID: PMC5633157 DOI: 10.1016/j.ymgmr.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 07/05/2017] [Accepted: 09/21/2017] [Indexed: 12/02/2022] Open
Abstract
Background The definitive dietary management of propionic acidaemia (PA) is unknown although natural protein restriction with adequate energy provision is of key importance. Aim To describe European dietary practices in the management of patients with PA prior to the publication of the European PA guidelines. Methods This was a cross-sectional survey consisting of 27 questions about the dietary practices in PA patients circulated to European IMD dietitians and health professionals in 2014. Results Information on protein restricted diets of 186 PA patients from 47 centres, representing 14 European countries was collected. Total protein intake [PA precursor-free L-amino acid supplements (PFAA) and natural protein] met WHO/FAO/UNU (2007) safe protein requirements for age in 36 centres (77%). PFAA were used to supplement natural protein intake in 81% (n = 38) of centres, providing a median of 44% (14–83%) of total protein requirement. Seventy-four per cent of patients were prescribed natural protein intakes below WHO/FAO/UNU (2007) safe levels in one or more of the following age groups: 0–6 m, 7–12 m, 1–10 y, 11–16 y and > 16 y. Sixty-three per cent (n = 117) of patients were tube fed (74% gastrostomy), but only 22% received nocturnal feeds. Conclusions There was high use of PFAA with intakes of natural protein commonly below WHO/FAO/UNU (2007) safe levels. Optimal dietary management can only be determined by longitudinal, multi-centre, prospective case controlled studies. The metabolic instability of PA and small patient cohorts in each centre ensure that this is a challenging undertaking.
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Affiliation(s)
- A. Daly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A. Pinto
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S. Evans
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - M.F. Almeida
- Centro de Genética Médica, Centro Hospitalar do Porto - CHP, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, Porto, Portugal
- Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar do Porto - CHP, Porto, Portugal
| | - M. Assoun
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker Enfants Malades, Paris, France
| | - A. Belanger-Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatria, Hospital Ramon y Cajal Madrid, Spain
| | - S.M. Bernabei
- Children Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | | | - D. Cassiman
- Metabolic Center, University Hospitals Leuven and KU Leuven, Belgium
| | | | - H. Chan
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J. Dalmau
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - F. de Boer
- University of Groningen, University Medical Center Groningen, Netherlands
| | - C. de Laet
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - A. de Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - A. Dianin
- Department of Pediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, University Hospital of Verona, Italy
| | - M. Dixon
- Great Ormond Street Hospital for Children NHS FoundationTrust, London, UK
| | - K. Dokoupil
- Dr. von Hauner Children's Hospital, Munich, Germany
| | - S. Dubois
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker Enfants Malades, Paris, France
| | - F. Eyskens
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A. Faria
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, EPE, Portugal
| | - I. Fasan
- Division of Inherited Metabolic Diseases, Department of Pediatrics, University Hospital of Padova, Italy
| | - E. Favre
- Reference center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | - F. Feillet
- Reference center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | | | - G. Gallo
- Children Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | | | - J. Gribben
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K. Kaalund Hansen
- Charles Dent Metabolic Unit National Hospital for Neurology and Surgery, London, UK
| | | | - C. Jankowski
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | | | - I. Jones
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - G.E. Kahrs
- Haukeland University Hospital, Bergen, Norway
| | - I.L. Kok
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - A. Kowalik
- Institute of Mother & Child, Warsaw, Poland
| | - C. Laguerre
- Centre de Compétence de L'Hôpital des Enfants de Toulouse, France
| | - S. Le Verge
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker Enfants Malades, Paris, France
| | - R. Lilje
- Oslo University Hospital, Norway
| | - C. Maddalon
- University Children's Hospital Zurich, Switzerland
| | - D. Mayr
- Ernährungsmedizinische Beratung, Universitätsklinik für Kinder- und Jugendheilkunde, Salzburg, Austria
| | - U. Meyer
- Clinic of Paediatric Kidney, Liver- and Metabolic Diseases, Medical School Hannover, Germany
| | - A. Micciche
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - U. Och
- University Children's Hospital, Munster, Germany
| | - M. Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - J.C. Rocha
- Centro de Genética Médica, Centro Hospitalar do Porto - CHP, Porto, Portugal
- Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar do Porto - CHP, Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Portugal
| | | | - C. Rohde
- Hospital of Children's & Adolescents, University of Leipzig, Germany
| | - K. Ross
- Royal Aberdeen Children's Hospital, Scotland
| | - I. Saruggia
- Centre de Reference des Maladies Héréditaires du Métabolisme du Pr. B. Chabrol CHU Timone Enfant, Marseille, France
| | - A. Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | | | - E. Sjoqvist
- Children's Hospital, University Hospital, Lund, Sweden
| | - R. Skeath
- Great Ormond Street Hospital for Children NHS FoundationTrust, London, UK
| | | | - A. Terry
- Alder Hey Children's Hospital NHS Foundation Trust Liverpool, UK
| | - C. Timmer
- Academisch Medisch Centrum, Amsterdam, Netherlands
| | - L. Tomlinson
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - A. Tooke
- Nottingham University Hospitals, UK
| | | | - E. van Dam
- University of Groningen, University Medical Center Groningen, Netherlands
| | - T. van den Hurk
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | | | | | - M. van Rijn
- University of Groningen, University Medical Center Groningen, Netherlands
| | | | - C. Vasconcelos
- Centro Hospitalar São João - Unidade de Doenças Metabólicas, Porto, Portugal
| | | | - I. Vitoria
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - D. Webster
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | - F.J. White
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - L. White
- Sheffield Children's Hospital, UK
| | - H. Zweers
- Radboud University Medical Center Nijmegen, Netherlands
| | - A. MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
- Corresponding author at: Dietetic Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.Dietetic DepartmentBirmingham Children's HospitalSteelhouse LaneBirminghamB4 6NHUK
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Behar JM, James S, Betts TR, Sieniewicz B, Turley A, Webster D, Claridge S, Gould J, Rinaldi CA. 20A multi-centre UK clinical experience with wireless intracardiac left ventricular endocardial stimulation for delivery of cardiac resynchronisation therapy (WiSE CRT). Europace 2017. [DOI: 10.1093/europace/eux283.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Leo M, Pedersen M, Rajappan K, Bowers R, Ginks M, Webster D, Bashir Y, Betts T. 35Power, lesion size index and oesophageal temperature alerts during atrial fibrillation ablation (PILOT-AF): a randomized study. Europace 2017. [DOI: 10.1093/europace/eux283.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Marques-da-Silva D, Francisco R, Webster D, Dos Reis Ferreira V, Jaeken J, Pulinilkunnil T. Cardiac complications of congenital disorders of glycosylation (CDG): a systematic review of the literature. J Inherit Metab Dis 2017; 40:657-672. [PMID: 28726068 DOI: 10.1007/s10545-017-0066-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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] [Received: 03/10/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 01/03/2023]
Abstract
Congenital disorders of glycosylation (CDG) are inborn errors of metabolism due to protein and lipid hypoglycosylation. This rapidly growing family of genetic diseases comprises 103 CDG types, with a broad phenotypic diversity ranging from mild to severe poly-organ -system dysfunction. This literature review summarizes cardiac involvement, reported in 20% of CDG. CDG with cardiac involvement were divided according to the associated type of glycosylation: N-glycosylation, O-glycosylation, dolichol synthesis, glycosylphosphatidylinositol (GPI)-anchor biosynthesis, COG complex, V-ATPase complex, and other glycosylation pathways. The aim of this review was to document and interpret the incidence of heart disease in CDG patients. Heart disorders were grouped into cardiomyopathies, structural defects, and arrhythmogenic disorders. This work may contribute to improved early management of cardiac complications in CDG.
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Affiliation(s)
- D Marques-da-Silva
- UCIBIO, Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Lisbon, Portugal
- Portuguese Association for CDG, Lisbon, Portugal
- CDG & Allies - Professionals and Patient Associations International Network (CDG & Allies - PPAIN), Caparica, Portugal
| | - R Francisco
- UCIBIO, Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Lisbon, Portugal
- Portuguese Association for CDG, Lisbon, Portugal
- CDG & Allies - Professionals and Patient Associations International Network (CDG & Allies - PPAIN), Caparica, Portugal
| | - D Webster
- Division of Infectious Diseases, Department of Medicine, Saint John Regional Hospital, Dalhousie University, Saint John, NB, Canada
| | - V Dos Reis Ferreira
- Portuguese Association for CDG, Lisbon, Portugal
- CDG & Allies - Professionals and Patient Associations International Network (CDG & Allies - PPAIN), Caparica, Portugal
| | - J Jaeken
- CDG & Allies - Professionals and Patient Associations International Network (CDG & Allies - PPAIN), Caparica, Portugal
- Center for Metabolic Diseases, UZ and KU Leuven, Leuven, Belgium
| | - T Pulinilkunnil
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Dalhousie University, Dalhousie Medicine New Brunswick, 100 Tucker Park Road, Saint John, NB, E2L 4L5, Canada.
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Leo M, Pedersen M, Bowers R, Webster D, Kalla M, Ginks M, Bashir Y, Hunter R, Rajappan K, Betts TR. P1415Should radiofrequency power be titrated according to BMI in order to reduce esophageal injury during atrial fibrillation ablation? Europace 2017. [DOI: 10.1093/ehjci/eux158.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Behar JM, James S, Betts TR, Sieniewicz B, Turley A, Webster D, Claridge S, Gould J, Rinaldi CA. 234A multi centre UK experience with optimal site implantation of a wireless intracardiac LV endocardial electrode (WiCS-LV) for delivery of cardiac resynchronisation therapy. Europace 2017. [DOI: 10.1093/ehjci/eux139.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ansite J, Balamurugan AN, Barbaro B, Battle J, Brandhorst D, Cano J, Chen X, Deng S, Feddersen D, Friberg A, Gilmore T, Goldstein JS, Holbrook E, Khan A, Kin T, Lei J, Linetsky E, Liu C, Luo X, McElvaney K, Min Z, Moreno J, O'Gorman D, Papas KK, Putz G, Ricordi C, Szot G, Templeton T, Wang L, Wilhelm JJ, Willits J, Wilson T, Zhang X, Avila J, Begley B, Cano J, Carpentier S, Holbrook E, Hutchinson J, Larsen CP, Moreno J, Sears M, Turgeon NA, Webster D, Deng S, Lei J, Markmann JF, Bridges ND, Czarniecki CW, Goldstein JS, Putz G, Templeton T, Wilson T, Eggerman TL, Al-Saden P, Battle J, Chen X, Hecyk A, Kissler H, Luo X, Molitch M, Monson N, Stuart E, Wallia A, Wang L, Wang S, Zhang X, Bigam D, Campbell P, Dinyari P, Kin T, Kneteman N, Lyon J, Malcolm A, O'Gorman D, Onderka C, Owen R, Pawlick R, Richer B, Rosichuk S, Sarman D, Schroeder A, Senior PA, Shapiro AMJ, Toth L, Toth V, Zhai W, Johnson K, McElroy J, Posselt AM, Ramos M, Rojas T, Stock PG, Szot G, Barbaro B, Martellotto J, Oberholzer J, Qi M, Wang Y, Bayman L, Chaloner K, Clarke W, Dillon JS, Diltz C, Doelle GC, Ecklund D, Feddersen D, Foster E, Hunsicker LG, Jasperson C, Lafontant DE, McElvaney K, Neill-Hudson T, Nollen D, Qidwai J, Riss H, Schwieger T, Willits J, Yankey J, Alejandro R, Corrales AC, Faradji R, Froud T, Garcia AA, Herrada E, Ichii H, Inverardi L, Kenyon N, Khan A, Linetsky E, Montelongo J, Peixoto E, Peterson K, Ricordi C, Szust J, Wang X, Abdulla MH, Ansite J, Balamurugan AN, Bellin MD, Brandenburg M, Gilmore T, Harmon JV, Hering BJ, Kandaswamy R, Loganathan G, Mueller K, Papas KK, Pedersen J, Wilhelm JJ, Witson J, Dalton-Bakes C, Fu H, Kamoun M, Kearns J, Li Y, Liu C, Luning-Prak E, Luo Y, Markmann E, Min Z, Naji A, Palanjian M, Rickels M, Shlansky-Goldberg R, Vivek K, Ziaie AS, Fernandez L, Kaufman DB, Zitur L, Brandhorst D, Friberg A, Korsgren O. Purified Human Pancreatic Islets, CIT Culture Media with Lisofylline or Exenatide. CellR4 Repair Replace Regen Reprogram 2017; 5:e2377. [PMID: 30613755 PMCID: PMC6319648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Petrie T, Domenico L, Webster D, Samatham R, Leachman S. 824 MoleMapper: What's good for users is good for science. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heather NL, Hofman PL, de Hora M, Carll J, Derraik JGB, Webster D. Evaluation of the revised New Zealand national newborn screening protocol for congenital hypothyroidism. Clin Endocrinol (Oxf) 2017; 86:431-437. [PMID: 27696498 DOI: 10.1111/cen.13250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Received: 06/26/2016] [Revised: 09/07/2016] [Accepted: 09/28/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to assess the performance of the revised New Zealand (NZ) newborn screening TSH cut-offs for congenital hypothyroidism (CHT). METHODS Screening data over 24 months were obtained from the NZ newborn metabolic screening programme, which utilizes a 2-tier system of direct clinical referral for infants with markedly elevated TSH, and second samples from those with mild TSH elevation. We evaluated the impact of a reduced TSH threshold (50 to 30 mIU/l blood) for direct notification and a lower cut-off (15 to 8 mIU/l blood) applied to second samples and babies older than 14 days. RESULTS In 2013 and 2014, 117 528 infants underwent newborn screening for CHT. Fifty-two CHT cases were identified by screening (47 general newborn population, five repeat testing in low-birth-weight infants) and one case was missed. Thirty-two infants with screening TSH ≥30 mIU/l were directly referred at a median of 9 days (5-14) and 15 with TSH 15-29 mIU/l were referred after a second sample at a median of 20 days (9-52, P < 0·001). All directly referred infants were confirmed as CHT cases with no earlier referrals as a result of the reduced threshold. The lower TSH cut-off applied to second samples lead to the identification of six extra cases of CHT (15% increase) from seven extra clinical referrals. CONCLUSIONS The NZ screening programme achieved a 15% increase in CHT case detection for minimal increase in workload or anxiety for families of healthy infants. A further decrease in the threshold for direct referral may allow earlier diagnoses.
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Affiliation(s)
- Natasha L Heather
- New Zealand Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland, New Zealand
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Mark de Hora
- New Zealand Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland, New Zealand
| | - Joan Carll
- New Zealand Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Dianne Webster
- New Zealand Newborn Metabolic Screening Programme, LabPlus, Auckland District Health Board, Auckland, New Zealand
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Pinto A, Daly A, Evans S, Almeida MF, Assoun M, Belanger-Quintana A, Bernabei S, Bollhalder S, Cassiman D, Champion H, Chan H, Dalmau J, de Boer F, de Laet C, de Meyer A, Desloovere A, Dianin A, Dixon M, Dokoupil K, Dubois S, Eyskens F, Faria A, Fasan I, Favre E, Feillet F, Fekete A, Gallo G, Gingell C, Gribben J, Kaalund-Hansen K, Horst N, Jankowski C, Janssen-Regelink R, Jones I, Jouault C, Kahrs GE, Kok IL, Kowalik A, Laguerre C, Le Verge S, Lilje R, Maddalon C, Mayr D, Meyer U, Micciche A, Robert M, Rocha JC, Rogozinski H, Rohde C, Ross K, Saruggia I, Schlune A, Singleton K, Sjoqvist E, Stolen LH, Terry A, Timmer C, Tomlinson L, Tooke A, Vande Kerckhove K, van Dam E, van den Hurk T, van der Ploeg L, van Driessche M, van Rijn M, van Teeffelen-Heithoff A, van Wegberg A, Vasconcelos C, Vestergaard H, Vitoria I, Webster D, White FJ, White L, Zweers H, MacDonald A. Dietary practices in isovaleric acidemia: A European survey. Mol Genet Metab Rep 2017; 12:16-22. [PMID: 28275552 PMCID: PMC5328917 DOI: 10.1016/j.ymgmr.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/28/2017] [Accepted: 02/14/2017] [Indexed: 12/21/2022] Open
Abstract
Background In Europe, dietary management of isovaleric acidemia (IVA) may vary widely. There is limited collective information about dietetic management. Aim To describe European practice regarding the dietary management of IVA, prior to the availability of the E-IMD IVA guidelines (E-IMD 2014). Methods A cross-sectional questionnaire was sent to all European dietitians who were either members of the Society for the Study of Inborn Errors of Metabolism Dietitians Group (SSIEM-DG) or whom had responded to previous questionnaires on dietetic practice (n = 53). The questionnaire comprised 27 questions about the dietary management of IVA. Results Information on 140 patients with IVA from 39 centres was reported. 133 patients (38 centres) were given a protein restricted diet. Leucine-free amino acid supplements (LFAA) were routinely used to supplement protein intake in 58% of centres. The median total protein intake prescribed achieved the WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Centres that prescribed LFAA had lower natural protein intakes in most age groups except 1 to 10 y. In contrast, when centres were not using LFAA, the median natural protein intake met WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Enteral tube feeding was rarely prescribed. Conclusions This survey demonstrates wide differences in dietary practice in the management of IVA across European centres. It provides unique dietary data collectively representing European practices in IVA which can be used as a foundation to compare dietary management changes as a consequence of the first E-IMD IVA guidelines availability.
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Affiliation(s)
- A Pinto
- Birmingham Children's Hospital, Birmingham, UK
| | - A Daly
- Birmingham Children's Hospital, Birmingham, UK
| | - S Evans
- Birmingham Children's Hospital, Birmingham, UK
| | - M F Almeida
- Centro de Genética Médica, Centro Hospitalar do Porto - CHP, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, Porto, Portugal
| | - M Assoun
- Centre de référence des maladies héréditaires du métabolisme, hôpital Necker enfants Malades, Paris
| | - A Belanger-Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatria, Hospital Ramon y Cajal Madrid, Spain
| | - S Bernabei
- Children's Hospital Bambino Gesù, Division of Metabolism, Rome, Italy
| | | | - D Cassiman
- Metabolic Center, University Hospitals Leuven and KU Leuven, Belgium
| | | | - H Chan
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Dalmau
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - F de Boer
- University of Groningen, University Medical Center Groningen, Netherlands
| | - C de Laet
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - A de Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - A Dianin
- Pediatric Department, University Hospital of Borgo Roma Verona, Italy
| | - M Dixon
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Dokoupil
- Dr. von Hauner Children's Hospital, Munich, Germany
| | - S Dubois
- Centre de référence des maladies héréditaires du métabolisme, hôpital Necker enfants Malades, Paris
| | - F Eyskens
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A Faria
- Hospital Pediatrico, Centro Hospitalar e Universitário de Coimbra, EPE, Portugal
| | - I Fasan
- Division of Inherited Metabolic Diseases, Department of Pediatrics, University Hospital of Padova, Italy
| | - E Favre
- Reference center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | - F Feillet
- Reference center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | - A Fekete
- Metabolic Centre of Vienna, Austria
| | - G Gallo
- Children's Hospital Bambino Gesù, Division of Metabolism, Rome, Italy
| | | | - J Gribben
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Kaalund-Hansen
- Charles Dent Metabolic Unit National Hospital for Neurology and Surgery, London, UK
| | - N Horst
- Emma Children's Hospital, AMC Amsterdam, Netherlands
| | - C Jankowski
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | | | - I Jones
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - G E Kahrs
- Haukeland University Hospital, Bergen, Norway
| | - I L Kok
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - A Kowalik
- Institute of Mother & Child, Warsaw, Poland
| | - C Laguerre
- Centre de Compétence de L'Hôpital des Enfants de Toulouse, France
| | - S Le Verge
- Centre de référence des maladies héréditaires du métabolisme, hôpital Necker enfants Malades, Paris
| | - R Lilje
- Oslo University Hospital, Norway
| | - C Maddalon
- University Children's Hospital Zurich, Switzerland
| | - D Mayr
- Ernährungsmedizinische Beratung, Universitätsklinik für Kinder- und Jugendheilkunde, Salzburg, Austria
| | - U Meyer
- Clinic of Paediatric Kidney, Liver and Metabolic Diseases, Medical School Hannover, Germany
| | - A Micciche
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - J C Rocha
- Centro de Genética Médica, Centro Hospitalar do Porto - CHP, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Portugal; Centre for Health Technology and Services Research (CINTESIS), Portugal
| | - H Rogozinski
- Bradford Teaching Hospital NHS Foundation Trust, UK
| | - C Rohde
- Hospital of Children's & Adolescents, University of Leipzig, Germany
| | - K Ross
- Royal Aberdeen Children's Hospital, Scotland
| | - I Saruggia
- Centre de Reference des Maladies Héréditaires du Métabolisme du Pr. B. Chabrol CHU Timone Enfant, Marseille, France
| | - A Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | | | - E Sjoqvist
- Children's Hospital, University Hospital, Lund, Sweden
| | | | - A Terry
- Alder Hey Children's Hospital NHS Foundation Trust Liverpool, UK
| | - C Timmer
- Academisch Medisch Centrum, Amsterdam, Netherlands
| | - L Tomlinson
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - A Tooke
- Nottingham University Hospitals, UK
| | - K Vande Kerckhove
- Metabolic Center, University Hospitals Leuven and KU Leuven, Belgium
| | - E van Dam
- University of Groningen, University Medical Center Groningen, Netherlands
| | - T van den Hurk
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - L van der Ploeg
- Maastricht University Medical Centre + (MUMC +), Netherlands
| | | | - M van Rijn
- University of Groningen, University Medical Center Groningen, Netherlands
| | | | - A van Wegberg
- Radboud University Medical Center Nijmegen, The Netherlands
| | - C Vasconcelos
- Centro Hospitalar São João - Unidade de Doenças Metabólicas, Porto, Portugal
| | | | - I Vitoria
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - D Webster
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | - F J White
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - L White
- Sheffield Children's Hospital, UK
| | - H Zweers
- Radboud University Medical Center Nijmegen, The Netherlands
| | - A MacDonald
- Birmingham Children's Hospital, Birmingham, UK
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Nugent DB, Webster D, Mabayoje D, Chung E, El Bouzidi K, O'Sullivan A, Ainsworth J, Miller RF. Use of plasma human herpesvirus-8 viral load measurement: evaluation of practice in three UK HIV treatment centres. Int J STD AIDS 2017; 28:188-191. [PMID: 28120699 DOI: 10.1177/0956462416676031] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A retrospective audit of plasma human herpesvirus-8 (HHV-8) viral load testing was performed in three HIV treatment centres over 24 months. Reasons for testing (360 tests) were: symptoms of systemic inflammatory response syndrome (SIRS) (fever, lymphadenopathy and raised inflammatory markers); monitoring in known HHV-8 pathology other than Kaposi sarcoma (KS); investigation of known/suspected KS, and other/no reason. Of patients with multicentric Castleman disease (MCD), 14/16 (88%) had detectable plasma HHV-8, as did 27/45 (60%) with biopsy proven or clinically confirmed KS, and 6/19 (32%) with lymphoma. Neither of the two patients with MCD and no detectable HHV-8 had SIRS symptoms at the time of the test. There was wide variation between centres in the indications prompting HHV-8 testing, with a more conservative approach resulting in a higher proportion of positive results. Measuring plasma HHV-8 in the absence of SIRS symptoms, established HHV-8 disease monitoring, or confirmed/suspected KS is unlikely to yield detectable HHV-8 thus allowing potential cost savings.
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Affiliation(s)
- D B Nugent
- 1 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - D Webster
- 2 Royal Free London NHS Foundation Trust, London, UK
| | - D Mabayoje
- 2 Royal Free London NHS Foundation Trust, London, UK
| | - E Chung
- 1 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - K El Bouzidi
- 3 University College London Hospitals NHS Foundation Trust, London, UK.,4 University College London, London, UK
| | - A O'Sullivan
- 5 North Middlesex University Hospital NHS Trust, London, UK
| | - J Ainsworth
- 5 North Middlesex University Hospital NHS Trust, London, UK
| | - R F Miller
- 1 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.,3 University College London Hospitals NHS Foundation Trust, London, UK.,4 University College London, London, UK
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Wilson C, Knoll D, de Hora M, Kyle C, Glamuzina E, Webster D. The Risk of Fatty Acid Oxidation Disorders and Organic Acidemias in Children with Normal Newborn Screening. JIMD Rep 2016; 35:53-58. [PMID: 27928776 DOI: 10.1007/8904_2016_25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/02/2016] [Revised: 11/13/2016] [Accepted: 11/15/2016] [Indexed: 01/11/2023] Open
Abstract
New Zealand has undertaken expanded newborn screening since 2006. During that period there have been no reported cases of fatty acid oxidation disorders or organic acidemias that have been diagnosed clinically that the screening programme missed. However there may have been patients that presented clinically that were not diagnosed correctly or notified.In order to investigate the false-negative screening rate a case-control study was undertaken whereby the clinical coding data and relevant medical records were reviewed for 150 controls and 525 cases. The cases had normal newborn screening but with key analytes and/or ratios just below the notification level for individual disorders and thus in theory were most at risk of having metabolic disease.Two cases had medical histories suggestive of metabolic disease and thus could represent a false-negative screen. One of these had marginally elevated octanoyl carnitine levels and thus possible medium-chain acyl Co-A dehydrogenase deficiency (MCADD) while the other had elevated isovaleryl carnitine and thus may have been a case of isovaleric acidemia (IVA). However, subsequent molecular analysis revealed that the diagnosis of MCADD and IVA was unlikely.Despite relatively high cut-offs the New Zealand Newborn Metabolic Screening Programme does not appear to have missed any confirmed cases of fatty acid oxidation disorders and organic acidemias in its first 8 years of expanded newborn screening. This would suggest a similar low false-negative screening rate in centres with comparable screening protocols and would indicate that the risk of fatty acid oxidation disorders and classical organic acidemias in children who had normal newborn screening is low.
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Affiliation(s)
- Callum Wilson
- National Metabolic Service, Starship Children's Hospital, PO Box 92024, Auckland, 1142, New Zealand.
| | - Detlef Knoll
- Newborn Metabolic Screening Unit, Auckland City Hospital, Auckland, New Zealand
| | - Mark de Hora
- Newborn Metabolic Screening Programme, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Campbell Kyle
- LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Emma Glamuzina
- National Metabolic Service, Starship Children's Hospital, PO Box 92024, Auckland, 1142, New Zealand
| | - Dianne Webster
- Newborn Metabolic Screening Programme, LabPlus, Auckland City Hospital, Auckland, New Zealand
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Ryder B, Knoll D, Love DR, Shepherd P, Love JM, Reed PW, de Hora M, Webster D, Glamuzina E, Wilson C. The natural history of elevated tetradecenoyl-L-carnitine detected by newborn screening in New Zealand: implications for very long chain acyl-CoA dehydrogenase deficiency screening and treatment. J Inherit Metab Dis 2016; 39:409-414. [PMID: 26743058 DOI: 10.1007/s10545-015-9911-z] [Citation(s) in RCA: 11] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/06/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022]
Abstract
Very long chain acyl-CoA dehydrogenase deficiency (VLCADD, OMIM #201475) has been increasingly diagnosed since the advent of expanded newborn screening (NBS). Elevated levels of tetradecenoyl-L-carnitine (C14:1) in newborn screening blood spot samples are particularly common in New Zealand, however this has not translated into increased VLCADD clinical presentations. A high proportion of screen-positive cases in NZ are of Maori or Pacific ethnicity and positive for the c.1226C > T (p.Thr409Met) ACADVL gene variant. We performed a retrospective, blinded, case-control study of 255 cases, born between 2006 and 2013, with elevated NBS C14:1 levels between 0.9 and 2.4 μmol/L, below the NZ C14:1 notification cut-off of 2.5 μmol/L. Coded healthcare records were audited for cases and age- and ethnicity- matched controls. The clinical records of those with possible VLCADD-related symptoms were reviewed. The follow-up period was 6 months to 7 years. Two of 247 cases (0.8 %) had possible VLCADD-like symptoms while four of 247 controls (2 %) had VLCADD-like symptoms (p = 0.81). Maori were overrepresented (68 % of the cohort vs 15 % of population). Targeted analysis of the c.1226 locus revealed the local increase in screening C14:1 levels is associated with the c.1226C > T variant (97/152 alleles tested), found predominantly in Maori and Pacific people. There was no increase in clinically significant childhood disease, irrespective of ethnicity. The study suggests that children with elevated C14:1, between 0.9-2.4 μmol/L, on NBS are at very low risk of clinically significant childhood disease. A minimally interventional approach to managing these patients is indicated, at least in the New Zealand population.
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Affiliation(s)
- Bryony Ryder
- Starship Children's Hospital, Auckland, New Zealand
| | - Detlef Knoll
- Newborn Metabolic Screening Unit, Auckland City Hospital, Auckland, New Zealand
| | - Donald R Love
- Diagnostic Genetics, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | | | - Jennifer M Love
- Diagnostic Genetics, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Peter W Reed
- Children's Research Centre, Starship Children's Health, Auckland, New Zealand
| | - Mark de Hora
- Newborn Metabolic Screening Unit, Auckland City Hospital, Auckland, New Zealand
| | - Dianne Webster
- Newborn Metabolic Screening Unit, Auckland City Hospital, Auckland, New Zealand
| | - Emma Glamuzina
- National Metabolic Service, Starship Children's Hospital, PO Box 92024, Auckland, New Zealand
| | - Callum Wilson
- National Metabolic Service, Starship Children's Hospital, PO Box 92024, Auckland, New Zealand.
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Eastwood A, Webster D, Taylor J, Mckay R, McEwen A, Sullivan J, Pope-Couston R, Stone P. Antenatal screening for aneuploidy--surveying the current situation and planning for non-invasive prenatal diagnosis in New Zealand. N Z Med J 2016; 129:57-63. [PMID: 26914300] [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: 06/05/2023]
Abstract
AIMS To gauge clinical opinion about the current system and possible changes as well as providing a forum for education about Non-Invasive Prenatal Testing (NIPT). METHODS A series of workshops for doctors and midwives, supported by the National Screening Unit of the Ministry of Health and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, were held in the main centres of New Zealand. Following a brief education session, a structured evaluation of current screening and future possibilities was undertaken by questionnaire. RESULTS One hundred and eight maternity carers participated in 5 workshops. Over 40% identified barriers to current screening. More than 60% would support NIPT in the first trimester. The majority of carers provided their own counselling support for women. CONCLUSIONS The survey has shown general enthusiasm for the introduction of publically funded NIPT into prenatal screening in New Zealand. Barriers to utilisation of the current system have been identified and enhancements to screening performance with guidelines around conditions to be screened for would be supported.
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Affiliation(s)
| | | | | | | | | | | | | | - Peter Stone
- Obstetrics and Gynaecology, The University of Auckland, Auckland.
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de Frutos C, Webster D, Fahrenkrug SC, Carlson DF. 240 PRECISE GENOME EDITING OF PDX1 BY DIRECT INJECTION OF TRANSCRIPTION ACTIVATOR-LIKE EFFECTOR NUCLEASES (TALENS) INTO PARTHENOGENETIC PIG EMBRYOS. Reprod Fertil Dev 2016. [DOI: 10.1071/rdv28n2ab240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pancreatic and duodenal homeobox 1 (PDX1) is one of the transcription factors involved in pancreatic organogenesis and plays a critical role as an early lineage marker of pancreatic specification and β-cell differentiation. In mature pancreas, PDX1 regulates a large number of genes involved in maintaining β-cell identity and function. In mice and humans, its homozygous disruption results in pancreas agenesis, while heterozygous mutations have been associated with early-onset (MODY) and late-onset forms of Type II diabetes mellitus in humans. Knockout of the PDX1 gene in pigs may lead to the generation of an apancreatic phenotype, which in turn could allow the potential generation of an exogenic pancreas. Moreover, this could help to create a large animal model for human diabetes. We used transcription activator-like effector nucleases (TALEN) technology with the aim of studying the efficiency of precise editing by homologous recombination in parthenogenetically activated porcine embryos. Mature oocytes were activated by incubation in ionomycin (10 µM) for 20 min, followed by a 4-h incubation in DMAP (2 mM) + cytochalasin B (7.5 µg mL–1). Cytoplasmic injection was performed 14 h post-activation. Post injections, embryos were cultured for 6 days in NCSU23+BSA media at 38.5°C in a 5% CO2 atmosphere. We first evaluated the activity of a pair of TALENs targeting the functional domain of the PDX1 gene. Three concentrations of mRNA were microinjected (10, 20, and 40 ng µL–1) and blastocysts were analysed for non-homologous end-joining (NHEJ) by sequencing. The efficiency of indel mutations at the PDX1-target loci (either monoallelic or biallelic) was 34.5, 52.6, and 80.0% for the 10, 20, and 40 ng µL–1 concentrations, respectively. Next, we tested whether ssODNs (single-stranded oligodeoxynucleotide) coinjected with TALENs would permit precise homology direct repair (HDR) in porcine parthenotes. TALEN mRNA (40 ng µL–1) was coinjected with an ssODN donor template (50 ng µL–1) designed to incorporate a novel stop codon, HindIII restriction site, and a frame shift mutation. Cleavage and blastocyst rates were recorded at Days 2 and 6 of development, respectively, in the TALEN/ssODN injected group (n = 260 zygotes), buffer-injected embryos (n = 135 zygotes), and the non-injected group (n = 132 zygotes). Day 7 embryos were analysed for NHEJ and HDR by RFLP assay and Sanger sequencing after whole-genome amplification and PCR. Blastocyst rates were 15% (TALEN/ssODN-injected group), 27% (buffer-injected group), and 34% (non-injected group). A total of 30 blastocysts were analysed for HDR after whole-genome amplification. The majority of analysed blastocysts (28/30, 93%) were mutant. Among them, 10 (36%) incorporated the ssODN, from which 3 (30%) showed a KO genotype with a precise biallelic modification. We report here a highly efficient and precise TALEN-mediated gene knockout in swine embryos, which represents an alternative to cloning for phenotype evaluation of knockouts related to organogenesis.
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Ellis J, Brown J, Smith C, Snell L, Capocci S, Ferro F, Ferreira J, Marshall N, Webster D, Johnson M, Lipman M. Influenza immunisation: knowledge and actions taken by UK HIV-positive adults. HIV Med 2015; 17:397-9. [DOI: 10.1111/hiv.12309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Ellis
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - J Brown
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
- Division of Medicine; University College London; London UK
| | - C Smith
- Department of Infection and Population Health; University College London; London UK
| | - L Snell
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - S Capocci
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - F Ferro
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - J Ferreira
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - N Marshall
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - D Webster
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - M Johnson
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - M Lipman
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
- Division of Medicine; University College London; London UK
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Aguiar A, Ahring K, Almeida MF, Assoun M, Belanger Quintana A, Bigot S, Bihet G, Blom Malmberg K, Burlina A, Bushueva T, Caris A, Chan H, Clark A, Clark S, Cochrane B, Corthouts K, Dalmau J, Dassy M, De Meyer A, Didycz B, Diels M, Dokupil K, Dubois S, Eftring K, Ekengren J, Ellerton C, Evans S, Faria A, Fischer A, Ford S, Freisinger P, Giżewska M, Gokmen-Ozel H, Gribben J, Gunden F, Heddrich-Ellerbrok M, Heiber S, Heidenborg C, Jankowski C, Janssen-Regelink R, Jones I, Jonkers C, Joerg-Streller M, Kaalund-Hansen K, Kiss E, Lammardo AM, Lang K, Lier D, Lilje R, Lowry S, Luyten K, MacDonald A, Meyer U, Moor D, Pal A, Robert M, Robertson L, Rocha JC, Rohde C, Ross K, Saruhan S, Sjöqvist E, Skeath R, Stoelen L, Ter Horst NM, Terry A, Timmer C, Tuncer N, Vande Kerckhove K, van der Ploeg L, van Rijn M, van Spronsen FJ, van Teeffelen-Heithoff A, van Wegberg A, van Wyk K, Vasconcelos C, Vitoria I, Wildgoose J, Webster D, White FJ, Zweers H. Practices in prescribing protein substitutes for PKU in Europe: No uniformity of approach. Mol Genet Metab 2015; 115:17-22. [PMID: 25862610 DOI: 10.1016/j.ymgme.2015.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There appears little consensus concerning protein requirements in phenylketonuria (PKU). METHODS A questionnaire completed by 63 European and Turkish IMD centres from 18 countries collected data on prescribed total protein intake (natural/intact protein and phenylalanine-free protein substitute [PS]) by age, administration frequency and method, monitoring, and type of protein substitute. Data were analysed by European region using descriptive statistics. RESULTS The amount of total protein (from PS and natural/intact protein) varied according to the European region. Higher median amounts of total protein were prescribed in infants and children in Northern Europe (n=24 centres) (infants <1 year, >2-3g/kg/day; 1-3 years of age, >2-3 g/kg/day; 4-10 years of age, >1.5-2.5 g/kg/day) and Southern Europe (n=10 centres) (infants <1 year, 2.5 g/kg/day, 1-3 years of age, 2 g/kg/day; 4-10 years of age, 1.5-2 g/kg/day), than by Eastern Europe (n=4 centres) (infants <1 year, 2.5 g/kg/day, 1-3 years of age, >2-2.5 g/kg/day; 4-10 years of age, >1.5-2 g/kg/day) and with Western Europe (n=25 centres) giving the least (infants <1 year, >2-2.5 g/kg/day, 1-3 years of age, 1.5-2 g/kg/day; 4-10 years of age, 1-1.5 g/kg/day). Total protein prescription was similar in patients aged >10 years (1-1.5 g/kg/day) and maternal patients (1-1.5 g/kg/day). CONCLUSIONS The amounts of total protein prescribed varied between European countries and appeared to be influenced by geographical region. In PKU, all gave higher than the recommended 2007 WHO/FAO/UNU safe levels of protein intake for the general population.
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Affiliation(s)
- A Aguiar
- Hospital de Santo Espirito da Ilha Terceira, Portugal
| | - K Ahring
- Kennedy Centre, Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - M F Almeida
- Centro de Genética Médica Doutor Jacinto de Magalhães, CHP EPE, Porto, Portugal; Multidisciplinary Unit for Biomedical Research, UMIB-FCT, Porto, Portugal
| | - M Assoun
- Service des Maladies Héréditaires du Métabolisme, Hospital Necker Enfants Malades, Paris, France
| | | | - S Bigot
- Centre Hospitalier Universitaire de Rennes, France
| | - G Bihet
- Centre Hospitalier Chrétien, Centre Pinocchio Liège, Belgium
| | | | - A Burlina
- Division of Inherited Metabolic Diseases, Department of Pediatrics, University Hospital of Padova, Italy
| | - T Bushueva
- Scientific Center of Children's Health, Moscow, Russian Federation
| | - A Caris
- Centre Wallon de Génétique Humaine, Maladies Métaboliques, CHU de Liège Sart-Tilman, Belgium
| | - H Chan
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Clark
- National Centre for Inherited Metabolic Disorders, Dublin, Ireland
| | - S Clark
- Addenbrooke's Hospital, Cambridge, UK
| | - B Cochrane
- Royal Hospital for Sick Children, Glasgow, Scotland, UK
| | - K Corthouts
- University Hospitals Leuven, Center of Metabolic Diseases, Leuven, Belgium
| | | | - M Dassy
- Cliniques Universitaires St Luc, Brussels, Belgium
| | - A De Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - B Didycz
- University Children's Hospital, Cracow, Poland
| | - M Diels
- University Hospitals Leuven, Center of Metabolic Diseases, ZOL, Genk, Belgium
| | - K Dokupil
- Dr. von Hauner Children's Hospital, Munich, Germany
| | - S Dubois
- Service des Maladies Héréditaires du Métabolisme, Hospital Necker Enfants Malades, Paris, France
| | - K Eftring
- Queen Silvia's Children Hospital, Gothenburg, Sweden
| | - J Ekengren
- Queen Silvia's Children Hospital, Gothenburg, Sweden
| | | | - S Evans
- Birmingham Children's Hospital, Birmingham, UK
| | - A Faria
- Hospital Pediatrico, Centro Hospitalar e Universitário de Coimbra, EPE, Portugal
| | - A Fischer
- Klinikum am Steinenberg, Klinik für Kinder- und Jugendmedizin Reutlingen, Germany
| | - S Ford
- North Bristol NHS Trust Southmead and Frenchay, UK
| | - P Freisinger
- Klinikum am Steinenberg, Klinik für Kinder- und Jugendmedizin Reutlingen, Germany
| | - M Giżewska
- Pomeranian Medical University, Szczecin, Poland
| | - H Gokmen-Ozel
- Haccettepe University Children's Hospital, Ankara, Turkey
| | - J Gribben
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Gunden
- Uludag University Medical Faculty, Bursa, Turkey
| | | | - S Heiber
- University Hospital, Basel, Switzerland
| | - C Heidenborg
- Karolinska University Hospital, Stockholm, Sweden
| | - C Jankowski
- University Hospitals Bristol NHS Foundation Trust, UK
| | | | - I Jones
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - C Jonkers
- Academic Medical Hospital, Amsterdam, Netherlands
| | - M Joerg-Streller
- Medical University of Innsbruck, Clinic for Pediatrics, Inherited Metabolic Disorders, Austria
| | | | - E Kiss
- Semmelweis University, Hungary
| | | | - K Lang
- Ninewells Hospital, Dundee, Scotland, UK
| | - D Lier
- Klinikum am Steinenberg, Klinik für Kinder- und Jugendmedizin Reutlingen, Germany
| | - R Lilje
- Oslo University Hospital Rikshospitalet, Norway
| | - S Lowry
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - K Luyten
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A MacDonald
- Birmingham Children's Hospital, Birmingham, UK.
| | - U Meyer
- Clinic of Paediatric Kidney, Liver and Metabolic Diseases Medical School Hannover, Germany
| | - D Moor
- Kinderspital Zürich, Switzerland
| | - A Pal
- Akademiska University Hospital (Children's Centre), Sweden
| | - M Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | | | - J C Rocha
- Centro de Genética Médica Doutor Jacinto de Magalhães, CHP EPE, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Portugal
| | - C Rohde
- Hospital for Children and Adolescents, University Hospitals, University of Leipzig, Germany
| | - K Ross
- Royal Aberdeen Children's Hospital, Scotland, UK
| | - S Saruhan
- Haccettepe University Children's Hospital, Ankara, Turkey
| | - E Sjöqvist
- Children's Hospital, University Hospital Skåne, Sweden
| | - R Skeath
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - L Stoelen
- Oslo University Hospital Rikshospitalet, Norway
| | | | - A Terry
- Alderhey Children's Hospital, Liverpool, UK
| | | | - N Tuncer
- Dokuz Eylül University Nevvar-Salih İşgören Children Hospital, Turkey
| | - K Vande Kerckhove
- University Hospitals Leuven, Center of Metabolic Diseases, Leuven, Belgium
| | | | - M van Rijn
- University of Groningen, University Medical Center, Groningen, Netherlands
| | - F J van Spronsen
- University of Groningen, University Medical Center, Groningen, Netherlands
| | | | - A van Wegberg
- Radboud University Nijmegen Medical Centre, Netherlands
| | - K van Wyk
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C Vasconcelos
- Centro Hospitalar São João - Unidade de Doenças Metabólicas, Porto, Portugal
| | | | | | - D Webster
- University Hospitals Bristol NHS Foundation Trust, UK
| | - F J White
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - H Zweers
- Radboud University Nijmegen Medical Centre, Netherlands
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Heather NL, Seneviratne SN, Webster D, Derraik JGB, Jefferies C, Carll J, Jiang Y, Cutfield WS, Hofman PL. Newborn screening for congenital adrenal hyperplasia in New Zealand, 1994-2013. J Clin Endocrinol Metab 2015; 100:1002-8. [PMID: 25494862 DOI: 10.1210/jc.2014-3168] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 11/19/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the efficacy of national newborn screening for severe congenital adrenal hyperplasia (CAH) in New Zealand over the past 20 years. METHODS Newborn screening for CAH is performed through the estimation of 17-hydroxyprogesterone by a Delfia immunoassay. CAH cases diagnosed in the newborn period from 1994 to 2013 were identified from Newborn Metabolic Screening Programme records. RESULTS Between 1994 and 2013, 44 neonates (28 females, 16 males) were diagnosed with CAH, giving an incidence of 1:26 727. Almost half (n = 21) of the newborns with CAH were detected solely via screening (not clinically suspected), including 21% of all affected females. Among the group solely ascertained by screening, 17-hydroxyprogesterone sampling occurred at a mean age of 3.3 days (range 2-8 d), the duration from sampling to notification was 5.2 days (0-12 d), and treatment was initiated at 12.0 days (6-122 d). Vomiting was present in 14% of those ascertained by screening, but none had hypotension or collapse at diagnosis. Increasing age at treatment was correlated with a progressive decrease in serum sodium (r = -0.56; P < .0001) and an increase in serum potassium concentrations (r = 0.38; P = .017). Compared with newborns diagnosed by screening alone, those clinically diagnosed were predominantly female (96% vs 29%; P < .0001), notification occurred earlier (4.8 vs 8.5 d; P = .002), and had higher serum sodium (136.8 vs 130.8 mmol/L; P < .0001) and lower serum potassium (5.3 vs 6.0 mmol/L; P = .011) concentrations. CONCLUSIONS Screening alone accounted for nearly 50% cases of CAH detected in the newborn period, including a fifth of affected females, indicating that clinical diagnosis is unreliable in both genders. Symptoms were mild at diagnosis and there were no adrenal crises. This study confirms the benefits of newborn CAH screening.
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Affiliation(s)
- Natasha L Heather
- Starship Children's Hospital (N.L.H., C.J.), 1023 Auckland, New Zealand; Liggins Institute (S.N.S., J.G.B.D., W.S.C., P.L.H.) and Department of Statistics (Y.J.), University of Auckland, 1142 Auckland, New Zealand; and New Zealand National Screening Unit (D.W., J.C.), Ministry of Health, 1051 Auckland, New Zealand
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Meyer B, Byrne M, Collier C, Parletta N, Crawford D, Winberg P, Webster D, Chapman K, Thomas G, Dally J, Batterham M, Farquhar I, Grant L. Baseline omega-3 index correlates with aggressive and attention deficit behaviours in adult prisoners. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.022] [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] Open
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Chisnall B, Webster D. A rare cause of anaemia in pregnancy. J OBSTET GYNAECOL 2014; 34:742-3. [PMID: 25020207 DOI: 10.3109/01443615.2014.935728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McNeil SA, Shinde V, Andrew M, Hatchette TF, LeBlanc J, Ambrose A, Boivin G, Bowie WR, Diaz-Mitoma F, ElSherif M, Green K, Haguinet F, Halperin S, Ibarguchi B, Katz K, Langley JM, Lagacé-Wiens P, Light B, Loeb M, McElhaney JE, MacKinnon-Cameron D, McCarthy AE, Poirier M, Powis J, Richardson D, Semret M, Smith S, Smyth D, Stiver G, Trottier S, Valiquette L, Webster D, Ye L, McGeer A. Interim estimates of 2013/14 influenza clinical severity and vaccine effectiveness in the prevention of laboratory-confirmed influenza-related hospitalisation, Canada, February 2014. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.9.20729] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- S A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - V Shinde
- GlaxoSmithKline Biologicals, Wavre, Belgium
| | - M Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - T F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - J LeBlanc
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - W R Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - F Diaz-Mitoma
- Advanced Medical Research Institute of Canada, Sudbury, Ontario, Canada
| | - M ElSherif
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - K Green
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - F Haguinet
- GlaxoSmithKline Biologicals, Wavre, Belgium
| | - S Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - B Ibarguchi
- GlaxoSmithKline, Mississauga, Ontario, Canada
| | - K Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - JM Langley
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - B Light
- St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - M Loeb
- McMaster University, Hamilton, Ontario, Canada
| | - J E McElhaney
- Advanced Medical Research Institute of Canada, Sudbury, Ontario, Canada
| | - D MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - M Poirier
- Centre de santé et de service sociaux de Trois-Rivieres, Trois-Rivieres, Quebec, Canada
| | - J Powis
- Toronto East General Hospital, Toronto, Ontario, Canada
| | - D Richardson
- William Osler Health Centre, Brampton, Ontario, Canada
| | - M Semret
- McGill University, Montreal, Quebec, Canada
| | - S Smith
- University of Alberta, Edmonton, Alberta, Canada
| | - D Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - G Stiver
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - L Valiquette
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - D Webster
- Horizon Health, Saint John, New Brunswick, Canada
| | - L Ye
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A McGeer
- Mount Sinai Hospital, Toronto, Ontario, Canada
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Adam S, Almeida MF, Assoun M, Baruteau J, Bernabei SM, Bigot S, Champion H, Daly A, Dassy M, Dawson S, Dixon M, Dokoupil K, Dubois S, Dunlop C, Evans S, Eyskens F, Faria A, Favre E, Ferguson C, Goncalves C, Gribben J, Heddrich-Ellerbrok M, Jankowski C, Janssen-Regelink R, Jouault C, Laguerre C, Le Verge S, Link R, Lowry S, Luyten K, Macdonald A, Maritz C, McDowell S, Meyer U, Micciche A, Robert M, Robertson LV, Rocha JC, Rohde C, Saruggia I, Sjoqvist E, Stafford J, Terry A, Thom R, Vande Kerckhove K, van Rijn M, van Teeffelen-Heithoff A, Wegberg AV, van Wyk K, Vasconcelos C, Vestergaard H, Webster D, White FJ, Wildgoose J, Zweers H. Dietary management of urea cycle disorders: European practice. Mol Genet Metab 2013; 110:439-45. [PMID: 24113687 DOI: 10.1016/j.ymgme.2013.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 06/06/2013] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is no published data comparing dietary management of urea cycle disorders (UCD) in different countries. METHODS Cross-sectional data from 41 European Inherited Metabolic Disorder (IMD) centres (17 UK, 6 France, 5 Germany, 4 Belgium, 4 Portugal, 2 Netherlands, 1 Denmark, 1 Italy, 1 Sweden) was collected by questionnaire describing management of patients with UCD on prescribed protein restricted diets. RESULTS Data for 464 patients: N-acetylglutamate synthase (NAGS) deficiency, n=10; carbamoyl phosphate synthetase (CPS1) deficiency, n=29; ornithine transcarbamoylase (OTC) deficiency, n=214; citrullinaemia, n=108; argininosuccinic aciduria (ASA), n=80; arginase deficiency, n=23 was reported. The majority of patients (70%; n=327) were aged 0-16y and 30% (n=137) >16y. Prescribed median protein intake/kg body weight decreased with age with little variation between disorders. The UK tended to give more total protein than other European countries particularly in infancy. Supplements of essential amino acids (EAA) were prescribed for 38% [n=174] of the patients overall, but were given more commonly in arginase deficiency (74%), CPS (48%) and citrullinaemia (46%). Patients in Germany (64%), Portugal (67%) and Sweden (100%) were the most frequent users of EAA. Only 18% [n=84] of patients were prescribed tube feeds, most commonly for CPS (41%); and 21% [n=97] were prescribed oral energy supplements. CONCLUSIONS Dietary treatment for UCD varies significantly between different conditions, and between and within European IMD centres. Further studies examining the outcome of treatment compared with the type of dietary therapy and nutritional support received are required.
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Affiliation(s)
- S Adam
- Royal Hospital for Sick Children, Glasgow Royal Infirmary, Glasgow, UK
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Adam S, Almeida MF, Carbasius Weber E, Champion H, Chan H, Daly A, Dixon M, Dokoupil K, Egli D, Evans S, Eyskens F, Faria A, Ferguson C, Hallam P, Heddrich-Ellerbrok M, Jacobs J, Jankowski C, Lachmann R, Lilje R, Link R, Lowry S, Luyten K, MacDonald A, Maritz C, Martins E, Meyer U, Müller E, Murphy E, Robertson LV, Rocha JC, Saruggia I, Schick P, Stafford J, Stoelen L, Terry A, Thom R, van den Hurk T, van Rijn M, van Teefelen-Heithoff A, Webster D, White FJ, Wildgoose J, Zweers H. Dietary practices in pyridoxine non-responsive homocystinuria: a European survey. Mol Genet Metab 2013; 110:454-9. [PMID: 24206934 DOI: 10.1016/j.ymgme.2013.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 10/04/2013] [Accepted: 10/05/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Within Europe, the management of pyridoxine (B6) non-responsive homocystinuria (HCU) may vary but there is limited knowledge about treatment practice. AIM A comparison of dietetic management practices of patients with B6 non-responsive HCU in European centres. METHODS A cross-sectional audit by questionnaire was completed by 29 inherited metabolic disorder (IMD) centres: (14 UK, 5 Germany, 3 Netherlands, 2 Switzerland, 2 Portugal, 1 France, 1 Norway, 1 Belgium). RESULTS 181 patients (73% >16 years of age) with HCU were identified. The majority (66%; n=119) were on dietary treatment (1-10 years, 90%; 11-16 years, 82%; and >16 years, 58%) with or without betaine and 34% (n=62) were on betaine alone. The median natural protein intake (g/day) on diet only was, by age: 1-10 years, 12 g; 11-16 years, 11 g; and >16 years, 45 g. With diet and betaine, median natural protein intake (g/day) by age was: 1-10 years, 13 g; 11-16 years, 20 g; and >16 years, 38 g. Fifty-two percent (n=15) of centres allocated natural protein by calculating methionine rather than a protein exchange system. A methionine-free l-amino acid supplement was prescribed for 86% of diet treated patients. Fifty-two percent of centres recommended cystine supplements for low plasma concentrations. Target treatment concentrations for homocystine/homocysteine (free/total) and frequency of biochemical monitoring varied. CONCLUSION In B6 non-responsive HCU the prescription of dietary restriction by IMD centres declined with age, potentially associated with poor adherence in older patients. Inconsistencies in biochemical monitoring and treatment indicate the need for international consensus guidelines.
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Affiliation(s)
- S Adam
- Glasgow Royal Infirmary, Royal Hospital for Sick Children, UK
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