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Chen J, Neil JA, Tan JP, Rudraraju R, Mohenska M, Sun YBY, Walters E, Bediaga NG, Sun G, Zhou Y, Li Y, Drew D, Pymm P, Tham WH, Wang Y, Rossello FJ, Nie G, Liu X, Subbarao K, Polo JM. Author Correction: A placental model of SARS-CoV-2 infection reveals ACE2-dependent susceptibility and differentiation impairment in syncytiotrophoblasts. Nat Cell Biol 2024; 26:305. [PMID: 38110493 PMCID: PMC10866712 DOI: 10.1038/s41556-023-01335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- J Chen
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - J A Neil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - J P Tan
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - R Rudraraju
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - M Mohenska
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - Y B Y Sun
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - E Walters
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
- Adelaide Centre for Epigenetics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Immunogenomics Cancer Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - N G Bediaga
- Adelaide Centre for Epigenetics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Immunogenomics Cancer Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - G Sun
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - Y Zhou
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - Y Li
- Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - D Drew
- Infectious Diseases and Immune Defences Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - P Pymm
- Infectious Diseases and Immune Defences Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - W H Tham
- Infectious Diseases and Immune Defences Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Y Wang
- Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - F J Rossello
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
- University of Melbourne Centre for Cancer Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - G Nie
- Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - X Liu
- School of Life Sciences, Westlake University, Hangzhou, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China
- Westlake Institute for Advanced Study, Hangzhou, China
| | - K Subbarao
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Victoria, Australia.
| | - J M Polo
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia.
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia.
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia.
- Adelaide Centre for Epigenetics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
- South Australian Immunogenomics Cancer Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
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Chen J, Neil JA, Tan JP, Rudraraju R, Mohenska M, Sun YBY, Walters E, Bediaga NG, Sun G, Zhou Y, Li Y, Drew D, Pymm P, Tham WH, Wang Y, Rossello FJ, Nie G, Liu X, Subbarao K, Polo JM. A placental model of SARS-CoV-2 infection reveals ACE2-dependent susceptibility and differentiation impairment in syncytiotrophoblasts. Nat Cell Biol 2023; 25:1223-1234. [PMID: 37443288 PMCID: PMC10415184 DOI: 10.1038/s41556-023-01182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/02/2023] [Indexed: 07/15/2023]
Abstract
SARS-CoV-2 infection causes COVID-19. Several clinical reports have linked COVID-19 during pregnancy to negative birth outcomes and placentitis. However, the pathophysiological mechanisms underpinning SARS-CoV-2 infection during placentation and early pregnancy are not clear. Here, to shed light on this, we used induced trophoblast stem cells to generate an in vitro early placenta infection model. We identified that syncytiotrophoblasts could be infected through angiotensin-converting enzyme 2 (ACE2). Using a co-culture model of vertical transmission, we confirmed the ability of the virus to infect syncytiotrophoblasts through a previous endometrial cell infection. We further demonstrated transcriptional changes in infected syncytiotrophoblasts that led to impairment of cellular processes, reduced secretion of HCG hormone and morphological changes vital for syncytiotrophoblast function. Furthermore, different antibody strategies and antiviral drugs restore these impairments. In summary, we have established a scalable and tractable platform to study early placental cell types and highlighted its use in studying strategies to protect the placenta.
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Affiliation(s)
- J Chen
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - J A Neil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - J P Tan
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - R Rudraraju
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - M Mohenska
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - Y B Y Sun
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - E Walters
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
- Adelaide Centre for Epigenetics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Immunogenomics Cancer Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - N G Bediaga
- Adelaide Centre for Epigenetics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Immunogenomics Cancer Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - G Sun
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - Y Zhou
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
| | - Y Li
- Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - D Drew
- Infectious Diseases and Immune Defences Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - P Pymm
- Infectious Diseases and Immune Defences Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - W H Tham
- Infectious Diseases and Immune Defences Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Y Wang
- Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - F J Rossello
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia
- University of Melbourne Centre for Cancer Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - G Nie
- Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - X Liu
- School of Life Sciences, Westlake University, Hangzhou, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China
- Westlake Institute for Advanced Study, Hangzhou, China
| | - K Subbarao
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Victoria, Australia.
| | - J M Polo
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia.
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia.
- Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria, Australia.
- Adelaide Centre for Epigenetics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
- South Australian Immunogenomics Cancer Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
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Palmer M, Seddon JA, van der Zalm MM, Hesseling AC, Goussard P, Schaaf HS, Morrison J, van Ginneken B, Melendez J, Walters E, Murphy K. Optimising computer aided detection to identify intra-thoracic tuberculosis on chest x-ray in South African children. PLOS Glob Public Health 2023; 3:e0001799. [PMID: 37192175 PMCID: PMC10187911 DOI: 10.1371/journal.pgph.0001799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 04/10/2023] [Indexed: 05/18/2023]
Abstract
Diagnostic tools for paediatric tuberculosis remain limited, with heavy reliance on clinical algorithms which include chest x-ray. Computer aided detection (CAD) for tuberculosis on chest x-ray has shown promise in adults. We aimed to measure and optimise the performance of an adult CAD system, CAD4TB, to identify tuberculosis on chest x-rays from children with presumptive tuberculosis. Chest x-rays from 620 children <13 years enrolled in a prospective observational diagnostic study in South Africa, were evaluated. All chest x-rays were read by a panel of expert readers who attributed each with a radiological reference of either 'tuberculosis' or 'not tuberculosis'. Of the 525 chest x-rays included in this analysis, 80 (40 with a reference of 'tuberculosis' and 40 with 'not tuberculosis') were allocated to an independent test set. The remainder made up the training set. The performance of CAD4TB to identify 'tuberculosis' versus 'not tuberculosis' on chest x-ray against the radiological reference read was calculated. The CAD4TB software was then fine-tuned using the paediatric training set. We compared the performance of the fine-tuned model to the original model. Our findings were that the area under the receiver operating characteristic curve (AUC) of the original CAD4TB model, prior to fine-tuning, was 0.58. After fine-tuning there was an improvement in the AUC to 0.72 (p = 0.0016). In this first-ever description of the use of CAD to identify tuberculosis on chest x-ray in children, we demonstrate a significant improvement in the performance of CAD4TB after fine-tuning with a set of well-characterised paediatric chest x-rays. CAD has the potential to be a useful additional diagnostic tool for paediatric tuberculosis. We recommend replicating the methods we describe using a larger chest x-ray dataset from a more diverse population and evaluating the potential role of CAD to replace a human-read chest x-ray within treatment-decision algorithms for paediatric tuberculosis.
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Affiliation(s)
- Megan Palmer
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Demond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - James A. Seddon
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Demond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Marieke M. van der Zalm
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Demond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Anneke C. Hesseling
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Demond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Pierre Goussard
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - H. Simon Schaaf
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Demond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Julie Morrison
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Jaime Melendez
- Radboud University Medical Center, Nijmegen, The Netherlands
- Delft Imaging, ‘s-Hertogenbosch, The Netherlands
| | - Elisabetta Walters
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Demond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
- Newcastle-upon-Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Keelin Murphy
- Radboud University Medical Center, Nijmegen, The Netherlands
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Scaife J, Walters E, Fisher N, Kumar S. 1293 A MULTIDISCIPLINARY TEAM DERIVED QUALITY IMPROVEMENT PROJECT TO IMPROVE THE EFFICIENCY AND EFFECTIVENESS OF THEIR HYBRID MEETING. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Working in a small district general hospital in Llanelli, West Wales, a weekly hybrid multi-disciplinary team (MDT) meeting is held on the stroke and care of the elderly unit. There are 3 separate geriatric teams covering the ward. Typically, these meetings are attended by physiotherapists, occupational therapists, speech and language therapists, discharge nurses, social workers, nurses and a doctor. The main agenda is to discuss the patients’ current medical issues, rehabilitation needs and likely discharge destination/complexities. Medically, these meetings were attended by a single doctor who often found it difficult to concisely summarise the patient’s medical problems from the notes of patients not under their care. Our aim was to streamline the MDT meeting with regards to quality of content, understanding of patient issues and general efficiency.
Intervention
An initial questionnaire was used to gather prospective data. 90% of MDT members suggested that a doctor from each team should attend to present patients under their care and engage in onward discussions. This was implemented over the period of a month. A follow-up questionnaire collected quantitative data by asking MDT members to retrospectively rate, on a scale of 1 to 10, the efficiency of the meeting and the understanding of patient’s medical conditions before and after implementing the change.
Results
The average efficiency was rated at 4.8/10 before the change was implemented and 8.8/10 afterwards, a 40% improvement. Understanding of patient medical issues had a 28% improvement, from an average rating of 6 to 8.8. Qualitative and free text data was also collected highlighting a secondary benefit of reciprocal communication between the therapy MDT and the appropriate medical doctors hopefully improving the timeliness of any required action.
Conclusions
Suggestions of further changes include making the meeting fully face-to-face, providing a “proforma” to document what was discussed and introducing other members of community teams.
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Affiliation(s)
- J Scaife
- Prince Philip Hospital Department of Elderly Care; , Llanelli
| | - E Walters
- Prince Philip Hospital Department of Elderly Care; , Llanelli
| | - N Fisher
- Prince Philip Hospital Department of Elderly Care; , Llanelli
| | - S Kumar
- Prince Philip Hospital Department of Elderly Care; , Llanelli
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Malik AA, Gandhi NR, Marcy O, Walters E, Tejiokem M, Chau GD, Omer SB, Lash TL, Becerra MC, Njuguna IN, LaCourse SM, Maleche-Obimbo E, Wamalwa D, John-Stewart GC, Cranmer LM. Development of a Clinical Prediction Score Including Monocyte-to-Lymphocyte Ratio to Inform Tuberculosis Treatment Among Children With HIV: A Multicountry Study. Open Forum Infect Dis 2022; 9:ofac548. [PMID: 36381621 PMCID: PMC9645646 DOI: 10.1093/ofid/ofac548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Clinical pediatric tuberculosis (TB) diagnosis may lead to overdiagnosis particularly among children with human immunodeficiency virus (CHIV). We assessed the performance of monocyte-lymphocyte ratio (MLR) as a diagnostic biomarker and constructed a clinical prediction score to improve specificity of TB diagnosis in CHIV with limited access to microbiologic testing. Methods We pooled data from cohorts of children aged ≤13 years from Vietnam, Cameroon, and South Africa to validate the use of MLR ≥0.378, previously found as a TB diagnostic marker among CHIV. Using multivariable logistic regression, we created an internally validated prediction score for diagnosis of TB disease in CHIV. Results The combined cohort had 601 children (median age, 1.9 [interquartile range, 0.9-5.3] years); 300 (50%) children were male, and 283 (47%) had HIV. Elevated MLR ≥0.378 had sensitivity of 36% (95% confidence interval [CI], 23%-51%) and specificity of 79% (95% CI, 71%-86%) among CHIV in the validation cohort. A model using MLR ≥0.28, age ≥4 years, tuberculin skin testing ≥5 mm, TB contact history, fever >2 weeks, and chest radiograph suggestive of TB predicted active TB disease in CHIV with an area under the receiver operating characteristic curve of 0.85. A prediction score of ≥5 points had a sensitivity of 94% and specificity of 48% to identify confirmed TB, and a sensitivity of 82% and specificity of 48% to identify confirmed and unconfirmed TB groups combined. Conclusions Our score has comparable sensitivity and specificity to algorithms including microbiological testing and should enable clinicians to rapidly initiate TB treatment among CHIV when microbiological testing is unavailable.
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Affiliation(s)
- Amyn A Malik
- Correspondence: Amyn A. Malik, PhD, Yale Institute for Global Health, 1 Church St, Suite 340, New Haven, CT 06510 ()
| | - Neel R Gandhi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Olivier Marcy
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Centre INSERM U1219, Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | | | - Saad B Omer
- Yale Institute for Global Health, New Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Irene N Njuguna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sylvia M LaCourse
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Palmer M, Gunasekera KS, van der Zalm MM, Morrison J, Simon Schaaf H, Goussard P, Hesseling AC, Walters E, Seddon JA. The Diagnostic Accuracy of Chest Radiographic Features for Pediatric Intrathoracic Tuberculosis. Clin Infect Dis 2022; 75:1014-1021. [PMID: 35015857 PMCID: PMC9522424 DOI: 10.1093/cid/ciac011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The chest radiograph (CR) remains a key tool in the diagnosis of pediatric tuberculosis (TB). In children with presumptive intrathoracic TB, we aimed to identify CR features that had high specificity for, and were strongly associated with, bacteriologically confirmed TB. METHODS We analyzed CR data from children with presumptive intrathoracic TB prospectively enrolled in a cohort study in a high-TB burden setting and who were classified using standard clinical case definitions as "confirmed," "unconfirmed," or "unlikely" TB. We report the CR features and inter-reader agreement between expert readers who interpreted the CRs. We calculated the sensitivity and specificity of the CR features with at least moderate inter-reader agreement and analyzed the relationship between these CR
features and the classification of TB in a multivariable regression model. RESULTS Of features with at least moderate inter-reader agreement, enlargement of perihilar and/or paratracheal lymph nodes, bronchial deviation/compression, cavities, expansile pneumonia, and pleural effusion had a specificity of > 90% for confirmed TB, compared with unlikely TB. Enlargement of perihilar (adjusted odds ratio [aOR]: 6.6; 95% confidence interval [CI], 3.80-11.72) and/or paratracheal lymph nodes (aOR: 5.14; 95% CI, 2.25-12.58), bronchial deviation/compression (aOR: 6.22; 95% CI, 2.70-15.69), pleural effusion (aOR: 2.27; 95% CI, 1.04-4.78), and cavities (aOR: 7.45; 95% CI, 3.38-17.45) were associated with confirmed TB in the multivariate regression model, whereas alveolar opacification (aOR: 1.16; 95% CI, .76-1.77) and expansile pneumonia (aOR: 4.16; 95% CI, .93-22.34) were not. CONCLUSIONS In children investigated for intrathoracic TB enlargement of perihilar or paratracheal lymph nodes, bronchial compression/deviation, pleural effusion, or cavities on CR strongly support the diagnosis.
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Affiliation(s)
- Megan Palmer
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kenneth S Gunasekera
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julie Morrison
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pierre Goussard
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Great North Children’s Hospital, Newcastle upon Tyne Hospitals Trust, Newcastle, United Kingdom
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
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7
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Gunasekera KS, Walters E, van der Zalm MM, Palmer M, Warren JL, Hesseling AC, Cohen T, Seddon JA. Development of a Treatment-decision Algorithm for Human Immunodeficiency Virus-uninfected Children Evaluated for Pulmonary Tuberculosis. Clin Infect Dis 2021; 73:e904-e912. [PMID: 33449999 PMCID: PMC8366829 DOI: 10.1093/cid/ciab018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Limitations in the sensitivity and accessibility of diagnostic tools for childhood tuberculosis contribute to the substantial gap between estimated cases and cases notified to national tuberculosis programs. Thus, tools to make accurate and rapid clinical diagnoses are necessary to initiate antituberculosis treatment in more children. METHODS We analyzed data from a prospective cohort of children <13 years old being routinely evaluated for pulmonary tuberculosis in Cape Town, South Africa, from March 2012 to November 2017. We developed a regression model to describe the contributions of baseline clinical evaluation to the diagnosis of tuberculosis using standardized, retrospective case definitions. We included baseline chest radiographic and Xpert MTB/RIF assay results to the model to develop an algorithm with ≥90% sensitivity in predicting tuberculosis. RESULTS Data from 478 children being evaluated for pulmonary tuberculosis were analyzed (median age, 16.2 months; interquartile range, 9.8-30.9 months); 242 (50.6%) were retrospectively classified with tuberculosis, bacteriologically confirmed in 104 (43.0%). The area under the receiver operating characteristic curve for the final model was 0.87. Clinical evidence identified 71.4% of all tuberculosis cases in this cohort, and inclusion of baseline chest radiographic results increased the proportion to 89.3%. The algorithm was 90.1% sensitive and 52.1% specific, and maintained a sensitivity of >90% among children <2 years old or with low weight for age. CONCLUSIONS Clinical evidence alone was sufficient to make most clinical antituberculosis treatment decisions. The use of evidence-based algorithms may improve decentralized, rapid treatment initiation, reducing the global burden of childhood mortality.
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Affiliation(s)
- Kenneth S Gunasekera
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Elisabetta Walters
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Megan Palmer
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Anneke C Hesseling
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - James A Seddon
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
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Goussard P, Croucamp R, Bosch C, Demers AM, Morrison J, Mfingwana L, Palmer M, van der Zalm MM, Friedrich SO, Janson JT, Whitelaw AC, Andronikou S, Hesseling AC, Walters E, Lopez-Varela E. Diagnostic utility of bronchoalveolar lavage in children with complicated intrathoracic tuberculosis. Pediatr Pulmonol 2021; 56:2186-2194. [PMID: 33818927 DOI: 10.1002/ppul.25405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Bronchoscopy can be a useful tool in children with pulmonary tuberculosis (PTB) with severe disease potentially requiring intervention or in the face of diagnostic dilemmas. The aim of this study was to determine the value of Xpert MTB/RIF assay (Xpert) on bronchoalveolar lavage (BAL) samples in children with complicated PTB. METHODS Retrospective analysis of children with clinically diagnosed PTB, who underwent routine bronchoscopy over a 5-year period at a large referral hospital. BAL and other respiratory samples were tested by microscopy, culture, and Xpert. We explored whether clinical, radiographic and bronchoscopy findings, and duration of antituberculosis treatment were associated with bacteriological confirmation. RESULTS One hundred and twelve out of one hundred and forty-six (76.7%) children (median age 16 months) were on antituberculosis treatment for a median of 10 days at the time of bronchoscopy. Overall, bacteriological confirmation was achieved in 115 (78.7%), with 101 (69.2%) detected on BAL. Of those bacteriologically confirmed on BAL, 61.4% were positive by both Xpert and culture, 34.7% only by Xpert, and 3.9% only by culture. Sensitivity and specificity of Xpert compared with culture on BAL samples for children not on antituberculosis treatment were 94.1% (95% confidence interval [CI]: 71.3, 99.8) and 68.7% (95% CI: 41.3, 89.0), respectively. CONCLUSIONS In children undergoing bronchoscopy for complicated PTB, Xpert testing of BAL had a high diagnostic yield in children already on antituberculosis treatment. Bronchoscopy should be considered if noninvasive respiratory specimens fail to confirm complicated TB.
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Affiliation(s)
- Pierre Goussard
- Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Roland Croucamp
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Corne Bosch
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anne-Marie Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julie Morrison
- Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Lunga Mfingwana
- Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sven O Friedrich
- Division of Medical Physiology, MRC Centre for Tuberculosis Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Jacques T Janson
- Department of Cardio-Thoracic Surgery, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Andrew C Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisa Lopez-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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9
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Abstract
INTRODUCTION The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. METHODS A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. RESULTS A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score (p = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, p = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% (p < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% (p < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% (p < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (p < 0.001). CONCLUSIONS The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.
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Affiliation(s)
| | - L Hurt
- Morriston Hospital, Swansea, UK
| | | | - N Reeves
- University Hospital of Wales, Cardiff, UK
| | | | | | - J Cornish
- University Hospital of Wales, Cardiff, UK
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10
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van der Zalm MM, Walters E, Claassen M, Palmer M, Seddon JA, Demers AM, Shaw ML, McCollum ED, van Zyl GU, Hesseling AC. High burden of viral respiratory co-infections in a cohort of children with suspected pulmonary tuberculosis. BMC Infect Dis 2020; 20:924. [PMID: 33276721 PMCID: PMC7716283 DOI: 10.1186/s12879-020-05653-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background The presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology. As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up. Methods In an observational cohort study, children < 13 years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24 weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8. Results Seventy-three children were enrolled [median age 22.0 months; (interquartile range 10.0–48.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, ≥1 virus were detected in 95.9% (70/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (p = 0.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (p = 0.07). At follow-up, ≥1 respiratory virus was detected in 92.2% (47/51) at week 4, and 94.2% (49/52) at week 8. Conclusions We found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses.
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Affiliation(s)
- M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - E Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Paediatrics, Great North Children's Hospital, Newcastle-Upon-Tyne Health Trust, Newcastle upon Tyne, UK
| | - M Claassen
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - M Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Infectious Diseases, Imperial College London, London, UK
| | - A M Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M L Shaw
- Department of Medical Biosciences, University of the Western Cape, Cape Town, South Africa.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, USA.,Global Program in Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA.,Health Systems Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - G U van Zyl
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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11
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Walters E, McCloskey S, Gent L, De Nunzio A. Trunk control in people with low back pain: the importance of muscle spindles input originating from the erector spinae. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.202] [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: 10/24/2022]
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12
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Byamungu LN, du Preez K, Walters E, Nachega JB, Schaaf HS. Timing of HIV diagnosis in children with tuberculosis managed at a referral hospital in Cape Town, South Africa. Int J Tuberc Lung Dis 2019; 22:488-495. [PMID: 29663952 DOI: 10.5588/ijtld.17.0613] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tygerberg Hospital, Western Cape Province, Cape Town, South Africa. OBJECTIVE To investigate the prevalence of and factors associated with simultaneous tuberculosis (TB) and human immunodeficiency virus (HIV) diagnoses in children. DESIGN Retrospective cohort study in TB-HIV co-infected children aged <13 years admitted to Tygerberg Hospital in 2012. Data were collected from medical records, laboratory results and electronic TB treatment registers. A simultaneous TB-HIV diagnosis was defined as an HIV diagnosis made within 7 days before or after a diagnosis of TB. RESULTS Of 88 children with TB-HIV co-infection, 37 (42%) had a simultaneous TB-HIV diagnosis; 51 children had been known to have HIV before their TB diagnosis. Interruption of antiretroviral therapy (ART) was reported in 9/32 (28%) children with known HIV infection at TB diagnosis, while missed opportunities for ART initiation were identified in 8/19 (42%) ART-naïve children. Simultaneous TB-HIV diagnosis was more likely if maternal HIV infection was unknown at the time of the child's birth (OR 2.7, 95%CI 1.0-7.2), and was associated with unfavourable TB treatment outcomes (OR 5.9, 95%CI 1.4-25.2). CONCLUSION TB diagnosis provides an important opportunity to test children for HIV. Missed opportunities for HIV prevention, earlier diagnosis and ART initiation were identified.
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Affiliation(s)
- L N Byamungu
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - E Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - J B Nachega
- Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Departments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, South Africa
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13
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Obihara NJ, Walters E, Lawrenson J, Garcia-Prats AJ, Hesseling AC, Schaaf HS. Tuberculous Pericardial Effusions in Children. J Pediatric Infect Dis Soc 2018; 7:346-349. [PMID: 29096017 DOI: 10.1093/jpids/pix087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/14/2017] [Indexed: 11/14/2022]
Abstract
Current data on tuberculous pericardial effusion in children are limited. In this study, the cases of 30 children with tuberculous pericardial effusion were reviewed retrospectively. The prevalence of human immunodeficiency virus and of culture-confirmed tuberculosis was high. Chest radiography provided lower diagnostic sensitivity than sonography but detected all large and complicated effusions. Outcomes were generally good, and residual complications were mainly due to comorbidity.
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Affiliation(s)
- Ndidi J Obihara
- Faculty of Medical Sciences, Radboud University, Nijmegen, the Netherlands
| | | | - John Lawrenson
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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14
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van Bavel J, Lucherini S, Zeilinski C, Walters E, Eckart G, Davies N, Okhuoya P, Pellisier J, Roediger A. Budget and Health Impact of the PD-1/PD-L1 inhibitor class in Austria. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.087] [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] Open
Affiliation(s)
| | | | | | - E Walters
- Institute for Pharmacoeconomic Research, Pinkafeld, Austria
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15
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Strombotne K, Horner E, Walters E, Lapham SJ. NON-CREDIBLE ADOLESCENT SURVEY RESPONSES AND LATER-IN-LIFE ALZHEIMER’S DISEASE AND RELATED DISORDERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2049] [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: 11/14/2022] Open
Affiliation(s)
- K Strombotne
- American Institutes for Research, Washington, District of Columbia, United States
| | - E Horner
- American Institutes for Research, Washington, DC, USA
| | - E Walters
- Research Consultant, Los Angeles, CA, USA
| | - S J Lapham
- American Institutes for Research, Washington, DC, USA
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16
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Walters E, Scott L, Nabeta P, Demers AM, Reubenson G, Bosch C, David A, van der Zalm M, Havumaki J, Palmer M, Hesseling AC, Ncayiyana J, Stevens W, Alland D, Denkinger C, Banada P. Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method. J Clin Microbiol 2018; 56:e00781-18. [PMID: 29997199 PMCID: PMC6113478 DOI: 10.1128/jcm.00781-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022] Open
Abstract
The microbiological diagnosis of tuberculosis (TB) in children is challenging, as it relies on the collection of relatively invasive specimens by trained health care workers, which is not feasible in many settings. Mycobacterium tuberculosis is detectable from the stools of children using molecular methods, but processing stool specimens is resource intensive. We evaluated a novel, simple, centrifugation-free processing method for stool specimens for use on the Xpert MTB/RIF assay (Xpert), using two different stool masses: 0.6 g and a swab sample. Two hundred eighty children (median age, 15.5 months; 35 [12.5%] HIV infected) with suspected intrathoracic TB were enrolled from two sites in South Africa. Compared to a single Xpert test on respiratory specimens, the sensitivity of Xpert on stools using the 0.6-g and swab samples was 44.4% (95% confidence interval [CI], 13.7 to 78.8%) for both methods, with a specificity of >99%. The combined sensitivities of two stool tests versus the first respiratory Xpert were 70.0% (95% CI, 34.8 to 93.3) and 50.0% (95% CI, 18.7 to 81.3) for the 0.6-g and swab sample, respectively. Retesting stool specimens with nondeterminate Xpert results improved nondeterminate rates from 9.3% to 3.9% and from 8.6% to 4.3% for 0.6-g and swab samples, respectively. Overall, stool Xpert detected 14/94 (14.9%) children who initiated antituberculosis treatment, while respiratory specimens detected 23/94 (24.5%). This stool processing method is well suited for settings with low capacity for respiratory specimen collection. However, the overall sensitivity to detect confirmed and clinical TB was lower than that of respiratory specimens. More sensitive rapid molecular assays are needed to improve the utility of stools for the diagnosis of intrathoracic TB in children from resource-limited settings.
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Affiliation(s)
- Elisabetta Walters
- Desmond Tutu TB Centre, Stellenbosch University, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Lesley Scott
- Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela Nabeta
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Anne-Marie Demers
- Desmond Tutu TB Centre, Stellenbosch University, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Gary Reubenson
- Rahima Moosa Mother & Child Hospital, University of the Witwatersrand, Faculty of Health Sciences, Paediatrics and Child Health, Johannesburg, South Africa
| | - Corné Bosch
- Desmond Tutu TB Centre, Stellenbosch University, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Anura David
- Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marieke van der Zalm
- Desmond Tutu TB Centre, Stellenbosch University, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Joshua Havumaki
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan Palmer
- Desmond Tutu TB Centre, Stellenbosch University, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Stellenbosch University, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Jabulani Ncayiyana
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wendy Stevens
- Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Priority Program of the National Health Laboratory Service, Johannesburg, South Africa
| | - David Alland
- Rutgers, New Jersey Medical School, Faculty of Medicine, Newark, New Jersey, USA
| | | | - Padmapriya Banada
- Rutgers, New Jersey Medical School, Faculty of Medicine, Newark, New Jersey, USA
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17
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Walters E, Brown J, Krisher R, Swain J, Voelkel S. Impact of a controlled temperature gradient from 35.0°- 37.5°C on mouse embryo development and morphokinetics. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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du Preez K, Schaaf HS, Dunbar R, Walters E, Swartz A, Solomons R, Hesseling AC. Complementary surveillance strategies are needed to better characterise the epidemiology, care pathways and treatment outcomes of tuberculosis in children. BMC Public Health 2018; 18:397. [PMID: 29566651 PMCID: PMC5865349 DOI: 10.1186/s12889-018-5252-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/22/2017] [Accepted: 03/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) in young and HIV-infected children is frequently diagnosed at hospital level. In settings where general hospitals do not function as TB reporting units, the burden and severity of childhood TB may not be accurately reflected in routine TB surveillance data. Given the paucibacillary nature of childhood TB, microbiological surveillance alone will miss the majority of hospital-managed children. The study objective was to combine complementary hospital-based surveillance strategies to accurately report the burden, spectrum and outcomes of childhood TB managed at referral hospital-level in a high TB burden setting. METHODS We conducted a prospective cohort study including all children (< 13 years) managed for TB at a large referral hospital in Cape Town, South Africa during 2012. Children were identified through newly implemented clinical surveillance in addition to existing laboratory surveillance. Data were collected from clinical patient records, the National Health Laboratory Service database, and provincial electronic TB registers. Descriptive statistics were used to report overall TB disease burden, spectrum, care pathways and treatment outcomes. Univariate analysis compared characteristics between children identified through the two hospital-based surveillance strategies to characterise the group of children missed by existing laboratory surveillance. RESULTS During 2012, 395 children (180 [45.6%] < 2 years) were managed for TB. Clinical surveillance identified 237 (60%) children in addition to laboratory surveillance. Ninety (24.3%) children were HIV co-infected; 113 (29.5%) had weight-for-age z-scores <- 3. Extra-pulmonary TB (EPTB) was diagnosed in 188 (47.6%); 77 (19.5%) with disseminated TB. Favourable TB treatment outcomes were reported in 300/344 (87.2%) children with drug-susceptible and 50/51 (98.0%) children with drug-resistant TB. Older children (OR 1.7; 95% CI 1.0-2.8), children with EPTB (OR 2.3; 95% CI 1.5-3.6) and in-hospital deaths (OR 5.4; 95% CI 1.1-26.9) were more frequently detected by laboratory surveillance. TB/HIV co-infected children were less likely to be identified through laboratory surveillance (OR 0.3; 95% CI 0.2-0.5). CONCLUSIONS The burden and spectrum of childhood TB disease managed at referral hospital level in high burden settings is substantial. Hospital-based surveillance in addition to routine TB surveillance is essential to provide a complete picture of the burden, spectrum and impact of childhood TB in settings where hospitals are not TB reporting units.
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Affiliation(s)
- Karen du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Tygerberg Hospital, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alvera Swartz
- Western Cape Department of Health, Cape Town, South Africa
| | - Regan Solomons
- Tygerberg Hospital, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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19
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Liu C, Lyon CJ, Bu Y, Deng Z, Walters E, Li Y, Zhang L, Hesseling AC, Graviss EA, Hu Y. Clinical Evaluation of a Blood Assay to Diagnose Paucibacillary Tuberculosis via Bacterial Antigens. Clin Chem 2018; 64:791-800. [PMID: 29348166 DOI: 10.1373/clinchem.2017.273698] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 12/08/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The diagnosis of active tuberculosis (TB) cases primarily relies on methods that detect Mycobacterium tuberculosis (Mtb) bacilli or their DNA in patient samples (e.g., mycobacterial culture and Xpert MTB/RIF assays), but these tests have low clinical sensitivity for patients with paucibacillary TB disease. Our goal was to evaluate the clinical performance of a newly developed assay that can rapidly diagnose active TB cases by direct detection of Mtb-derived antigens in patients' blood samples. METHODS Nanoparticle (NanoDisk)-enriched peptides derived from the Mtb virulence factors CFP-10 (10-kDa culture factor protein) and ESAT-6 (6-kDa early secretory antigenic target) were analyzed by high-throughput mass spectrometry (MS). Serum from 294 prospectively enrolled Chinese adults were analyzed with this NanoDisk-MS method to evaluate the performance of direct serum Mtb antigen measurement as a means for rapid diagnosis of active TB cases. RESULTS NanoDisk-MS diagnosed 174 (88.3%) of the study's TB cases, with 95.8% clinical specificity, and with 91.6% and 85.3% clinical sensitivity for culture-positive and culture-negative TB cases, respectively. NanoDisk-MS also exhibited 88% clinical sensitivity for pulmonary and 90% for extrapulmonary TB, exceeding the diagnostic performance of mycobacterial culture for these cases. CONCLUSIONS Direct detection and quantification of serum Mtb antigens by NanoDisk-MS can rapidly and accurately diagnose active TB in adults, independent of disease site or culture status, and outperform Mycobacterium-based TB diagnostics.
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Affiliation(s)
- Chang Liu
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ.,School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ.,Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX
| | - Christopher J Lyon
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ.,Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX
| | - Yang Bu
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX.,College of Materials Sciences and Opto-Electronics, University of Chinese Academy of Sciences, Beijing, China
| | - Zaian Deng
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX.,School of Biomedical Engineering, School of Ophthalmology and Optometry, The Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yan Li
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Liqun Zhang
- Department of Tuberculosis, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX
| | - Ye Hu
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ; .,School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ.,Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX
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Dimarco AD, Onwordi E, Walters E, Mullan N, Willis L, Tanner M. P461Diagnostic utility of smartphone ECG technology in the initial investigation of palpitations. Europace 2017. [DOI: 10.1093/ehjci/eux141.184] [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: 11/12/2022] Open
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21
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Detjen AK, Walters E. Editorial Commentary: Improving Children's Access to New Tuberculosis Diagnostic Tools Starts With the Collection of Appropriate Specimens. Clin Infect Dis 2016; 62:1169-71. [PMID: 26908805 DOI: 10.1093/cid/ciw042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Elisabetta Walters
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
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Wiseman CA, Mandalakas AM, Kirchner HL, Gie RP, Schaaf HS, Walters E, Hesseling AC. Novel application of NIH case definitions in a paediatric tuberculosis contact investigation study. Int J Tuberc Lung Dis 2016; 19:446-53. [PMID: 25860001 DOI: 10.5588/ijtld.14.0585] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International (National Institutes of Health [NIH]) case definitions have been proposed for paediatric tuberculosis (TB) diagnostic studies. The relevance of these definitions for contact tracing studies is unknown. METHODS We developed case definitions for a community-based contact tracing diagnostic study. We compare disease certainty using protocol-defined and NIH case definitions and describe TB disease spectrum and severity. RESULTS There were 111 potential disease episodes in 109 (21% human immunodeficiency virus [HIV] infected) of 1093 children enrolled. Based on NIH definitions, there were 8 confirmed, 12 probable, 17 possible and 3 unlikely TB and 2 non-TB episodes. Using protocol case definitions, there were 23 episodes of confirmed, 36 probable, 27 possible and 0 unlikely TB and 21 non-TB. Of 111 potential episodes, 69 were unclassifiable using the NIH definition, while 4 were unclassifiable using the protocol definition. Agreement between definitions was 0.30 (95%CI 0.23-0.38). There were 62 episodes (72%) of non-severe and 24 (28%) of severe TB. CONCLUSIONS The NIH definition had limited applicability to household contact studies, despite the wide spectrum of disease observed. Further research is needed to develop case definitions relevant to different research settings, including contact investigation to capture the wide spectrum of paediatric TB in clinical research.
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Affiliation(s)
- C A Wiseman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A M Mandalakas
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Section on Retrovirology and Global Health, Department of Paediatrics, Baylor College of Medicine, Houston, Texas, USA; The TB Initiative, Texas Children's Hospital, Houston, Texas, USA
| | - H L Kirchner
- Division of Medicine, Geisinger Clinic, Danville, Pennsylvania, USA
| | - R P Gie
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - E Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Whitworth KM, Murphy SL, Benne JA, Spate LD, Walters E, Hickey R, Nyberg SL, Wells KD, Prather RS. 25 GENOME EDITING OF SOMATIC CELL NUCLEAR TRANSFER DERIVED ZYGOTES BY CLUSTERED REGULARLY INTERSPACED SHORT PALINDROMIC REPEATS (CRISPR)/Cas9 GUIDE RNA INJECTION. Reprod Fertil Dev 2016. [DOI: 10.1071/rdv28n2ab25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recent applications of the clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 system have greatly improved the efficiency of genome editing in pigs. However, in some cases, genetically modified pig models need an additional modification to improve their application. The objective of this experiment was to determine whether a combination of somatic cell NT (SCNT) by using a previously modified donor cell line and subsequent zygote injection with CRISPR/Cas9 guide RNA to target a second gene would result in embryos and offspring successfully containing both modifications. Fibroblast cell lines were collected from fumarylacetoacetate hydrolase deficient (FAH–/–) fetuses and used as the donor cell line. Somatic cell NT was performed by standard technique. A CRISPR guide RNA specific for recombination activating gene 2 (RAG2) was designed and in vitro transcribed from a synthesised gBlock (IDT) containing a T7 promoter sequence, the CRISPR Guide RNA (20 bp), and 85 bp of tracer RNA. The gBlock was PCR amplified with Q5 polymerase (NEB, Ipswich, MA, USA) and in vitro transcribed with the MEGAshortscript™ T7 Transcription Kit (Life Technologies, Grand Island, NY, USA). Guide RNA (20 ng μL–1) and polyadenylated Cas9 (20 ng μL–1, Sigma, St. Louis, MO, USA) were co-injected into the cytoplasm of SCNT zygotes at 14 to 16 h after fusion and activation. Injected SCNT were then cultured in vitro in PZM3 + 1.69 mM arginine medium (MU1) to Day 5. Three embryo transfers were performed surgically into recipient gilts on Day 4 or 5 of oestrus (50, 62, or 70 embryos per pig) to evaluate in vivo development. The remaining embryos were cultured in MU1 to Day 7 and analysed for the presence of modifications to the RAG2 gene. Embryos were classified as modified if they contained an INDEL as measured by both gel electrophoresis and DNA sequencing of PCR amplicons spanning the targeted exon. The RAG2 modification rate was 83.3% (n = 6), of which 50% (n = 3) of the embryos contained biallelic modifications. All control embryos contained a wild-type RAG2 gene (n = 5). Embryo transfer resulted in a 33.3% pregnancy rate (1/3). The combination of SCNT and CRISPR/Cas9 zygote injection can be a highly efficient tool to successfully create pig embryos with an additional modification. This additional technique further improves the usefulness of already created genetically modified pig models.
This study was funded by the National Institutes of Health via U42 OD011140.
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Mourão MPB, Kuijper S, Dang NA, Walters E, Janssen HG, Kolk AHJ. Direct detection of Mycobacterium tuberculosis in sputum: A validation study using solid phase extraction-gas chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 1012-1013:50-4. [PMID: 26807702 DOI: 10.1016/j.jchromb.2015.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 12/11/2015] [Accepted: 12/13/2015] [Indexed: 10/22/2022]
Abstract
Tuberculosis (TB) remains a worldwide health problem, especially in developing countries. Correct identification of Mycobacterium tuberculosis (MTB) infection is extremely important for providing appropriate treatment and care to patients. Here we describe a solid phase extraction-gas chromatography-mass spectrometry method (SPE-THM-GC-MS) for the detection of five biomarkers for M. tuberculosis. The method for classification is developed and validated through the analysis of 112 sputum samples from patients suspected of having TB. Twenty of twenty-five MTB culture-positive sputum samples were correctly classified as positive by our improved SPE-THM-GC-MS method. Eighty-five of eighty-seven MTB culture-negative samples were also negative by SPE-THM-GC-MS. The overall sensitivity of the new SPE-THM-GC-MS method is 80% (20/25) and the specificity is 98% (85/87) compared with culture. The method proved to be reliable and, although complex in principle, easy to operate due to the high degree of automation.
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Affiliation(s)
- Marta P B Mourão
- University of Amsterdam, Van 't Hoff Institute for Molecular Sciences, Analytical Chemistry Group, P.O. Box 94157, 1090 GD Amsterdam, The Netherlands.
| | - Sjoukje Kuijper
- University of Amsterdam, Van 't Hoff Institute for Molecular Sciences, Analytical Chemistry Group, P.O. Box 94157, 1090 GD Amsterdam, The Netherlands
| | - Ngoc A Dang
- University of Amsterdam, Van 't Hoff Institute for Molecular Sciences, Analytical Chemistry Group, P.O. Box 94157, 1090 GD Amsterdam, The Netherlands
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa
| | - Hans-Gerd Janssen
- University of Amsterdam, Van 't Hoff Institute for Molecular Sciences, Analytical Chemistry Group, P.O. Box 94157, 1090 GD Amsterdam, The Netherlands; Unilever Research and Development, P.O. Box 114, 3130 AC Vlaardingen, The Netherlands
| | - Arend H J Kolk
- University of Amsterdam, Van 't Hoff Institute for Molecular Sciences, Analytical Chemistry Group, P.O. Box 94157, 1090 GD Amsterdam, The Netherlands
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25
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Beverly A, Walters E, Carraretto M. Management of temperature in sepsis: a survey of current practice and opinion of uk intensive care consultants. Intensive Care Med Exp 2015. [PMCID: PMC4798313 DOI: 10.1186/2197-425x-3-s1-a217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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26
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Sumra M, Walters E. A Long Term Analysis of The Clinical And Cost Effectiveness of Glatiramer Acetate From The Uk Multiple Sclerosis Risk Sharing Scheme. Value in Health 2015. [PMID: 0 DOI: 10.1016/j.jval.2015.09.2512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Affiliation(s)
| | - Greg King
- Woolcock Institute of Medical Research, Sydney, NSW
- University of Sydney, Sydney, NSW
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Glickman L, Neely L, Warres M, Walters E, White N, Chimatiro G. Community reintegration of clients post discharge from the Kachere rehabilitation centre Malawi. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dang NA, Mourão M, Kuijper S, Walters E, Janssen HG, Kolk AHJ. Direct detection of Mycobacterium tuberculosis in sputum using combined solid phase extraction-gas chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 986-987:115-22. [PMID: 25728368 DOI: 10.1016/j.jchromb.2015.01.045] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
Recently, thermally-assisted hydrolysis and methylation followed by gas chromatography-mass spectrometry (THM-GC-MS) in combination with chemometrics has been used to develop a 20-compound model for fast differentiation of Mycobacterium tuberculosis (MTB) from Non-tuberculous mycobacteria (NTM) in bacterial cultures. This model provided better than 95% accuracy. In our current work a hexane/methanol/water extraction followed by a solid phase extraction (SPE) clean-up procedure was developed for use before THM-GC-MS, to make the test suitable for the identification of mycobacteria in sputum. The 20 biomarker model had to be adapted since many compounds were also found in the sputum of non-tuberculosis patients. An algorithm was established based on tuberculostearic acid, hexacosanoic acid and mycoserosates. The detection limit of the method was approximately 1×10(4) bacteria/mL sputum. Sputum specimens from 32 patients from South Africa who were suspected of having tuberculosis were blindly tested using the new method. Eight of the nine culture-positive sputum specimens were detected by the new SPE-THM-GC-MS method, resulting in a sensitivity of 89%. The specimen that was missed by the new method was also microscopy negative. The specificity of the test was 100%; all 23 microscopy- and culture-negative specimens were correctly identified as negative by SPE-THM-GC-MS.
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Affiliation(s)
- Ngoc A Dang
- Analytical Chemistry & Forensic Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands.
| | - Marta Mourão
- Analytical Chemistry & Forensic Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - Sjoukje Kuijper
- Analytical Chemistry & Forensic Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa
| | - Hans-Gerd Janssen
- Analytical Chemistry & Forensic Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands; Unilever Research and Development, P.O. Box 114, 3130 AC Vlaardingen, The Netherlands
| | - Arend H J Kolk
- Analytical Chemistry & Forensic Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
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Walters E, Duvenhage J, Draper HR, Hesseling AC, Van Wyk SS, Cotton MF, Rabie H. Severe manifestations of extrapulmonary tuberculosis in HIV-infected children initiating antiretroviral therapy before 2 years of age. Arch Dis Child 2014; 99:998-1003. [PMID: 24938535 DOI: 10.1136/archdischild-2013-305509] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early initiation of antiretroviral therapy (ART) in HIV-infected infants reduces mortality and opportunistic infections including tuberculosis (TB). However, young HIV-infected children remain at high risk of TB disease following mycobacterial infection. We document the spectrum of TB disease in HIV-infected children <2 years of age on ART. METHODS Retrospective cohort study; records of children <2 years of age initiating routine ART at Tygerberg Children's Hospital, Cape Town, January 2003-December 2010 were reviewed. Clinical data at ART initiation (baseline) and TB episodes after ART initiation, to June 2012, were recorded. TB immune reconstitution syndrome (TB-IRIS) and incident TB were defined as TB diagnosed within 3 months, and >3 months after, ART initiation respectively. Baseline characteristics were compared in children with TB-IRIS and those with incident TB. RESULTS In 494 children, median follow-up time on ART was 10.7 months. Fifty-five TB treatment episodes occurred after ART initiation: 23 (42%) TB-IRIS (incidence 21.9/100 person years (py)) and 32 (58%) incident TB (incidence 3.9/100 py). Children with TB-IRIS and those with incident TB had similar baseline characteristics. Eight of 10 cases of extrapulmonary TB were severe: 4 IRIS (2 meningitis, 1 disseminated, 1 pericarditis) and 4 incident cases (1 each miliary, meningitis, pericarditis and spinal). Fifty-one children (10%) died (mortality rate 5.96/100 py). Starting ART at <1 year of age approached significance as a risk factor for TB-IRIS (adjusted OR (AOR) 8.64, p=0.06); weight-for-age Z score <-2 predicted death (AOR 6.37, p<0.001). CONCLUSIONS Severe TB manifestations were observed among young HIV-infected children on ART.
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Affiliation(s)
- Elisabetta Walters
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Joanie Duvenhage
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Heather R Draper
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Susan S Van Wyk
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Mark F Cotton
- Department of Paediatrics and Child Health, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
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Walters E, Goussard P, Bosch C, Hesseling AC, Gie RP. GeneXpert MTB/RIF on bronchoalveolar lavage samples in children with suspected complicated intrathoracic tuberculosis: a pilot study. Pediatr Pulmonol 2014; 49:1133-7. [PMID: 24339262 DOI: 10.1002/ppul.22970] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 11/03/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children with complicated intrathoracic tuberculosis (TB) require rapid confirmation of TB diagnosis and of drug susceptibility to institute appropriate therapy. In a pilot study, we evaluated the feasibility and potential utility of GeneXpert (Xpert) on bronchoalveolar lavage (BAL) samples in children undergoing routine diagnostic bronchoscopy. METHODS We included children <13 years of age undergoing bronchoscopy for suspected complicated intrathoracic TB at Tygerberg Children's Hospital, October 1, 2012-May 15, 2013. A minimum of two respiratory specimens in addition to BAL were obtained from each child. In addition to fluorescent smear microscopy and automated liquid culture performed on all samples, BAL samples were analyzed by Xpert. Drug susceptibility was confirmed by GenoType(®) MTBDRplus. RESULTS Fourteen children (2 HIV positive, median age 16 months) were included. The Mantoux tuberculin skin test was positive in 11. On chest radiograph, six children had expansile pneumonia and nine had airway compression (one had both). The median duration of TB treatment before bronchoscopy was 8 days. TB was confirmed by either culture or Xpert from any sample in 11 (78%) children. Among 9/14 (64%) cases confirmed by culture, BAL Xpert was positive in 7 (78% sensitivity); in addition, Xpert confirmed 2 cases who had negative culture (14% additional diagnostic yield). Two drug resistant cases were identified: one by BAL Xpert and one from genotypic testing of a culture from gastric aspirate. All children were initiated on anti-TB treatment and responded well to therapy. CONCLUSION BAL Xpert resulted in additional diagnostic yield and also in the rapid detection of drug resistance in children with complicated intrathoracic TB. The clinical impact of this modality should be further evaluated in children.
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Affiliation(s)
- Elisabetta Walters
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
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Eley V, Donovan K, Walters E, Brijball R, Eley D. The effect of antenatal anaesthetic consultation on maternal decision-making, anxiety level and risk perception in obese pregnant women. Int J Obstet Anesth 2014; 23:118-24. [DOI: 10.1016/j.ijoa.2013.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 10/28/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
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Dang NA, Kuijper S, Walters E, Claassens M, van Soolingen D, Vivo-Truyols G, Janssen HG, Kolk AHJ. Validation of biomarkers for distinguishing Mycobacterium tuberculosis from non-tuberculous mycobacteria using gas chromatography-mass spectrometry and chemometrics. PLoS One 2013; 8:e76263. [PMID: 24146846 PMCID: PMC3798606 DOI: 10.1371/journal.pone.0076263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/22/2013] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis (TB) remains a major international health problem. Rapid differentiation of Mycobacterium tuberculosis complex (MTB) from non-tuberculous mycobacteria (NTM) is critical for decisions regarding patient management and choice of therapeutic regimen. Recently we developed a 20-compound model to distinguish between MTB and NTM. It is based on thermally assisted hydrolysis and methylation gas chromatography-mass spectrometry and partial least square discriminant analysis. Here we report the validation of this model with two independent sample sets, one consisting of 39 MTB and 17 NTM isolates from the Netherlands, the other comprising 103 isolates (91 MTB and 12 NTM) from Stellenbosch, Cape Town, South Africa. All the MTB strains in the 56 Dutch samples were correctly identified and the model had a sensitivity of 100% and a specificity of 94%. For the South African samples the model had a sensitivity of 88% and specificity of 100%. Based on our model, we have developed a new decision-tree that allows the differentiation of MTB from NTM with 100% accuracy. Encouraged by these findings we will proceed with the development of a simple, rapid, affordable, high-throughput test to identify MTB directly in sputum.
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Affiliation(s)
- Ngoc A. Dang
- Analytical Chemistry and Forensic Science, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Sjoukje Kuijper
- Analytical Chemistry and Forensic Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Mareli Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Dick van Soolingen
- National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Clinical Microbiology and Department of Pulmonary Diseases, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gabriel Vivo-Truyols
- Analytical Chemistry and Forensic Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans-Gerd Janssen
- Analytical Chemistry and Forensic Science, University of Amsterdam, Amsterdam, The Netherlands
- Unilever Research and Development, Vlaardingen, The Netherlands
| | - Arend H. J. Kolk
- Analytical Chemistry and Forensic Science, University of Amsterdam, Amsterdam, The Netherlands
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Chegou NN, Detjen AK, Thiart L, Walters E, Mandalakas AM, Hesseling AC, Walzl G. Utility of host markers detected in Quantiferon supernatants for the diagnosis of tuberculosis in children in a high-burden setting. PLoS One 2013; 8:e64226. [PMID: 23691173 PMCID: PMC3655018 DOI: 10.1371/journal.pone.0064226] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/10/2013] [Indexed: 01/24/2023] Open
Abstract
Background The diagnosis of childhood tuberculosis (TB) disease remains a challenge especially in young and HIV-infected children. Recent studies have identified potential host markers which, when measured in Quantiferon (QFT-IT) supernatants, show promise in discriminating between Mycobacterium tuberculosis (M.tb) infection states. In this study, the utility of such markers was investigated in children screened for TB in a setting with high TB incidence. Methodology and Principal Findings 76 children (29% HIV-infected) with or without active TB provided blood specimens collected directly into QFT-IT tubes. After overnight incubation, culture supernatants were harvested, aliquoted and frozen for future immunological research purposes. Subsequently, the levels of 12 host markers previously identified as potential TB diagnostic markers were evaluated in these supernatants for their ability to discriminate between M.tb infection and disease states using the Luminex platform. Of the 76 children included, 19 (25%) had culture confirmed TB disease; 26 (46%) of the 57 without TB had positive markers of M.tb infection defined by a positive QFT-IT test. The potentially most useful analytes for diagnosing TB disease included IFN-α2, IL-1Ra, sCD40L and VEGF and the most useful markers for discriminating between QFT-IT positive children as TB or latent infection included IL-1Ra, IP-10 and VEGF. When markers were used in combinations of four, 84% of all children were accurately classified into their respective groups (TB disease or no TB), after leave-one-out cross validation. Conclusions Measurement of the levels of IFN-α2, IL-1Ra, sCD40L, IP-10 and VEGF in QFT-IT supernatants may be a useful method for diagnosing TB disease and differentiating between active TB disease and M.tb infection in children. Our observations warrant further investigation in larger well-characterized clinical cohorts.
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Affiliation(s)
- Novel N Chegou
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
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Baird D, Bhattacharya S, Devroey P, Diedrich K, Evers J, Fauser B, Jouannet P, Pellicer A, Walters E, Crosignani P, Fraser L, Geraedts J, Gianaroli L, Glasier A, Liebaers I, Sunde A, Tapanainen J, Tarlatzis B, Van Steirteghem A, Veiga A. Failures (with some successes) of assisted reproduction and gamete donation programs. Hum Reprod Update 2013; 19:354-65. [DOI: 10.1093/humupd/dmt007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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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Kolk AHJ, van Berkel JJBN, Claassens MM, Walters E, Kuijper S, Dallinga JW, van Schooten FJ. Breath analysis as a potential diagnostic tool for tuberculosis. Int J Tuberc Lung Dis 2012; 16:777-82. [DOI: 10.5588/ijtld.11.0576] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A. H. J. Kolk
- KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; and Analytical Chemistry and Forensic Science, Van 't Hoff Institute for Molecular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J. J. B. N. van Berkel
- Department of Toxicology, Research Institute NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - M. M. Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - E. Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - S. Kuijper
- KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Analytical Chemistry and Forensic Science, Van 't Hoff Institute for Molecular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J. W. Dallinga
- Department of Toxicology, Research Institute NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - F. J. van Schooten
- Department of Toxicology, Research Institute NUTRIM, Maastricht University, Maastricht, The Netherlands
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Cawood A, Stratton R, Rust S, Walters E, Elia M. PP116-SUN MALNUTRITION ‘SELF SCREENING’ WITH AN ELECTRONIC VERSION OF ‘MUST’ IN HOSPITAL OUTPATIENTS: CONCURRENT VALIDITY AND EASE OF USE. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1744-1161(11)70170-3] [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: 11/25/2022]
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Zhao J, Walters E, Calcaterra J, Ross J, Spate L, Samuel M, Rieke A, Murphy C, Butler S, Velander W, Prather R. 339 BIOENGINEERING OF THE MAMMARY GLAND OF LIVESTOCK: INCREASED PROPEPTIDE PROCESSING OF FACTOR IX IN THE MILK OF TRANSGENIC PIGS BY CO-EXPRESSION OF FURIN. Reprod Fertil Dev 2011. [DOI: 10.1071/rdv23n1ab339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Coagulation Factor IX is a vital protein that plays an important role in the blood coagulation cascade. Hereditary deficiency in the Factor IX gene can result in hemophilia type B, the second most common hemophilia. The milk of transgenic livestock can be an efficient vehicle for producing complex, post-translationally modified blood proteins. The advantages include decreased pathogen risk as well as 100-fold or more production efficiency over blood fractionation and cell culture biotechnology. Although the mammary gland can make many of the complex post-translational modifications necessary for biological function of blood proteins, improvements in propeptide cleavage and decreased proteolytic degradation are desirable. To explore the possibility of producing bioactive human Factor IX protein in pig milk, male and female Landrace fetal fibroblast cells were co-transfected by electroporation with 3 different transgene constructs, Factor IX (FIX), Furin, and SERPINA1. The SERPINA1 construct (containing a Neo selectable marker) was delivered into fetal fibroblasts at a 10-fold-lower molar concentration than the other 2 constructs. Following selection in Geneticin, the presence of all 3 genes was verified by PCR and then cells were used as donors for somatic cell nuclear transfer. Thirteen F0 female piglets from 3 potential different integrations were delivered, and 6 piglets were validated by PCR to be positive for all 3 genes. Among the 6 transgenic pigs, 3 are healthy and able to reach puberty. Milk was collected by induced lactation from 2 gilts. A short murine whey acidic protein promoter-Furin gene was used to limit Furin to the lowest levels needed for pro-FIX processing. Furin was expressed to increase propeptide cleavage efficiency, with the result being complete processing of pro-FIX to FIX at ∼0.3 g L–1 pro-FIX. Total FIX levels were ∼1 g L–1. SERPINA1 was also co-expressed at ∼1 g L–1 or more and this serine protease inhibitor did not seem to inhibit furin processing of the pro-FIX. Fifteen F0 male piglets from 3 potential different integration sites were delivered and all of them were positive for all 3 genes. Four F0 males were chosen to breed with wild-type females, and 5 litters of F1 piglets were born. Of 63 F1 piglets, 22 were tri-transgenic and 3 were di-transgenic (only carrying FIX and Furin). Two F1 females were mated with wild-type males, are confirmed to be pregnant, and will be used to determine the expression level and bioactivity of the Factor IX protein in the milk.
Funded by the NIH NCRR (RR018877) and R01 HL078944.
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Abstract
Comparison has been made of the effect of alloxan-diabetes on the multiple forms of hexokinase (EC 2.7.1.1) in adipose tissue and lung. Types I and II hexokinase were distinguished in adipose tissue by their different stabilities to heat treatment, which made it possible to determine the activity of each form spectrophotometrically; additional confirmatory evidence was obtained from starch-gel electrophoresis. Type II hexokinase was markedly depressed in adipose tissue from alloxan-diabetic rats. Lung contained types I, II and III hexokinase, type I predominating. There was no significant change in the pattern of these multiple forms of hexokinase in lung from alloxan-diabetic rats. These results are discussed in relation to current ideas that the insulin-sensitivity of a tissue may be correlated with the content of type II hexokinase.
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Affiliation(s)
- P McLean
- Courtauld Institute of Biochemistry, The Middlesex Hospital Medical School, London, W. 1, and Department of Medicine, University of California, Los Angeles, Calif. 90024, U.S.A
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Ghafari F, Pelengaris S, Walters E, Hartshorne G. Influence of p53 and genetic background on prenatal oogenesis and oocyte attrition in mice. Hum Reprod 2009; 24:1460-72. [DOI: 10.1093/humrep/dep022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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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Walters E, Cotton MF, Rabie H, Schaaf HS, Walters LO, Marais BJ. Clinical presentation and outcome of tuberculosis in human immunodeficiency virus infected children on anti-retroviral therapy. BMC Pediatr 2008; 8:1. [PMID: 18186944 PMCID: PMC2246130 DOI: 10.1186/1471-2431-8-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [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: 08/08/2007] [Accepted: 01/11/2008] [Indexed: 11/10/2022] Open
Abstract
Background The tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics are poorly controlled in sub-Saharan Africa, where highly active antiretroviral treatment (HAART) has become more freely available. Little is known about the clinical presentation and outcome of TB in HIV-infected children on HAART. Methods We performed a comprehensive file review of all children who commenced HAART at Tygerberg Children's Hospital from January 2003 through December 2005. Results Data from 290 children were analyzed; 137 TB episodes were recorded in 136 children; 116 episodes occurred before and 21 after HAART initiation; 10 episodes were probably related to immune reconstitution inflammatory syndrome (IRIS). The number of TB cases per 100 patient years were 53.3 during the 9 months prior to HAART initiation, and 6.4 during post HAART follow-up [odds ratio (OR) 16.6; 95% confidence interval (CI) 12.5–22.4]. A positive outcome was achieved in 97/137 (71%) episodes, 6 (4%) cases experienced no improvement, 16 (12%) died and the outcome could not be established in 18 (13%). Mortality was less in children on HAART (1/21; 4.8%) compared to those not on HAART (15/116; 12.9%). Conclusion We recorded an extremely high incidence of TB among HIV-infected children, especially prior to HAART initiation. Starting HAART at an earlier stage is likely to reduce morbidity and mortality related to TB, particularly in TB-endemic areas. Management frequently deviated from standard guidelines, but outcomes in general were good.
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Affiliation(s)
- Elisabetta Walters
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Abstract
INTRODUCTION Meningococcal septicemia remains one of the most common infectious causes of admission to a pediatric intensive care unit. Numerous treatment strategies aimed at the thromboembolic complications inducing purpura fulminans and limb/digital ischemia have been attempted, with variable results. The successful use of medicinal leeches for pneumococcal purpura fulminans has been described, and we present a similar case of meningococcal purpura fulminans. PATIENT AND INTERVENTION A 5-wk-old female infant with meningococcal meningitis and septicemia and progressive purpura fulminans of the left hand was treated with medicinal leeches. Medicinal leeches were applied to the left dorsal hand on a daily basis for 4 consecutive days. RESULT The swelling and limited functionality visibly improved after 48 hrs, and by 120 hrs, perfusion in the distal phalanges of the thumb and middle finger was evident. Reperfusion of the distal phalanges was not fully sustained, and at 6 wks the plastic surgery department debrided the distal phalanges of her left hand, excluding the thumb. She fully recovered from the meningococcal septicemic shock; the functionality of her left thumb was preserved, and she has limited functionality of her left hand. CONCLUSION The unique combination of salivary products in leech therapy has theoretical benefits and requires future study.
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Affiliation(s)
- Ricky Dippenaar
- Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg Children's Hospital, Tygerberg, South Africa
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Abstract
The original objection to the paper by Kwong et al. was that the use of an inappropriate (between-pup) estimate of experimental error had exaggerated the importance of the maternal nutrition effect. From the group's most recent response, it has been possible to regenerate the raw data and carry out a further detailed analysis. It is apparent that despite now using a more sophisticated statistical tool, Kwong et al. have still, in effect, used the between-pup error, thus repeating the previous, probably exaggerated, finding. It is maintained that the nutrition effect should be studied using the between-rat variation, which then provides a result that is a good deal less emphatic. Further, it is felt that there is a very important point of principle involved in this dispute, relating to the rigorous analysis of hierarchical data, particularly in small studies.
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Affiliation(s)
- E Walters
- Babraham Institute and Churchill College Cambridge, UK.
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Kawsar M, Anfield A, Walters E, McCabe S, Forster GE. Prevalence of sexually transmitted infections and mental health needs of female child and adolescent survivors of rape and sexual assault attending a specialist clinic. Sex Transm Infect 2004; 80:138-41. [PMID: 15054179 PMCID: PMC1744817 DOI: 10.1136/sti.2003.007252] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the prevalence of sexually transmitted infections (STIs) and the mental health needs of female child and adolescent survivors of rape and sexual assault who were referred to a specialist genitourinary medicine (GUM) clinic. METHOD Retrospective case notes review of 98 females aged 16 or less, who attended over a 5 year period (1996-2000). RESULTS The overall prevalence of STIs was 26%. Among the girls who were aged 0-12 years (n = 16), one had gonorrhoea and another had Trichomonas vaginalis infection. Prevalence of STIs in those aged 13-16 years, who were not sexually active before the index assault, was 24% and in those who gave a history of previous consensual sexual activity it was 39% (p = 0.17). Chlamydial infection was more common among the girls who disclosed previous consensual sexual activity than in those did not disclose previous sexual activity (p = 0.012). The overall prevalence of vaginal candidiasis was 17% and bacterial vaginosis 13%. More than one third of the study population gave a history of previous sexual, physical, or other abuse. 81% reported having current psychological difficulties. Mood changes and sleep disturbances were reported more frequently than other psychological symptoms; 15% attempted self harm. All types of psychological difficulties, except mood changes, were not affected by the time interval between index assault and first presentation to the clinic and the type of assailant. 29% had no involvement with social and mental health services before their attendance at the clinic CONCLUSIONS The prevalence of STIs among female child and adolescent survivors of rape and sexual assault attending a specialist clinic was high. The range of mental health and social difficulties was wide and multiple. The importance of an early assessment for the presence of STIs and mental health difficulties was demonstrated.
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Affiliation(s)
- M Kawsar
- Department of Genitourinary Medicine, Luton and Dunstable Hospital NHS Trust, Lewsey Road, Luton LU4 0DZ, UK.
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Armstrong T, Walters E, Varshney S, Johnson CD. Deficiencies of micronutrients, altered bowel function, and quality of life during late follow-up after pancreaticoduodenectomy for malignancy. Pancreatology 2003; 2:528-34. [PMID: 12435865 DOI: 10.1159/000066095] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM A previous study in our unit showed an inadequate dietary intake of fat-soluble vitamins and energy after pancreaticoduodenectomy (PD). This study was designed to determine whether deficiencies in dietary intake of micronutrients lead to nutritional deficiencies and to examine the impact of dietary advice on nutrition, bowel function, and quality of life. METHODS Ten patients who had undergone PD for malignant disease more than 6 months previously were studied at baseline and follow-up 8 weeks apart. Dietary intakes of energy, fat, and micronutrients were assessed by analysis of weighed food diaries, and serum vitamins and trace elements were measured at each visit. Quality of life questionnaires (EORTC QLQ30 and PAN 26) were answered, and a clinical assessment of the bowel function was made. Targeted dietary intervention was given, where indicated, and its impact on the study parameters was assessed at the second clinic visit. RESULTS The patients were generally well nourished. Dietary deficiencies of fat-soluble vitamins were detected (vitamin A, n = 2; vitamin D, n = 10; vitamin E, n = 2), but these correlated with serum deficiency only for vitamin A. The selenium intake was borderline or insufficient in 6 patients' diet, with serum deficiencies in 4. Despite normal intakes of iron and zinc, half the patients showed serum deficiency. The bowel function was an important factor in quality of life, and symptoms improved in 3 patients with enzyme supplements and antidiarrhoeal medication. CONCLUSIONS PD patients appear to be prone to a predictable set of micronutrient deficiencies that may be compounded by insufficient dietary intake. The bowel function is important to these patients, and it should be optimized with aggressive enzyme replacement. Dietary intervention appears to make little short-term impact in the areas studied.
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Affiliation(s)
- T Armstrong
- University Department of Surgery, Southampton General Hospital, UK
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46
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Quilliot D, Walters E, Böhme P, Lacroix B, Bonte JP, Fruchart JC, Drouin P, Duriez P, Ziegler O. Fatty acid abnormalities in chronic pancreatitis: effect of concomitant diabetes mellitus. Eur J Clin Nutr 2003; 57:496-503. [PMID: 12627189 DOI: 10.1038/sj.ejcn.1601556] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2001] [Revised: 06/12/2002] [Accepted: 06/18/2002] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Patients with chronic pancreatitis suffer from malabsorption and nutritional deficiencies. However there is little data available concerning the fatty acid profile in chronic pancreatitis. Diabetes mellitus, a common complication of this disease, could interfere with the metabolism of fatty acids. SUBJECTS We therefore compared the fatty acid composition of LDL from four groups of male patients with (a) chronic pancreatitis without diabetes (ND-CP; n=12), (b) diabetes secondary to chronic pancreatitis and insulin-treated (CP-D; n=35); (c) type 1 diabetes (n=25); and (d) controls (n=20). RESULTS The patients in both groups of chronic pancreatitis (ND-CP and CP-D) had lower mean values for linoleic acid than that seen in the type 1 DM and control groups, whereas monounsaturated fatty acids (MUFA; 18 : 1(n-9) and (16 : 1(n-7)) were significantly increased in these two groups (ND-CP and CP-D). Docosa-hexaenoic-acid (22 : 6(n-3)) was significantly decreased in the CP-D group (P>0.05), a response that could be explained by the effects of diabetes mellitus and by selenium deficiency. In this way, diabetes was associated with a decrease in the docosa-hexaenoic-acid (22 : 6(n-3); r=0.30, P=0.005), and selenium was correlated with DHA (r=0.28, P=0.029) and with the 22 : 6(n-3)/20 : 5(n-3) ratio (evaluating the delta 4 desaturation); r=0.31, P=0.022), independently of the diabetes effect. Selenium was negatively correlated with 20 : 4(n-6)/20 : 3(n-6) ratio (evaluating the delta 5 desaturase; r=-0.30; P=0.025). These results suggest that these two factors may have a role in the regulation of the desaturation process. If we consider that a ratio of 16 : 1(n-7)/18 : 2(n-6) greater than 0.086 in plasma indicates an EFAn-6 deficiency, 40% of our CP patients, 57.6% of CP-D patients and 13.6% of type 1 DM patients were involved. CONCLUSIONS The consequences of these deficiencies are not evaluated in this disease. However, correction of the fundamental deficiencies in essential fatty acids and in selenium seems desirable in chronic pancreatitis.
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Affiliation(s)
- D Quilliot
- Centre d'Investigation Clinique, Centre Hospitalo Universitaire et INSERM, France.
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Abstract
The physical tools used in assisted reproduction have changed little over several decades. Microfluidics is an emerging technology that allows a fresh examination of the way assisted reproduction is performed. Here we review our work to develop microfluidic devices to perform the functions required in assisted reproduction. These functions include loading/unloading, culture, chemical manipulation, and mechanical manipulation of embryos and oocytes. Basic microfluidic theory and microfluidic device design and operation are discussed. Results are presented for mechanical removal of cumulus cells and for embryo culture. Results suggest that microfluidic systems will lead to improved efficiencies in assisted reproduction.
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Affiliation(s)
- D Beebe
- Department of Biomedical Engineering, University of Wisconsin-Madison, USA
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Abstract
The customary method of combining success rates in meta-analyses may often result in serious biases, leading to erroneous inferences. This arises because of an inadmissible pooling of frequencies from heterogeneous sources. The fundamental statistical principle, that the magnitude of an 'effect' should always be tested against the variation in that effect over the sample, may not therefore be satisfied. A simple, but rigorous, alternative method is described.
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Affiliation(s)
- E Walters
- Thorpes, The Grip, Linton, Cambridge CB1 6NR, UK.
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Quilliot D, Walters E, Guerci B, Fruchart JC, Duriez P, Drouin P, Ziegler O. Effect of the inflammation, chronic hyperglycemia, or malabsorption on the apolipoprotein A-IV concentration in type 1 diabetes mellitus and in diabetes secondary to chronic pancreatitis. Metabolism 2001; 50:1019-24. [PMID: 11555832 DOI: 10.1053/meta.2001.25656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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] [Indexed: 11/11/2022]
Abstract
The metabolism of apolipoprotein (apo) A-IV in diabetes mellitus (DM) is poorly understood. Several factors, such as dietary fat intake, fat malabsorption, acute inflammation, and hormonal dysregulation can disturb the plasma apo A-IV concentration. We have compared the plasma apo A-IV concentrations in patients with type 1 DM and DM secondary to chronic pancreatitis to determine the effects of combinations of these factors. We examined 4 groups of male patients with chronic pancreatitis without diabetes (ND-CP) (n = 12), diabetes secondary to chronic pancreatitis and insulin-treated (CP-DM) (n = 32), type 1 diabetes (n = 25), and controls (n = 20). Plasma apo A-IV was significantly lower in the chronic pancreatitis patients (ND-CP and CP-DM) than in the other patients. Inflammatory proteins (fibrinogen, ceruloplasmin, and haptoglobin) were significantly elevated in the 2 chronic pancreatitis groups. The apo A-IV concentration was positively correlated with hemoglobin A(1c) (HbA(1c)) percentage in each group of diabetic patients (CP-DM, r =.35; P =.046; type 1 DM, r =.53; P =.010), in both groups of diabetic patients (r =.472; P <.0001) and negatively correlated with ceruloplasmin concentration in each group of diabetic patients (CP-DM, r = -.48; P =.0052; type 1 DM, r = -.66; P =.003), in both groups of diabetic patients (r = -.561; P <.0001), and in the whole population (r = -.463; P <.0001). Apo A-IV was also negatively correlated with haptoglobin in type 1 DM patients (r = -.434; P =.0435), in the both groups of diabetic patients (r = -.349; P =.0154), and in the whole population (r = -.351; P =.0019). Multiple linear regression analysis revealed that only HbA(1c) and ceruloplasmin were independent explanatory variables. Plasma apo A-IV is positively correlated with HbA(1c) suggesting that hyperglycemia per se selectively affects apo A-IV metabolism. The correlation between the concentrations of inflammatory protein and apo A-IV suggest a link between chronic inflammation and apo A-IV synthesis or catabolism. As apo A-IV is involved in reverse cholesterol transport, its low level in CP-DM may contribute to the accelerated development of atherosclerosis in these patients.
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Affiliation(s)
- D Quilliot
- Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Jeanne d'Arc, CHU de Nancy, Toul, France.
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Walters E. Prioritising documentation. Br J Perioper Nurs 2001; 11:382. [PMID: 11892579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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