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Kaku JS, Ahmad RA, Main S, Oktofiana D, Dwihardiani B, Triasih R, du Cros P, Chan G. Tuberculosis Case Finding in Kulon Progo District, Yogyakarta, Indonesia: Passive versus Active Case Finding Using Mobile Chest X-ray. Trop Med Infect Dis 2024; 9:75. [PMID: 38668536 PMCID: PMC11053704 DOI: 10.3390/tropicalmed9040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/24/2024] [Accepted: 03/16/2024] [Indexed: 04/29/2024] Open
Abstract
Active-case finding (ACF) using chest X-ray is an essential method of finding and diagnosing Tuberculosis (TB) cases that may be missed in Indonesia's routine TB case finding. This study compares active and passive TB case-finding strategies. A retrospective study of TB case notification was conducted. Data between 1 January and 31 December 2021, was used. The population in this study were TB cases notified from Kulon Progo District health facilities, including those found through routine activities or active-case findings. A total of 249 TB cases were diagnosed in Kulon Progo in 2021, and 102 (41%) were bacteriologically confirmed. The TB patients' ages ranged from 0 to 85 years (median 52, IQR 31-61). The majority of cases were male (59%, 147/249) and mostly among people aged 15-59 (61.4%, 153/249). The proportion of clinical TB diagnoses among cases found from active-case findings was 74.7% (68/91) while the proportion among passive-case findings was 50% (79/158). Active-case finding contributed 91 (36.5%) TB cases to the total cases detected in Kulon Progo in 2021. The use of chest X-rays in active-case findings likely contributed to the detection of a higher proportion of clinical TB than in passive-case findings.
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Affiliation(s)
- John Silwanus Kaku
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Riris Andono Ahmad
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Stephanie Main
- International Development, Burnet Institute, Melbourne, VIC 3000, Australia
| | - Dwi Oktofiana
- Kulon Progo District Health Office, Yogyakarta 55611, Indonesia
| | - Bintari Dwihardiani
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Rina Triasih
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Department of Pediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Philipp du Cros
- International Development, Burnet Institute, Melbourne, VIC 3000, Australia
| | - Geoffrey Chan
- International Development, Burnet Institute, Melbourne, VIC 3000, Australia
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Shopsowitz K, Lofroth J, Chan G, Kim J, Rana M, Brinkman R, Weng A, Medvedev N, Wang X. MAGIC-DR: An interpretable machine-learning guided approach for acute myeloid leukemia measurable residual disease analysis. Cytometry B Clin Cytom 2024. [PMID: 38415807 DOI: 10.1002/cyto.b.22168] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Abstract
Multiparameter flow cytometry is widely used for acute myeloid leukemia minimal residual disease testing (AML MRD) but is time consuming and demands substantial expertise. Machine learning offers potential advancements in accuracy and efficiency, but has yet to be widely adopted for this application. To explore this, we trained single cell XGBoost classifiers from 98 diagnostic AML cell populations and 30 MRD negative samples. Performance was assessed by cross-validation. Predictions were integrated with UMAP as a heatmap parameter for an augmented/interactive AML MRD analysis framework, which was benchmarked against traditional MRD analysis for 25 test cases. The results showed that XGBoost achieved a median AUC of 0.97, effectively distinguishing diverse AML cell populations from normal cells. When integrated with UMAP, the classifiers highlighted MRD populations against the background of normal events. Our pipeline, MAGIC-DR, incorporated classifier predictions and UMAP into flow cytometry standard (FCS) files. This enabled a human-in-the-loop machine learning guided MRD workflow. Validation against conventional analysis for 25 MRD samples showed 100% concordance in myeloid blast detection, with MAGIC-DR also identifying several immature monocytic populations not readily found by conventional analysis. In conclusion, Integrating a supervised classifier with unsupervised dimension reduction offers a robust method for AML MRD analysis that can be seamlessly integrated into conventional workflows. Our approach can support and augment human analysis by highlighting abnormal populations that can be gated on for quantification and further assessment. This has the potential to speed up MRD analysis, and potentially improve detection sensitivity for certain AML immunophenotypes.
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Affiliation(s)
- Kevin Shopsowitz
- Division of Hematopathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of pathology and laboratory medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jack Lofroth
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey Chan
- Division of Hematopathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jubin Kim
- Terry Fox Lab, BC Cancer, Vancouver, British Columbia, Canada
| | - Makhan Rana
- Division of Hematopathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ryan Brinkman
- Terry Fox Lab, BC Cancer, Vancouver, British Columbia, Canada
| | - Andrew Weng
- Department of pathology and laboratory medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Terry Fox Lab, BC Cancer, Vancouver, British Columbia, Canada
| | - Nadia Medvedev
- Division of Hematopathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of pathology and laboratory medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xuehai Wang
- Division of Hematopathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of pathology and laboratory medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Nababan B, Triasih R, Chan G, Dwihardiani B, Hidayat A, Dewi SC, Unwanah L, Mustofa A, du Cros P. The Yield of Active Tuberculosis Disease and Latent Tuberculosis Infection in Tuberculosis Household Contacts Investigated Using Chest X-ray in Yogyakarta Province, Indonesia. Trop Med Infect Dis 2024; 9:34. [PMID: 38393123 PMCID: PMC10891579 DOI: 10.3390/tropicalmed9020034] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
In Indonesia, the implementation of tuberculosis (TB) contact investigation is limited, with low detection rates. We report the yield of and risk factors for TB disease and infection for household contacts (HHCs) investigated using chest X-ray (CXR) screening. We identified HHCs aged five years and above of bacteriologically confirmed index cases from 2018 to 2022 in Yogyakarta City and Kulon Progo. All HHCs were offered screening for TB symptoms; TB infection testing with either tuberculin skin testing or interferon gamma release assay; and referral for CXR. Sputum from those with symptoms or CXR suggestive of TB was tested with Xpert MTB/RIF. Risk factors for active TB disease and latent TB infection (LTBI) were identified by logistic regression models. We screened 2857 HHCs for TB between June 2020 and December 2022, with 68 (2.4%) diagnosed with active TB. Of 2621 HHCs eligible for LTBI investigation, 1083 (45.7%) were diagnosed with LTBI. The factors associated with active TB were age, being underweight, diabetes mellitus, urban living, and sleeping in the same house as an index case. Factors associated with LTBI were increasing age and male gender. Conclusions: Screening for HHC including CXR and TST/IGRA yielded a moderate prevalence of TB disease and infection.
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Affiliation(s)
- Betty Nababan
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman, Yogyakarta 55281, Indonesia
| | - Rina Triasih
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman, Yogyakarta 55281, Indonesia
- Department of Pediatric, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Dr. Sardjito Hospital, Sleman, Yogyakarta 55281, Indonesia
| | - Geoffrey Chan
- TB Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Bintari Dwihardiani
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman, Yogyakarta 55281, Indonesia
| | - Arif Hidayat
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman, Yogyakarta 55281, Indonesia
| | - Setyogati C. Dewi
- Yogyakarta City Health Office, Yogyakarta, Yogyakarta 55165, Indonesia
| | - Lana Unwanah
- Yogyakarta City Health Office, Yogyakarta, Yogyakarta 55165, Indonesia
| | - Arif Mustofa
- Kulon Progo District Health Office, Yogyakarta, Yogyakarta 55165, Indonesia
| | - Philipp du Cros
- TB Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC 3004, Australia
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Simon AF, Chan G, Williamson W. [Anterior segment ischemia in giant cell arteritis: A case report]. J Fr Ophtalmol 2024; 47:103947. [PMID: 37743222 DOI: 10.1016/j.jfo.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023]
Affiliation(s)
- A F Simon
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France.
| | - G Chan
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
| | - W Williamson
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
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Felisia F, Triasih R, Nababan BWY, Sanjaya GY, Dewi SC, Rahayu ES, Unwanah L, du Cros P, Chan G. High Tuberculosis Preventive Treatment Uptake and Completion Rates Using a Person-Centered Approach among Tuberculosis Household Contact in Yogyakarta. Trop Med Infect Dis 2023; 8:520. [PMID: 38133452 PMCID: PMC10747839 DOI: 10.3390/tropicalmed8120520] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Coverage of tuberculosis preventive treatment (TPT) in Indonesia is inadequate, and persons who start TPT often do not complete treatment. In 2020, Zero TB Yogyakarta implemented person-centered contact investigation and shorter TPT regimen provision in collaboration with primary health care centers. Between 1 January 2020 and 31 August 2022, we assessed eligibility for TPT among household contacts of persons with bacteriologically confirmed TB (index cases) and offered them a 3-month TPT regimen (3RH or 3HP). A dedicated nurse monitored contacts on TPT for treatment adherence and side effects every week in the first month and every two weeks in the next months. Contacts were also able to contact a nurse by phone or ask for home visits at any point if they had any concerns. A total of 1016 contacts were eligible for TPT: 772 (78.8%) started short regimen TPT with 706 (91.5%) completing their TPT. Side effects were reported in 26 (39%) of the non-completion group. We conclude that high rates of TPT uptake and completion among contacts assessed as eligible for TPT can be achieved through person-centered care and the use of shorter regimens. Side-effect monitoring and management while on TPT is vital for improving TPT completion.
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Affiliation(s)
- Felisia Felisia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia;
| | - Rina Triasih
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia;
- Department of Pediatric, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia
| | - Betty Weri Yolanda Nababan
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia;
| | - Guardian Yoki Sanjaya
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia;
| | - Setyogati Candra Dewi
- Yogyakarta City Health Office, Yogyakarta 55165, Yogyakarta, Indonesia; (S.C.D.); (E.S.R.); (L.U.)
| | - Endang Sri Rahayu
- Yogyakarta City Health Office, Yogyakarta 55165, Yogyakarta, Indonesia; (S.C.D.); (E.S.R.); (L.U.)
| | - Lana Unwanah
- Yogyakarta City Health Office, Yogyakarta 55165, Yogyakarta, Indonesia; (S.C.D.); (E.S.R.); (L.U.)
| | - Philipp du Cros
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC 3004, Australia (G.C.)
| | - Geoffrey Chan
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC 3004, Australia (G.C.)
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Sekeres MA, Montesinos P, Novak J, Wang J, Jeyakumar D, Tomlinson B, Mayer J, Jou E, Robak T, Taussig DC, Dombret H, Merchant A, Shaik N, O'Brien T, Roh W, Liu X, Ma W, DiRienzo CG, Chan G, Cortes JE. Glasdegib plus intensive or non-intensive chemotherapy for untreated acute myeloid leukemia: results from the randomized, phase 3 BRIGHT AML 1019 trial. Leukemia 2023; 37:2017-2026. [PMID: 37604981 PMCID: PMC10539167 DOI: 10.1038/s41375-023-02001-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/15/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
This is the primary report of the randomized, placebo-controlled phase 3 BRIGHT AML 1019 clinical trial of glasdegib in combination with intensive chemotherapy (cytarabine and daunorubicin) or non-intensive chemotherapy (azacitidine) in patients with untreated acute myeloid leukemia. Overall survival (primary endpoint) was similar between the glasdegib and placebo arms in the intensive (n = 404; hazard ratio [HR] 1.05; 95% confidence interval [CI]: 0.782-1.408; two-sided p = 0.749) and non-intensive (n = 325; HR 0.99; 95% CI: 0.768-1.289; two-sided p = 0.969) studies. The proportion of patients who experienced treatment-emergent adverse events was similar for glasdegib versus placebo (intensive: 99.0% vs. 98.5%; non-intensive: 99.4% vs. 98.8%). The most common treatment-emergent adverse events were nausea, febrile neutropenia, and anemia in the intensive study and anemia, constipation, and nausea in the non-intensive study. The addition of glasdegib to either cytarabine and daunorubicin or azacitidine did not significantly improve overall survival and the primary efficacy endpoint for the BRIGHT AML 1019 phase 3 trial was not met. Clinical trial registration: ClinicalTrials.gov: NCT03416179.
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Affiliation(s)
- Mikkael A Sekeres
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Jan Novak
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Department of Haematology, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jianxiang Wang
- Department of Clinical Hematology, Institute of Hematology and Blood Diseases Hospital, Tianjin, China
| | - Deepa Jeyakumar
- University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA, USA
| | - Benjamin Tomlinson
- Division of Hematology, University Hospitals of Cleveland Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jiri Mayer
- Department of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Erin Jou
- Department of Hematology/Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | | | - Hervé Dombret
- Institut de Recherche Saint-Louis, Hôpital Saint-Louis Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Akil Merchant
- Division of Hematology and Cellular Therapy, Cedars Sinai Cancer, Los Angeles, CA, USA
| | | | | | - Whijae Roh
- Pfizer Oncology, Pfizer Inc, San Diego, CA, USA
| | - Xueli Liu
- Pfizer Oncology, Pfizer Inc, San Diego, CA, USA
| | - Wendy Ma
- Pfizer Oncology, Pfizer Inc, San Diego, CA, USA
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Reich K, Silverberg JI, Papp KA, Deleuran M, Katoh N, Strober B, Beck LA, de Bruin-Weller M, Werfel T, Zhang F, Biswas P, DiBonaventura MD, Chan G, Farooqui SA, Kerkmann U, Clibborn C. Abrocitinib effect on patient-reported outcomes in patients with moderate-to-severe atopic dermatitis: Results from phase 3 studies, including the long-term extension JADE EXTEND study. J Eur Acad Dermatol Venereol 2023; 37:2047-2055. [PMID: 37319109 DOI: 10.1111/jdv.19254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Abrocitinib improved signs and symptoms of moderate-to-severe atopic dermatitis (AD) at Weeks 12 and 16 in phase 3 studies, with a manageable safety profile. Patient-reported outcomes with long-term abrocitinib treatment were not reported. OBJECTIVE To evaluate patient-reported outcomes with long-term abrocitinib treatment in patients with moderate-to-severe AD. METHODS JADE EXTEND (NCT03422822) is an ongoing, phase 3, long-term extension study that enrolled patients from previous abrocitinib AD trials. This analysis includes patients from the phase 3 trials JADE MONO-1 (NCT03349060), JADE MONO-2 (NCT03575871) and JADE COMPARE (NCT03720470) who completed the full treatment period of placebo or abrocitinib (200 or 100 mg once daily) and subsequently entered JADE EXTEND and were randomised to receive once-daily abrocitinib 200 or 100 mg. Patient-reported endpoints to Week 48 included the proportion of patients who achieved Dermatology Life Quality Index (DLQI) scores of 0/1 (no effect of AD on quality of life [QoL]) and a ≥4-point improvement in Patient-Oriented Eczema Measure (POEM) score (clinically meaningful improvement). Data cut-off: April 22, 2020. RESULTS Baseline DLQI mean scores were 15.4 and 15.3 in the abrocitinib 200- and 100-mg groups, respectively, which corresponded to a 'very large effect' on QoL; at Week 48, mean DLQI scores were lower with abrocitinib 200 mg (4.6; 'small effect' on QoL) and abrocitinib 100 mg (5.9; 'moderate effect' on QoL). Baseline POEM mean scores were 20.4 and 20.5 in the abrocitinib 200- and 100-mg groups, respectively; at Week 48, mean POEM scores were 8.2 and 11.0. Week 48 patient-reported responses with abrocitinib 200 mg and abrocitinib 100 mg were 44% and 34% for DLQI 0/1, and 90% and 77% for a ≥4-point reduction in POEM score. CONCLUSION In patients with moderate-to-severe AD, long-term abrocitinib treatment resulted in clinically meaningful improvement in patient-reported symptoms of AD, including QoL.
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Affiliation(s)
- K Reich
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Moonlake Immunotherapeutics AG, Zug, Switzerland
| | - J I Silverberg
- The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - K A Papp
- Alliance Clinical Trials and Probity Medical Research, Waterloo, Ontario, Canada
- The University of Toronto, Toronto, Ontario, Canada
| | - M Deleuran
- Aarhus University Hospital, Aarhus, Denmark
| | - N Katoh
- Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - B Strober
- Yale University, New Haven, Connecticut, USA
- Central Connecticut Dermatology Research, Cromwell, Connecticut, USA
| | - L A Beck
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - T Werfel
- Hannover Medical School, Hannover, Germany
| | - F Zhang
- Pfizer Inc., Groton, Connecticut, USA
| | - P Biswas
- Pfizer Inc., New York City, New York, USA
| | | | - G Chan
- Pfizer Inc., Groton, Connecticut, USA
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Simon A, Mercier AE, Chan G, Williamson W. [Multimodal imaging of Perifoveal Exudative Vascular Anomalous Complex (PEVAC)]. J Fr Ophtalmol 2023; 46:968-971. [PMID: 37481453 DOI: 10.1016/j.jfo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/09/2023] [Indexed: 07/24/2023]
Affiliation(s)
- A Simon
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France.
| | - A-E Mercier
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
| | - G Chan
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
| | - W Williamson
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
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Yang H, Qian D, Chan G, Wang J, Sun X, Chen Y. Influence of miosis and laser peripheral iridotomy on intraocular lens power calculation in patients with primary angle closure disease. Eye (Lond) 2023; 37:2744-2752. [PMID: 36707639 PMCID: PMC10482892 DOI: 10.1038/s41433-023-02408-z] [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: 08/07/2022] [Revised: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To evaluate the effect of miosis and laser peripheral iridotomy (LPI) on intraocular lens (IOL) power prediction and ocular biometry in eyes with primary angle closure disease (PACD). METHODS In this prospective observational study, primary angle closure suspects (PACS), and subjects classified with primary angle closure (PAC)/primary angle-closure glaucoma (PACG) undergoing LPI were enrolled. Ocular biometric parameters were measured with IOLMaster700 at baseline (T0), one week after pilocarpine instillation (T1), and another week post LPI (T2). Biometric changes and the IOL power predicted for emmetropia using Barrett Universal II, Haigis, Holladay2, Hoffer Q and SRK/T formulae were analysed and compared among different time points. RESULTS 100 eyes of 50 PACS and 50 PAC/PACG patients were enrolled. Following pilocarpine-induced miosis, lens thickness (LT) increased and anterior chamber depth (ACD) decreased (all groups p < 0.01), while white-to-white diameter decreased and central corneal thickness increased significantly only in the PACS cohort (both p < 0.01). Compared to baseline, LPI induced an increase of ACD and a slight decrease of LT in PACS (both p < 0.01), whereas only axial length changed significantly (p = 0.012) in the PAC/PACG cohort. Regardless of the formula used, no significant difference to the predicted IOL power for emmetropia existed among the three time points in each group (all p > 0.1). CONCLUSION We report the changes of anterior segment parameters induced by miosis and LPI in PACD. These interventions do not significantly affect the IOL power calculation predicted for emmetropia in Chinese eyes when common third-, fourth-and new generation IOL formulae are used.
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Affiliation(s)
- Hongfang Yang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Dongjin Qian
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Geoffrey Chan
- Lions Eye Institute, University of Western Australia, Perth, WA, Australia
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia
| | - Jiajian Wang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China.
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China.
| | - Yuhong Chen
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China.
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Simon A, Mercier AE, Chan G, Williamson W. [Cystic maculopathy of the inner nuclear layer in a glaucoma patient: Case report]. J Fr Ophtalmol 2023; 46:821-825. [PMID: 37088622 DOI: 10.1016/j.jfo.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 04/25/2023]
Affiliation(s)
- A Simon
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France.
| | - A-E Mercier
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
| | - G Chan
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
| | - W Williamson
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
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Erchick DJ, Hazel EA, Katz J, Lee ACC, Diaz M, Wu LSF, Yoshida S, Bahl R, Grandi C, Labrique AB, Rashid M, Ahmed S, Roy AD, Haque R, Shaikh S, Baqui AH, Saha SK, Khanam R, Rahman S, Shapiro R, Zash R, Silveira MF, Buffarini R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zeng L, Zhu Z, He J, Qiu X, Gebreyesus SH, Tesfamariam K, Bekele D, Chan G, Baye E, Workneh F, Asante KP, Kaali EB, Adu-Afarwuah S, Dewey KG, Gyaase S, Wylie BJ, Kirkwood BR, Manu A, Thulasiraj RD, Tielsch J, Chowdhury R, Taneja S, Babu GR, Shriyan P, Ashorn P, Maleta K, Ashorn U, Mangani C, Acevedo-Gallegos S, Rodriguez-Sibaja MJ, Khatry SK, LeClerq SC, Mullany LC, Jehan F, Ilyas M, Rogerson SJ, Unger HW, Ghosh R, Musange S, Ramokolo V, Zembe-Mkabile W, Lazzerini M, Rishard M, Wang D, Fawzi WW, Minja DTR, Schmiegelow C, Masanja H, Smith E, Lusingu JPA, Msemo OA, Kabole FM, Slim SN, Keentupthai P, Mongkolchati A, Kajubi R, Kakuru A, Waiswa P, Walker D, Hamer DH, Semrau KEA, Chaponda EB, Chico RM, Banda B, Musokotwane K, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021. BJOG 2023. [PMID: 37156239 DOI: 10.1111/1471-0528.17510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. DESIGN Descriptive multi-country secondary data analysis. SETTING Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. POPULATION Liveborn infants. METHODS Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. RESULTS Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). CONCLUSIONS Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.
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Affiliation(s)
- D J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - E A Hazel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Diaz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - L S F Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - R Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - C Grandi
- Argentine Society of Paediatrics, Ciudad Autónoma de Buenos Aires, Argentina
| | - A B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - M Rashid
- IntraHealth International, Dhaka, Bangladesh
| | - S Ahmed
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - A D Roy
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - R Haque
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - S Shaikh
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - A H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - R Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Rahman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - R Shapiro
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - R Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - M F Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - R Buffarini
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - P Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - C Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - L Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - D Roberfroid
- Medicine Department, Faculty of Medicine, University of Namur, Namur, Belgium
| | - L Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Z Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - J He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - X Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - S H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - K Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - D Bekele
- Department of Obstetrics and Gynecology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - G Chan
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - E Baye
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - F Workneh
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - K P Asante
- Kintampo Health Research Centre, Research and Development Division, Kintampo, Ghana
| | - E B Kaali
- Kintampo Health Research Centre, Research and Development Division, Kintampo, Ghana
| | - S Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - K G Dewey
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, California, USA
| | - S Gyaase
- Department of Statistics, Kintampo Health Research Centre, Kintampo, Ghana
| | - B J Wylie
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - B R Kirkwood
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - A Manu
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- University of Ghana School of Public Health, Accra, Ghana
| | | | - J Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - R Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, Delhi, India
| | - S Taneja
- Centre for Health Research and Development, Society for Applied Studies, Delhi, India
| | - G R Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - P Shriyan
- Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, India
| | - P Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - K Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - U Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - C Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - S Acevedo-Gallegos
- National Institute of Perinatology, Maternal-Fetal Medicine Department, Mexico City, Mexico
| | - M J Rodriguez-Sibaja
- National Institute of Perinatology, Maternal-Fetal Medicine Department, Mexico City, Mexico
| | - S K Khatry
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - S C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - L C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - F Jehan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - M Ilyas
- The Aga Khan University, Karachi, Pakistan
| | - S J Rogerson
- Department of Infectious Diseases, University of Melbourne, Doherty Institute, Melbourne, Victoria, Australia
| | - H W Unger
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - R Ghosh
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - S Musange
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - V Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - W Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- College Graduate of Studies, University of South Africa, Johannesburg, South Africa
| | - M Lazzerini
- Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| | - M Rishard
- University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka
- Department of Obstetrics & Gynaecology, University of Colombo, Colombo, Sri Lanka
| | - D Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - W W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - D T R Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - C Schmiegelow
- Centre for Medical Parasitology, Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Masanja
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - E Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, DC, USA
| | - J P A Lusingu
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - O A Msemo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - F M Kabole
- Ministry of Health Zanzibar, Zanzibar, Tanzania
| | - S N Slim
- Ministry of Health Zanzibar, Zanzibar, Tanzania
| | - P Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - A Mongkolchati
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
| | - R Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - A Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - P Waiswa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - D Walker
- Institute for Global Health Sciences and Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA
| | - D H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - K E A Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity & Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E B Chaponda
- Department of Biological Sciences, School of Natural Sciences, University of Zambia, Lusaka, Zambia
| | - R M Chico
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - B Banda
- Research Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - K Musokotwane
- Health Specialist PMTCT and Pediatric AIDS, UNICEF, Lusaka, Zambia
| | - A Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - B Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - J Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - R E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Curlewis K, Leung B, Sinclair L, Thornhill C, Chan G, Ricketts D. Systemic medical complications following joint replacement: a review of the evidence. Ann R Coll Surg Engl 2023; 105:191-195. [PMID: 35686748 PMCID: PMC9974346 DOI: 10.1308/rcsann.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Arthroplasty procedures are commonly performed in the UK. Informed consent is required for each procedure. To obtain informed consent the patient and their surgeon should discuss the risks and benefits of the proposed operation. This discussion should include both regional and systemic complication rates. Regional complications of arthroplasty are generally well documented in the literature. Systemic medical complications are less well described. This lack of accurate data could make it difficult for the treating surgeon to obtain valid consent. The aim of this paper was to review and compare the literature regarding the rate of systemic medical complications after common arthroplasty procedures. METHODS A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Studies regarding the systemic medical complications and mortality rate of joint replacement were included. FINDINGS We found that systemic complications were more frequent than regional complications following arthroplasty. The systemic complication rates were: hip, 5.1%; knee, 6.9%; ankle, 3.0%; shoulder, 11.2%; elbow, 8.5%; and wrist, 0%. Mortality rates for arthroplasty procedures were: hip, 0.3%; knee, 0.2%; ankle, 0.3%; shoulder, 0.3%; elbow, 0.2%; and wrist, 0%. CONCLUSIONS The most common systemic medical complication following arthroplasty was venous thromboembolism. Preoperative comorbidity was the most important risk factor for both postoperative mortality and systemic medical complications following arthroplasty procedures. We recommend that to obtain informed consent the given rates of systemic medical complications of joint replacement should be discussed and documented.
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Affiliation(s)
- K Curlewis
- Royal Free London NHS Foundation Trust, UK
| | | | - L Sinclair
- Brighton and Sussex University Hospitals NHS Trust, UK
| | | | - G Chan
- University Hospitals Sussex NHS Foundation Trust, UK
| | - D Ricketts
- University Hospitals Sussex NHS Foundation Trust, UK
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Verla W, Barratt R, Chan G, Campos-Juanatey F, Esperto F, Greenwell T, Lumen N, Martins F, Osman N, Ploumidis A, Riechardt S, Waterloos M, Dimitropoulos K. Is a course of Intermittent Self-Dilatation (ISD) with topical corticosteroids superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of ISD alone? A systematic review and meta-analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01051-5] [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: 02/12/2023]
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14
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Stone A, Chan G, Sinclair L, Phadnis J. Elbow arthroplasty in trauma-current concepts review. J Orthop 2023; 35:126-133. [PMID: 36471696 PMCID: PMC9718957 DOI: 10.1016/j.jor.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Despite advancements in modern locking plate technology, distal humerus fractures in the elderly remain difficult to treat. A subset of fractures in this osteoporotic bone includes multiple, shallow articular fragments that renders fixation unreliable, precluding early motion and acceptable functional outcomes. Arthroplasty, in the form of either Total Elbow Arthroplasty (TEA) or Distal Humeral Hemiarthroplasty (DHH) are alternative treatment options in this cohort and are being increasingly used. Methods This article reviews the use of TEA or DHH for acute distal humerus fracture, including patient selection, pre-operative planning, surgical approach, implant positioning, rehabilitation, outcomes and complications. Results Arthroplasties are being increasingly used for acute distal humerus fractures, however they introduce potential complications not seen with fixation. Due care must be employed to correct implant positioning which is a function of implant rotation, implant length and implant sizing. We describe a robust technique for epicondyle repair in DHH and unlinked TEA to avoid instability. Outcomes of DHH and TEA for acute distal humerus fracture are encouraging, however further long-term outcome and comparative data regarding arthroplasty is required. Conclusions Short to medium term outcomes demonstrate that both DHH and TEA are valuable options for selected patients, although attention to technique is required to minimise potential complications.
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Affiliation(s)
- A. Stone
- Shoulder & Elbow Post-CCT Fellow, University Hospitals Sussex NHS Foundation Trust, UK
| | - G. Chan
- Specialty Registrar, University Hospitals Sussex NHS Foundation Trust, Honorary Clinical Lecturer, Brighton & Sussex Medical School, UK
| | - L. Sinclair
- Clinical Librarian, University Hospitals Sussex NHS Foundation Trust, UK
| | - J. Phadnis
- Consultant Trauma & Orthopaedic Surgeon, University Hospitals Sussex NHS Foundation Trust, Honorary Clinical Reader, Brighton & Sussex Medical School, UK
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Verla W, Barratt R, Chan G, Campos-Juanatey F, Esperto F, Greenwell T, Lumen N, Martins F, Osman N, Ploumidis A, Riechardt S, Waterloos M, Dimitropoulos K. Is a course of Intermittent Self-Dilatation (ISD) with topical corticosteroids superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of ISD alone? A systematic review and meta-analysis. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02051-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Main S, Dwihardiani B, Hidayat A, Khodijah S, Greig J, Chan G, Parry AE, Nababan B, Billy I, du Cros P, Triasih R. Knowledge and attitudes towards TB among healthcare workers in Yogyakarta, Indonesia. Public Health Action 2022; 12:133-140. [PMID: 36160721 PMCID: PMC9484592 DOI: 10.5588/pha.22.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/06/2022] [Indexed: 11/12/2022] Open
Abstract
SETTING: Healthcare workers (HCWs) are at an increased risk of TB worldwide. Individual knowledge and attitudes may influence HCW behaviour, and subsequently, TB risk. Indonesia has the second highest case-load globally. OBJECTIVE: To measure TB knowledge and attitudes among a subsection of HCWs in Yogyakarta, Indonesia, and to explore factors associated with knowledge. DESIGN: A cross-sectional study using an online survey targeting all HCW staff was conducted among HCWs from four pre-selected healthcare facilities in Yogyakarta. Descriptive analysis and a multivariable linear regression were undertaken. RESULTS: Of 792 HCWs, 290 (37%) completed the survey; 64% (n = 185) were medical staff, 33% (n = 95) reported previously being tested for active TB and 8% (n = 24) for latent TB. The mean knowledge score was 7.2/11 (SD 1.5): this was higher among medical staff and those with university education (average score increase: 0.53, 95% CI 0.15 to 0.90; and 0.38, 95% CI 0.01 to 0.74, respectively). Participants agreed that free access to TB screening (93%) and treatment (93%) should be available, and 57% of medical and 77% of non-medical staff would take preventive therapy if eligible. CONCLUSION: Participants had practical understanding of TB; however, gaps were identified in knowledge about TB disease progression and prevention. Prevention programmes were viewed positively. We suggest further TB education and engagement programmes for HCWs.
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Affiliation(s)
- S. Main
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC, Australia, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - B. Dwihardiani
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - A. Hidayat
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - S. Khodijah
- Department of Paediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - J. Greig
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC, Australia
| | - G. Chan
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC, Australia
| | - A. E. Parry
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - B. Nababan
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - I. Billy
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P. du Cros
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC, Australia
| | - R. Triasih
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, Department of Paediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital,
Yogyakarta, Indonesia
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Choo J, Rha S, Jung M, Tan H, Chan G, Ho J, Walsh R, Chee C, Raghav S, Yong W. 1255P da VINci: Safety and efficacy of the OTSGC-A24 vaccine and nivolumab in metastatic gastric cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mora J, Bear M, Chan G, Morgenstern D, Nysom K, Tornøe K, Sørensen P, Kushner B. 891P Naxitamab treatment for relapsed or refractory high-risk neuroblastoma: Outcomes from the first prespecified analyses of the Pivotal 201 Trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Sekeres MA, Schuster M, Joris M, Krauter J, Maertens J, Breems D, Gyan E, Kovacsovics T, Verma A, Vyas P, Wang ES, Ching K, O'Brien T, Gallo Stampino C, Ma WW, Kudla A, Chan G, Zeidan AM. A phase 1b study of glasdegib + azacitidine in patients with untreated acute myeloid leukemia and higher-risk myelodysplastic syndromes. Ann Hematol 2022; 101:1689-1701. [PMID: 35488900 DOI: 10.1007/s00277-022-04853-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 01/12/2022] [Accepted: 04/20/2022] [Indexed: 12/17/2022]
Abstract
This phase 1b study evaluated glasdegib (100 mg once daily) + azacitidine in adults with newly diagnosed acute myeloid leukemia (AML), higher-risk myelodysplastic syndromes (MDS), or chronic myelomonocytic leukemia (CMML) who were ineligible for intensive chemotherapy. Of 72 patients enrolled, 12 were in a lead-in safety cohort (LIC) and 60 were in the AML and MDS (including CMML) expansion cohorts. In the LIC, the safety profile of glasdegib + azacitidine was determined to be consistent with those of glasdegib or azacitidine alone, with no evidence of drug-drug interaction. In the expansion cohort, the most frequently (≥ 10%) reported non-hematologic Grade ≥ 3 treatment-emergent adverse events were decreased appetite, electrocardiogram QT prolongation, and hypertension in the AML cohort and sepsis, diarrhea, hypotension, pneumonia, and hyperglycemia in the MDS cohort. Overall response rates in the AML and MDS cohorts were 30.0% and 33.3%, respectively; 47.4% and 46.7% of patients who were transfusion dependent at baseline achieved independence. Median overall survival (95% confidence interval) was 9.2 (6.2-14.0) months and 15.8 (9.3-21.9) months, respectively, and response was associated with molecular mutation clearance. Glasdegib + azacitidine in patients with newly diagnosed AML or MDS demonstrated an acceptable safety profile and preliminary evidence of clinical benefits.Trial registration: ClinicalTrials.gov NCT02367456.
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Affiliation(s)
- Mikkael A Sekeres
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA.
| | - Michael Schuster
- Stony Brook University Hospital Cancer Center, Stony Brook, NY, USA
| | | | | | | | | | - Emmanuel Gyan
- Service d'hématologie et Thérapie Cellulaire, CIC INSERM U1415, Equipe CNRS ERL 7001 LNOx, Université de Tours, Tours, France
| | | | - Amit Verma
- Montefiore Medical Center, Bronx, NY, USA
| | - Paresh Vyas
- MRC Molecular Haematology Unit, Oxford Centre for Haematology, University of Oxford, Oxford, UK
| | - Eunice S Wang
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | | | | | | | | | | | - Amer M Zeidan
- Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
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Starr N, Perez-Garcia C, Beirne E, Dempsey E, Baby T, Ging P, Chan G, Hannan M, Fabre A, Keogan M, O'Neill J, Joyce E. Challenges of Treating Late Onset Severe Antibody Mediated Rejection Post Orthotopic Heart Transplant. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Roland K, Yakimec J, Markin T, Chan G, Hudoba M. Customized middleware experience in a tertiary care hospital hematology laboratory. J Pathol Inform 2022; 13:100143. [PMID: 36268082 PMCID: PMC9577123 DOI: 10.1016/j.jpi.2022.100143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/09/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background In the clinical laboratory, middleware is a software application that sits between the analyzer and the laboratory information system (LIS). One of the more common uses of middleware is to perform more efficient result autoverification than can be achieved by the LIS or analyzer alone. In addition to autoverification, middleware can support highly customized rules to handle samples and results from specific patient locations. The objective of this study was to review the impact of customized middleware rules that were designed and implemented in the hematology laboratory of a 1000-bed tertiary care adult academic center hospital. Methods Three novel initiatives using middleware rules to achieve workflow efficiencies were retrospectively reviewed over different audit periods: preliminary neutrophil resulting for oncology patients, microcytosis interpretive comments, and 1 white blood cell differential (WBCD) reported per day. In addition, autoverification rates for complete blood count and differential (CBCD) and coagulation tests were calculated. Results A preliminary neutrophil count was released from middleware on average 64 min before the final CBCD for Leukemia/Bone Marrow Transplant (L/BMT) outpatients, and on average 59 min earlier for oncology patients. Reflexing interpretive comments for select instances of microcytosis removed on average 500 slides per month from technologist review with an estimated cost savings of approximately $3383.33 CAD per month. The 1 WBCD per day rule resulted in a 5.1% cancelation rate, resulting in an estimated monthly cost savings of $943.46 CAD in reagents and technologist time. Finally, middleware rules achieved very high autoverification rates of 97.2% and 88.3% for CBC and CBCD results, respectively. Conclusions Implementation of customized middleware hematology rules in our institution resulted in multiple positive impacts on workflow, achieving high autoverification rates, reduced slide reviews, cost savings, and improved standardization.
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Mora J, Bear M, Chan G, Morgenstern D, Nysom K, Tornøe K, Hindsberger C, Kushner B. 161P Assessment of corticosteroid premedication for patients treated with the humanized GD2-binding monoclonal antibody naxitamab. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.180] [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: 10/19/2022] Open
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23
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Cork MJ, McMichael A, Teng J, Valdez H, Rojo R, Chan G, Zhang F, Myers DE, DiBonaventura M. Impact of oral abrocitinib on signs, symptoms and quality of life among adolescents with moderate-to-severe atopic dermatitis: an analysis of patient-reported outcomes. J Eur Acad Dermatol Venereol 2021; 36:422-433. [PMID: 34743361 PMCID: PMC9299698 DOI: 10.1111/jdv.17792] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/06/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022]
Abstract
Background A significant improvement in clinical signs was demonstrated with abrocitinib relative to placebo in adolescents with moderate‐to‐severe atopic dermatitis (AD) in three phase 3, randomized, double‐blinded, placebo‐controlled studies (JADE TEEN [ClinicalTrials.gov, NCT03796676], JADE MONO‐1 [NCT03349060] and JADE MONO‐2 [NCT03575871]). Objectives To evaluate the impact of abrocitinib on patient‐reported signs/symptoms, including sleep loss and quality of life among adolescents with moderate‐to‐severe AD. Methods JADE TEEN, JADE MONO‐1 and JADE MONO‐2 were conducted in the Asia‐Pacific region, Europe and North America and included patients aged 12–17 years with moderate‐to‐severe AD and inadequate response to ≥ 4 consecutive weeks of topical medication or treatment with systemic therapy for AD. Patients were randomly assigned (1 : 1 : 1, JADE TEEN; 2 : 2 : 1, JADE MONO‐1/‐2) to receive once‐daily oral abrocitinib (200 or 100 mg) or placebo for 12 weeks in combination with topical therapy (JADE TEEN) or as monotherapy (JADE MONO‐1/‐2). Data from adolescent patients in JADE MONO‐1/‐2 were pooled for these analyses. Results At week 12, more adolescents treated with abrocitinib (200 or 100 mg) vs. placebo achieved a ≥ 4‐point improvement from baseline in the Patient‐Oriented Eczema Measure in JADE TEEN (83.9% and 77.0% vs. 60.2%) and JADE MONO‐1/‐2 (83.0% and 69.4% vs. 43.5%) and a ≥ 6‐point improvement from baseline in the Children’s Dermatology Life Quality Index in JADE TEEN (73.8% and 67.5% vs. 56.5%) and JADE MONO‐1/‐2 (70.0% and 57.1% vs. 19.0%). Significant improvements in SCORing Atopic Dermatitis Visual Analog Scale for sleep loss scores were demonstrated with abrocitinib vs. placebo at weeks 2‐12 in JADE TEEN and JADE MONO‐1/‐2. Conclusions Patient‐reported signs/symptoms, including reduction of sleep loss and quality of life, were substantially improved with abrocitinib monotherapy or combination therapy relative to placebo in adolescents with moderate‐to‐severe AD.
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Affiliation(s)
- M J Cork
- Sheffield Dermatology Research, University of Sheffield, Sheffield, UK
| | - A McMichael
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J Teng
- Department of Dermatology, Stanford University, Stanford, CA, USA
| | | | - R Rojo
- Pfizer Inc, Groton, CT, USA
| | - G Chan
- Pfizer Inc, Groton, CT, USA
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24
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Ngo V, Chan G, Edmondson M. 470 Financial and Efficacy Analysis of a Centralised Neck of Femur Fracture Service. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.991] [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: 11/14/2022]
Abstract
Abstract
Aim
Osteoporotic fractures are rising in incidence, costing the National Health Service up to £1.1 billion for hospital care. The implementation of the Best Practice Tariff (BPT) of fragility fractures in 2010 created a financial incentive to achieve standards of best practice. In June 2015, a dedicated hip fracture unit (HFU) was set up at Princess Royal Hospital (PRH). The aim of this study is (A) to assess changes in performance to the BPT after the introduction of a dedicated HFU, and (B) whether the performance of a HFU is affected by direct/indirect presentation to the HFU.
Method
The performance of Brighton and Sussex University Hospitals (BSUH) to BPT pre and post HFU was assessed by a retrospective review of BPT performance data between 2015 and 2016. 870 patients who were treated for NOFF at BSUH were reviewed to assess whether the performance of the HFU was impacted by patients presenting either directly (PRH) to the HFU or indirectly (presentation to Royal Sussex County Hospital). Appropriate statistical tests were used to analyse the significant differences between these outcome measures.
Results
The comparison between pre and post HFU showed there was a significant increase in the time between A&E admission to ward, theatre or orthogeriatric (OG) assessment (P < 0.001) in patients presenting indirectly to HFU compared to direct presentations.
Conclusions
Having a HFU is cost neutral, and advantages of HFU include focusing NOFF care which improves in patient care. BPT achievements could be improved by increasing the direct admission of NOFF to the HFU.
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Affiliation(s)
- V Ngo
- Brighton and Sussex University Hospital, Brighton, United Kingdom
| | - G Chan
- Brighton and Sussex University Hospital, Brighton, United Kingdom
| | - M Edmondson
- Brighton and Sussex University Hospital, Brighton, United Kingdom
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Huang Y, Zhao J, Soon Y, Wong A, Ang Y, Asokumaran Y, Low J, Lee M, Choo J, Chan G, Kee A, Tay S, Goh B, Soo R. P28.01 Real-World Experience (RWE) of Consolidation Durvalumab After Concurrent Chemoradiotherapy (CCRT) In Stage III NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.392] [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: 10/20/2022]
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26
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Mora J, Bear M, Chan G, Morgenstern D, Nysom K, Tornøe K, Losic N, Kushner B. 963MO Naxitamab for the treatment of refractory/relapsed high-risk neuroblastoma (HR NB): Updated efficacy and safety data from the international, multicenter phase II trial 201. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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27
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Chan G, Triasih R, Nababan B, du Cros P, Wilks N, Main S, Huang GKL, Lin D, Graham SM, Majumdar SS, Bakker M, Khan A, Khan FA, Dwihardiani B. Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia. Public Health Action 2021; 11:41-49. [PMID: 34159059 PMCID: PMC8202624 DOI: 10.5588/pha.20.0071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.
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Affiliation(s)
- G Chan
- Burnet Institute, Melbourne, VIC, Australia
| | - R Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - B Nababan
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P du Cros
- Burnet Institute, Melbourne, VIC, Australia
| | - N Wilks
- Burnet Institute, Melbourne, VIC, Australia
| | - S Main
- Burnet Institute, Melbourne, VIC, Australia
| | | | - D Lin
- Burnet Institute, Melbourne, VIC, Australia
| | - S M Graham
- Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S S Majumdar
- Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - M Bakker
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - A Khan
- STOP TB Partnership, Geneva, Switzerland
| | - F A Khan
- STOP TB Partnership, Geneva, Switzerland
| | - B Dwihardiani
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Barratt R, Chan G, La Rocca R, Dimitropoulos K, Martins F, Juanatey F, Greenwell T, Waterloos M, Riechardt S, Osman N, Esperto F, Ploumidis A, Lumen N. Free graft augmentation urethroplasty for bulbar urethral strictures – Which technique is best? A systematic review. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00701-6] [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: 10/20/2022]
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Heuser M, Smith BD, Fiedler W, Sekeres MA, Montesinos P, Leber B, Merchant A, Papayannidis C, Pérez-Simón JA, Hoang CJ, O'Brien T, Ma WW, Zeremski M, O'Connell A, Chan G, Cortes JE. Correction to: Clinical benefit of glasdegib plus low-dose cytarabine in patients with de novo and secondary acute myeloid leukemia: long-term analysis of a phase II randomized trial. Ann Hematol 2021; 100:1917-1918. [PMID: 33978823 PMCID: PMC8496603 DOI: 10.1007/s00277-021-04545-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - B Douglas Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Walter Fiedler
- Department of Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mikkael A Sekeres
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Pau Montesinos
- Hospital Universitari I Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Brian Leber
- Juravinski Hospital At Hamilton Health Sciences, Hamilton, ON, Canada
| | - Akil Merchant
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - José A Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IbiS)/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | | | | | | | | | | | | | - Jorge E Cortes
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Georgia Cancer Center, Augusta, GA, USA
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McGinnis E, Chan G, Hudoba M, Markin T, Yakimec J, Roland K. Malaria Screening Using Front-Line Loop-Mediated Isothermal Amplification. Am J Clin Pathol 2021; 155:690-697. [PMID: 33283225 DOI: 10.1093/ajcp/aqaa173] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We implemented front-line loop-mediated isothermal amplification (LAMP)-based malaria screening in our nonendemic multicenter health region to reduce reliance on microscopy without sacrificing diagnostic efficiency. We aimed to evaluate changes in test volumes, positivity rates, turnaround times, and approximate labor time savings resulting from implementation of LAMP-based malaria testing to assess the efficacy of the novel testing algorithm in our regional hub-and-spoke testing model. METHODS We reviewed data generated from institutional malaria testing between 2016 and 2019, having implemented LAMP in October 2018 as a front-line screening test for all malaria investigations from our hub facility and investigations from satellite facilities with negative rapid diagnostic tests (RDTs) and microscopy. RESULTS Blood film microscopy and RDT workloads decreased substantially in the year following LAMP implementation (by 90% and 46%, respectively,) despite similar numbers of patients tested and positivity rates for malaria compared with historical data. LAMP turnaround times (TATs) were comparable to historical TATs for RDTs, and TATs for RDTs and thick films did not increase with the change in workflow. CONCLUSIONS LAMP was successfully implemented in our multicenter health region malaria diagnostic algorithm, significantly reducing reliance on microscopic evaluations and RDT and providing substantial labor time savings without compromising TATs.
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Affiliation(s)
- Eric McGinnis
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Geoffrey Chan
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Monika Hudoba
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Todd Markin
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Jim Yakimec
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Kristine Roland
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, Canada
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Quayle J, Barakat A, Klasan A, Mittal A, Chan G, Gibbs J, Edmondson M, Stott P. Management of peri-prosthetic joint infection and severe bone loss after total hip arthroplasty using a long-stemmed cemented custom-made articulating spacer (CUMARS). BMC Musculoskelet Disord 2021; 22:358. [PMID: 33863329 PMCID: PMC8052787 DOI: 10.1186/s12891-021-04237-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/09/2021] [Indexed: 02/02/2023] Open
Abstract
Background There is little evidence on techniques for management of peri-prosthetic infection (PJI) in the context of severe proximal femoral bone loss. Custom-made articulating spacers (CUMARS) utilising cemented femoral stems as spacers was described providing better bone support and longer survival compared to conventional articulating spacers. We retrospectively report our experience managing PJI by adaptation of this technique using long cemented femoral stems where bone loss precludes use of standard stems. Methods Patients undergoing 1st stage revision for infected primary and revision THA using a cemented long stem (> 205 mm) and standard all-polyethylene acetabulum between 2011 and 2018 were identified. After excluding other causes of revision (fractures or aseptic loosening), Twenty-one patients remained out of total 721 revisions. Medical records were assessed for demographics, initial microbiological and operative treatment, complications, eradication of infection and subsequent operations. 2nd stage revision was undertaken in the presence of pain or subsidence. Results Twenty-one patients underwent 1st stage revision with a cemented long femoral stem. Mean follow up was 3.9 years (range 1.7–7.2). Infection was eradicated in 15 (71.4%) patients. Two patients (9.5%) required repeat 1st stage and subsequently cleared their infection. Three patients (14.3%) had chronic infection and are on long term suppressive antibiotics. One patient (4.8%) was lost to follow up before 2 years. Complications occurred in seven patients (33%) during or after 1st stage revision. Where infection was cleared, 2nd stage revision was undertaken in 12 patients (76.5%) at average of 9 months post 1st stage. Five (23.8%) CUMARS constructs remained in-situ at an average of 3.8 years post-op (range 2.6–5.1). Conclusions Our technique can be used in the most taxing of reconstructive scenarios allowing mobility, local antibiotic delivery, maintenance of leg length and preserves bone and soft tissue, factors not afforded by alternative spacer options.
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Affiliation(s)
- J Quayle
- Brighton and Sussex University Hospitals, Brighton, UK.
| | - A Barakat
- Brighton and Sussex University Hospitals, Brighton, UK
| | - A Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - A Mittal
- Brighton and Sussex University Hospitals, Brighton, UK
| | - G Chan
- Brighton and Sussex University Hospitals, Brighton, UK
| | - J Gibbs
- Brighton and Sussex University Hospitals, Brighton, UK
| | - M Edmondson
- Brighton and Sussex University Hospitals, Brighton, UK
| | - P Stott
- Brighton and Sussex University Hospitals, Brighton, UK
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Heuser M, Smith BD, Fiedler W, Sekeres MA, Montesinos P, Leber B, Merchant A, Papayannidis C, Pérez-Simón JA, Hoang CJ, O'Brien T, Ma WW, Zeremski M, O'Connell A, Chan G, Cortes JE. Clinical benefit of glasdegib plus low-dose cytarabine in patients with de novo and secondary acute myeloid leukemia: long-term analysis of a phase II randomized trial. Ann Hematol 2021; 100:1181-1194. [PMID: 33740113 PMCID: PMC8043884 DOI: 10.1007/s00277-021-04465-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
This analysis from the phase II BRIGHT AML 1003 trial reports the long-term efficacy and safety of glasdegib + low-dose cytarabine (LDAC) in patients with acute myeloid leukemia ineligible for intensive chemotherapy. The multicenter, open-label study randomized (2:1) patients to receive glasdegib + LDAC (de novo, n = 38; secondary acute myeloid leukemia, n = 40) or LDAC alone (de novo, n = 18; secondary acute myeloid leukemia, n = 20). At the time of analysis, 90% of patients had died, with the longest follow-up since randomization 36 months. The combination of glasdegib and LDAC conferred superior overall survival (OS) versus LDAC alone; hazard ratio (HR) 0.495; (95% confidence interval [CI] 0.325–0.752); p = 0.0004; median OS was 8.3 versus 4.3 months. Improvement in OS was consistent across cytogenetic risk groups. In a post-hoc subgroup analysis, a survival trend with glasdegib + LDAC was observed in patients with de novo acute myeloid leukemia (HR 0.720; 95% CI 0.395–1.312; p = 0.14; median OS 6.6 vs 4.3 months) and secondary acute myeloid leukemia (HR 0.287; 95% CI 0.151–0.548; p < 0.0001; median OS 9.1 vs 4.1 months). The incidence of adverse events in the glasdegib + LDAC arm decreased after 90 days’ therapy: 83.7% versus 98.7% during the first 90 days. Glasdegib + LDAC versus LDAC alone continued to demonstrate superior OS in patients with acute myeloid leukemia; the clinical benefit with glasdegib + LDAC was particularly prominent in patients with secondary acute myeloid leukemia. ClinicalTrials.gov identifier: NCT01546038.
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Affiliation(s)
- Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - B Douglas Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Walter Fiedler
- Department of Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mikkael A Sekeres
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, FL, Miami, USA
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Brian Leber
- Juravinski Hospital at Hamilton Health Sciences, Hamilton, ON, Canada
| | - Akil Merchant
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - José A Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IbiS)/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | | | | | | | | | | | | | - Jorge E Cortes
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Georgia Cancer Center, Augusta, GA, USA
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Tremblay G, Daniele P, Bell T, Chan G, Brown A, Cappelleri JC. Comparative effectiveness of glasdegib versus venetoclax combined with low-dose cytarabine in acute myeloid leukemia. J Comp Eff Res 2021; 10:603-612. [PMID: 33733815 DOI: 10.2217/cer-2020-0280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Two combination therapies recently approved and recommended for use in combination with low-dose cytarabine (LDAC) in acute myeloid leukemia patients unfit for intensive chemotherapy are glasdegib+LDAC and venetoclax+LDAC. Materials & methods: An indirect treatment comparison used median overall survival, overall survival hazard ratios, complete remission (CR), CR+CR with incomplete blood count recovery and transfusion independence to assess comparative effectiveness, and a simulated treatment comparison accounted for differences in patient characteristics between trials. Results: Differences in efficacy between glasdegib+LDAC and venetoclax+LDAC were suggestive and not statistically significant. Conclusion: With no significant differences in comparative effectiveness, considerations such as safety profiles, burden of administration and patient preference are likely to guide treatment decisions.
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Malik-Tabassum K, Robertson A, Tadros BJ, Chan G, Crooks M, Buckle C, Rogers B, Selmon G, Arealis G. The effect of the COVID-19 lockdown on the epidemiology of hip fractures in the elderly: a multicentre cohort study. Ann R Coll Surg Engl 2021; 103:337-344. [PMID: 33715420 DOI: 10.1308/rcsann.2020.7071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic presented extraordinary challenges to the UK healthcare system. This study aimed to assess the impact of the COVID-19 lockdown on the epidemiology, treatment pathways and 30-day mortality rates of hip fractures. Outcomes of COVID-19 positive patients were compared against those who tested negative. METHODS An observational, retrospective, multicentre study was conducted across six hospitals in the South East of England. Data were retrieved from the National Hip Fracture Database and electronic medical records. Data was collected for the strictest UK lockdown period (period B=23 March 2020-11 May 2020), and the corresponding period in 2019 (period A). RESULTS A total of 386 patients were admitted during period A, whereas 381 were admitted during period B. Despite the suspension of the 'Best Practice Tariff' during period B, time to surgery, time to orthogeriatric assessment, and 30-day mortality were similar between period A and B. The length of inpatient stay was significantly shorter during period B (11.5 days vs 17.0 days, p<0.001). Comparison of COVID-19 positive and negative patients during period B demonstrated that a positive test was associated with a significantly higher rate of 30-day mortality (53.6% vs 6.7%), surgical delay >36h (46.4% vs 30.8%, p=0.049), and increased length of inpatient stay (15.8 vs 11.7 days, p=0.015). CONCLUSIONS The COVID-19 lockdown did not alter the epidemiology of hip fractures. A substantially higher mortality rate was observed among patients with a COVID-19 positive test. These findings should be taken into consideration by the healthcare policymakers while formulating contingency plans for a potential 'second wave'.
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Affiliation(s)
| | | | - B J Tadros
- East Kent Hospitals University NHS Foundation Trust, UK
| | - G Chan
- Western Sussex Hospitals NHS Trust, UK.,Brighton and Sussex Medical School, UK
| | - M Crooks
- East Sussex Healthcare NHS Trust, UK
| | - C Buckle
- Brighton and Sussex University Hospitals NHS Trust, UK
| | - B Rogers
- Brighton and Sussex University Hospitals NHS Trust, UK
| | - G Selmon
- East Sussex Healthcare NHS Trust, UK
| | - G Arealis
- East Kent Hospitals University NHS Foundation Trust, UK
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Ruiz‐Garcia A, Shaik N, Lin S, Jamieson C, Heuser M, Chan G. Evaluation of the Relationship of Glasdegib Exposure and Safety End Points in Patients With Refractory Solid Tumors and Hematologic Malignancies. J Clin Pharmacol 2021; 61:349-359. [PMID: 32974950 PMCID: PMC7891441 DOI: 10.1002/jcph.1742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
Glasdegib is approved for treating acute myeloid leukemia in elderly patients at 100 mg once daily in combination with low-dose cytarabine. Exposure-efficacy analysis showed that the survival benefit of glasdegib was not glasdegib exposure-dependent. The relationship between glasdegib exposure and adverse event (AE) cluster terms of clinical concern was explored in this analysis. The incidence and severity of dysgeusia, muscle spasms, renal toxicity, and QT interval prolonged was modeled using ordinal logistic regression. AEs were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03). Estimated pharmacokinetic parameters were used to derive glasdegib exposure metrics. Demographic characteristics, disease factors, and other variables of interest as potential moderators of safety signals were evaluated. Clinical trial data from patients who received single-agent glasdegib (N = 70; 5-640 mg once daily); or glasdegib (N = 202, 100-200 mg once daily) with low-dose cytarabine, decitabine, or daunorubicin and cytarabine were analyzed. Glasdegib exposure was statistically significantly associated with the cluster term safety end points dysgeusia, muscle spasms, renal toxicity, and QT interval prolonged. The impact of age on muscle spasms and baseline body weight and creatinine clearance on renal toxicity helped explain the AE grade distribution. At the 100 mg once daily clinical dose, the predicted probabilities of the highest AE grade were 11.3%, 6.7%, 7.7%, and 2.5% for dysgeusia, muscle spasms, renal toxicity, and QT interval prolonged, respectively. Overall, the predicted probability of developing an AE of any severity for these safety end points was low. Therefore, no starting dose adjustments are recommended for glasdegib based on the observed safety profile.
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Affiliation(s)
| | - Naveed Shaik
- Pfizer Clinical PharmacologySan DiegoCaliforniaUSA
| | - Swan Lin
- Pfizer Clinical PharmacologySan DiegoCaliforniaUSA
| | | | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell TransplantationHannover Medical SchoolHannoverGermany
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Narang A, Chan G, Aframian A, Ali Z, Carr A, Goodier H, Morgan C, Park C, Sugand K, Walton T, Wilson M, Belgaumkar A, Gallagher K, Ghosh K, Gibbons C, Keightley A, Nawaz Z, Wakeling C, Sarraf K, Rogers BA, Kieffer WKM. Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study. Int Orthop 2021. [PMID: 32862265 DOI: 10.1007/s00264-020-04739-y/figures/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients. METHODS A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019. RESULTS Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57-5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification. CONCLUSION COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.
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Affiliation(s)
- A Narang
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - G Chan
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - A Aframian
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Z Ali
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - A Carr
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - H Goodier
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - C Morgan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - C Park
- St Mary's Hospital, London, London, UK
| | - K Sugand
- St Mary's Hospital, London, London, UK
| | - T Walton
- Brighton and Sussex University Hospitals, Brighton, UK
| | - M Wilson
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - A Belgaumkar
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - K Gallagher
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - K Ghosh
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - C Gibbons
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Keightley
- Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Z Nawaz
- Frimley Park Hospital, Camberley, UK
| | - C Wakeling
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - K Sarraf
- St Mary's Hospital, London, London, UK
| | - B A Rogers
- Brighton and Sussex University Hospitals, Brighton, UK
| | - W K M Kieffer
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK.
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Bhutani T, Deleuran M, Fonacier L, Shi V, Shumack S, Biswas P, Cameron M, Chan G, Valdez H, Yin N. P551 EFFECTIVE MAINTENANCE OF RESPONSE IN ATOPIC DERMATITIS PATIENTS AFTER SWITCHING FROM DUPILUMAB TO ABROCITINIB (JADE-EXTEND). Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chan G, Ong P. P550 DIFFERENCES IN ADMISSION COMPLETE BLOOD COUNT PARAMETERS IN ECZEMA HERPETICUM IN CHILDREN. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lin S, Shaik N, Chan G, Cortes JE, Ruiz-Garcia A. An evaluation of overall survival in patients with newly diagnosed acute myeloid leukemia and the relationship with glasdegib treatment and exposure. Cancer Chemother Pharmacol 2020; 86:451-459. [PMID: 32885274 PMCID: PMC7515941 DOI: 10.1007/s00280-020-04132-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/22/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Glasdegib, an oral inhibitor of the Hedgehog signaling pathway, is approved in the United States in combination with low-dose cytarabine (LDAC) to treat patients with newly diagnosed acute myeloid leukemia (AML) ineligible to receive intensive chemotherapy. This population pharmacokinetic/pharmacodynamic analysis characterized the time course of survival with glasdegib + LDAC relative to LDAC alone, and explored whether the differences in glasdegib exposure at the clinical dose of 100 mg once daily (QD) significantly affected overall survival (OS). METHODS Data from the BRIGHT AML 1003 trial in patients with AML were included in treatment-response (glasdegib + LDAC, n = 78; LDAC alone, n = 38) and exposure-response (glasdegib + LDAC, n = 75) analyses. RESULTS The analyses demonstrate that patients treated with glasdegib + LDAC (vs LDAC alone) at any time point during the study period were 58% less likely to die, translating to prolonging of median OS by ~ 5 months (hazard ratio 0.42 [95% confidence interval 0.28-0.66]). Variability in glasdegib exposures did not impact the risk of death. Additionally, potential covariates such as patient demographics, prior treatment with a hypomethylating agent, baseline safety laboratory values, and disease characteristics, did not impact the probability of OS. CONCLUSION Together these results confirm that glasdegib + LDAC treatment (vs. LDAC alone) is associated with a significant survival benefit in patients with newly diagnosed AML, and that variability in glasdegib doses (e.g., for dose reductions) and exposures do not compromise the survival benefit of glasdegib 100 mg QD. CLINICAL TRIAL NUMBER NCT01546038.
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Affiliation(s)
- Swan Lin
- Clinical Pharmacology, Global Product Development, Pfizer Inc, 10555 Science Center Dr, San Diego, CA, 92121, USA.
| | - Naveed Shaik
- Clinical Pharmacology, Global Product Development, Pfizer Inc, 10555 Science Center Dr, San Diego, CA, 92121, USA
| | - Geoffrey Chan
- Pfizer Oncology, Global Product Development, Pfizer Inc, Collegeville, PA, USA
| | | | - Ana Ruiz-Garcia
- Clinical Pharmacology, Global Product Development, Pfizer Inc, 10555 Science Center Dr, San Diego, CA, 92121, USA
- Metrum Research Group, San Diego, CA, USA
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Chan G, Storey JD, Das MK, Sacks E, Johri M, Kabakian-Khasholian T, Paudel D, Yoshida S, Portela A. Global research priorities for social, behavioural and community engagement interventions for maternal, newborn and child health. Health Res Policy Syst 2020; 18:97. [PMID: 32854722 PMCID: PMC7450986 DOI: 10.1186/s12961-020-00597-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background Social, behavioural and community engagement (SBCE) interventions are essential for global maternal, newborn and child health (MNCH) strategies. Past efforts to synthesise research on SBCE interventions identified a need for clear priorities to guide future research. WHO led an exercise to identify global research priorities for SBCE interventions to improve MNCH. Methods We adapted the Child Health and Nutrition Research Initiative method and combined quantitative and qualitative methods to determine MNCH SBCE intervention research priorities applicable across different contexts. Using online surveys and meetings, researchers and programme experts proposed up to three research priorities and scored the compiled priorities against four criteria – health and social impact, equity, feasibility, and overall importance. Priorities were then ranked by score. A group of 29 experts finalised the top 10 research priorities for each of maternal, newborn or child health and a cross-cutting area. Results A total of 310 experts proposed 867 research priorities, which were consolidated into 444 priorities and scored by 280 experts. Top maternal and newborn health priorities focused on research to improve the delivery of SBCE interventions that strengthen self-care/family care practices and care-seeking behaviour. Child health priorities focused on the delivery of SBCE interventions, emphasising determinants of service utilisation and breastfeeding and nutrition practices. Cross-cutting MNCH priorities highlighted the need for better integration of SBCE into facility-based and community-based health services. Conclusions Achieving global targets for MNCH requires increased investment in SBCE interventions that build capacities of individuals, families and communities as agents of their own health. Findings from this exercise provide guidance to prioritise investments and ensure that they are best directed to achieve global objectives. Stakeholders are encouraged to use these priorities to guide future research investments and to adapt them for country programmes by engaging with national level stakeholders.
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Affiliation(s)
| | - J Douglas Storey
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Baltimore, United States of America
| | | | - Emma Sacks
- Department of Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland.
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Chan G, Morgan WH, Yu DY, Balaratnasingam C. Quantitative analysis of astrocyte and axonal density relationships: Glia to neuron ratio in the optic nerve laminar regions. Exp Eye Res 2020; 198:108154. [PMID: 32712181 DOI: 10.1016/j.exer.2020.108154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 12/01/2022]
Abstract
Astrocytes are critical for the maintenance of retinal ganglion cell (RGC) axonal function and viability, and form a key component of the functional neurovascular unit. Recently, we described the quantitative properties of astrocytes in relation to the capillary distributions in optic nerve laminar regions. Here, we provide a quantitative analysis of astrocytes and RGC axons in longitudinal sections of optic nerve tissue. Histological and immunocytochemical techniques are used to demonstrate the density of astrocytes, RGC axons and glia-neuron ratios across the pre laminar, lamina cribrosa and post laminar compartments of the optic nerve head (ONH). A study of human, pig, horse and rat optic nerves was performed and comparisons are made between species. This study demonstrates that the distribution of astrocytes correlates closely with the density of axonal processes, in accordance with the functional requirement of different regions of the ganglion cell axon. There was a consistency of glia-neuron ratios in the majority of laminar compartments, except for the human and rat prelaminar regions, which demonstrated lower ratios of astrocyte to axonal processes. The distribution of astrocytes may reflect a functional susceptibility to development of disease in the prelaminar region of the optic nerve. Interspecies comparison at the lamina cribrosa showed strikingly consistent glia-neuron ratios. Collectively, our findings suggest there may be a critical ratio of glia to neuron needed to maintain healthy cellular physiology across different laminar compartments of the optic nerve, with particular importance for the health of the lamina cribrosa region. It is possible that, in disease processes, the glia-neuron relationships across the different laminar compartments may be perturbed and this may be relevant for the development of glaucoma. Emerging technologies may further aid our understanding in how the physiology of optic nerve tissue cellular structure may be affected by changes to ONH characteristics and elevated intraocular pressure induced damage. Such findings may also permit the early identification of RGC axonal injury by identifying quantifiable changes in structural tissue architecture when pathophysiological pathways predominate.
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Affiliation(s)
- Geoffrey Chan
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia; Lions Eye Institute, The University of Western Australia, Perth, Australia.
| | - William H Morgan
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia; Lions Eye Institute, The University of Western Australia, Perth, Australia.
| | - Dao-Yi Yu
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia; Lions Eye Institute, The University of Western Australia, Perth, Australia.
| | - Chandrakumar Balaratnasingam
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia; Lions Eye Institute, The University of Western Australia, Perth, Australia.
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Chan KH, Sridhar S, Zhang RR, Chu H, Fung AYF, Chan G, Chan JFW, To KKW, Hung IFN, Cheng VCC, Yuen KY. Factors affecting stability and infectivity of SARS-CoV-2. J Hosp Infect 2020; 106:226-231. [PMID: 32652214 PMCID: PMC7343644 DOI: 10.1016/j.jhin.2020.07.009] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [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: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND In late 2019, a novel human coronavirus - severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) - emerged in Wuhan, China. This virus has caused a global pandemic involving more than 200 countries. SARS-CoV-2 is highly adapted to humans and readily transmits from person-to-person. AIM To investigate the infectivity of SARS-CoV-2 under various environmental and pH conditions. The efficacies of various laboratory virus inactivation methods and home disinfectants against SARS-CoV-2 were investigated. METHODS The residual virus in dried form or in solution was titrated on to Vero E6 cells on days 0, 1, 3, 5 and 7 after incubation at different temperatures. Viral viability was determined after treatment with various disinfectants and pH solutions at room temperature (20-25oC). FINDINGS SARS-CoV-2 was able to retain viability for 3-5 days in dried form or 7 days in solution at room temperature. SARS-CoV-2 could be detected under a wide range of pH conditions from pH 4 to pH 11 for several days, and for 1-2 days in stool at room temperature but lost 5 logs of infectivity. A variety of commonly used disinfectants and laboratory inactivation procedures were found to reduce viral viability effectively. CONCLUSION This study demonstrated the stability of SARS-CoV-2 on environmental surfaces, and raises the possibility of faecal-oral transmission. Commonly used fixatives, nucleic acid extraction methods and heat inactivation were found to reduce viral infectivity significantly, which could ensure hospital and laboratory safety during the SARS-CoV-2 pandemic.
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Affiliation(s)
- K-H Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China.
| | - S Sridhar
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - R R Zhang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - H Chu
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - A Y-F Fung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - G Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - J F-W Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - K K-W To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - I F-N Hung
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - V C-C Cheng
- Department of Microbiology, Queen Mary Hospital, Hospital Authority, Hong Kong Special Administrative Region, People's Republic of China
| | - K-Y Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China; Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China.
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Pepdjonovic L, Kealey J, Yao H, Chan G, Cheng J, O’connell H, Gani J. Never too old for Botox® – intravesical Botox® is efficacious and safe in the elderly population. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chan G, Gani J. Recurrent urinary tract infections: Utility of videourodynamics, imaging, and cystoscopy: Should we throw in the kitchen sink? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ke L, Yunhua M, Wenzhuan X, Mengli H, Chan G, Dejuan W, Jianguang Q. Differences in genomic profiles between Chinese and Caucasian castration-resistant prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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van Beekhuizen S, Hu Y, Gezin A, Heeg B, Bell T, Charaan M, Brown A, Chan G, Cappelleri JC. The comparative effectiveness of glasdegib in combination with low-dose cytarabine versus azacitidine by bone marrow blasts counts among patients with newly-diagnosed acute myeloid leukemia who are ineligible for intensive chemotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19512 Background: Acute myeloid leukemia (AML) is an orphan disease with one of the lowest five-year survival rates among myeloid malignancies. Recently, a randomized, open label study among previously untreated, chemotherapy-ineligible AML patients demonstrated improved overall survival (OS) among patients treated with glasdegib (GLAS) + LDAC compared with LDAC alone. Two trials of AZA vs. conventional care regimens report data by bone marrow blast (BMB) counts: one with 20-30% and the other with >30%. In the absence of head-to-head comparisons, this study aims to perform the indirect treatment comparison between GLAS+LDAC and AZA by BMB counts. Methods: As there were potential imbalances between the GLAS and AZA trials and within the AZA trial arms in the baseline characteristics (e.g. poor cytogenetics% and de novo%), simulated treatment comparisons (STCs) for GLAS+LDAC vs. LDAC were performed to derive robust estimation by adjusting for the imbalances in the baseline effect modifiers. Afterwards, the classical network meta-analysis (NMA) was conducted. To derive the hazard ratio (HR) of GLAS+LDAC vs. AZA, three NMAs were conducted in each BMB group. Each NMA used a different HR of GLAS+LDAC vs. LDAC: 1) an unadjusted HR (classical NMA), 2) an STC adjusted HR adjusting for potential imbalances between the trials, and 3) an STC adjusted HR additionally accounting for potential imbalances between arms within the AZA trial. Results: In the 20-30% BMB group (N = 30), the OS HRs of GLAS+LDAC vs. AZA resulting from the three respective NMAs were as follows: 1) 0.46 [95% confidence interval: 0.10-2.14], 2) 0.31 [0.06-1.69], and 3) 0.36 [0.06-2.15]. In the > 30% BMB group (N = 80), the HRs were 1) 0.69 [0.39-1.20], 2) 0.48 [0.23-0.97], and 3) 0.48 [0.24-1.00]. All the HRs suggest that patients with GLAS+LDAC have a survival advantage over patients with AZA. Conclusions: Both the classical NMAs and the NMAs based on the STC adjusted HRs correcting for the potential imbalances at baseline suggest that GLAS+LDAC may be preferred over AZA as a treatment option for previously untreated chemotherapy-ineligible AML patients regardless of BMB counts. [Table: see text]
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Affiliation(s)
| | - Yannan Hu
- Ingress-Health, Rotterdam, Netherlands
| | - Ana Gezin
- Ingress-Health.Com, Rotterdam, Netherlands
| | - Bart Heeg
- Ingress Health, Rotterdam, Netherlands
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Wang ES, Heuser M, Sekeres MA, Papayannidis C, Candoni A, Merchant A, Brown A, O'Connell A, Ma W, Chan G, Cortes JE. Effect of early blood counts on overall survival (OS) following glasdegib + LDAC in newly diagnosed AML: BRIGHT AML 1003 post hoc analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7525 Background: Addition of glasdegib (GLAS) to LDAC approximately doubled OS without significant worsening of myelosuppression-related complications, ostensibly by targeting leukemic stem cells dependent on the hedgehog pathway, which is not involved in normal adult hematopoiesis. We assessed potential association of early blood counts and OS. Methods: In BRIGHT AML 1003, patients (pts) with newly diagnosed AML were randomized to GLAS + LDAC (n = 78) or LDAC alone (n = 38). GLAS was given once daily continuously and LDAC on days 1–10 of a 28-day cycle. We evaluated peripheral blood counts measured early in the study (cycle 2 day 1 [C2D1]), approximately 1 month before the first bone marrow assessments. OS was compared for GLAS+LDAC vs LDAC alone subgroups meeting thresholds of absolute neutrophil count (ANC; ≥1000 or 500/µL), hemoglobin (Hb; ≥10 or 9 g/dL) or platelets (≥100,000 or 50,000/µL). Data cut-off was Apr 2019. Results: Among all pts regardless of baseline values, achievement of ANC, Hb and platelet thresholds at C2D1 was associated with improved OS with GLAS+LDAC (table, left side). Notably, in pts who did not meet ANC, Hb or platelet thresholds (table, right side), OS benefit with GLAS+LDAC was also observed (table, all p≤0.05). Among pts below threshold at baseline, C2D1 recovery of platelets ≥50,000 or 100,000 and Hb ≥9 or 10 was associated with improved OS (not shown). Clinical trial information: NCT01546038 . Conclusions: In pts with newly diagnosed AML, improved OS was associated with various blood count thresholds after 1 cycle of GLAS+LDAC vs LDAC alone. In pts with baseline measurements below threshold, recovery of specific thresholds was associated with improved OS. These exploratory results are consistent with the hematopoiesis-sparing mechanism of GLAS, and merit further evaluation. [Table: see text]
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Affiliation(s)
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | | | - Anna Candoni
- Azienda Ospedaliero Universitaria S. Maria della Misericordia di Udine, Udine, Italy
| | - Akil Merchant
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | | | | | - Jorge E. Cortes
- Georgia Cancer Center, Medical College of Georgia, Augusta, GA
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Wang ES, Bell T, Zeidan AM, Bhattacharyya H, Kudla A, Chan G, Sekeres MA. Health-related quality of life (HRQoL) in patients with untreated higher-risk myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), and chronic myelomonocytic leukemia (CMML) receiving glasdegib + azacitidine (AZA). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7527 Background: Glasdegib + AZA showed promising remission rates and overall survival in an analysis of BRIGHT MDS & AML 1012 in patients (pts) with MDS, AML and CMML. Here we assess the impact of glasdegib + AZA on HRQoL in this ongoing Phase Ib study. Methods: Untreated pts with MDS, AML and CMML ineligible for intensive chemotherapy received glasdegib (100 mg QD) + AZA (75 mg/m2/D on D1–7 q28D). Pt-reported outcomes (PRO) that characterize HRQoL were measured using the MD Anderson Symptom Inventory (MDASI)-AML/MDS, Pt Global Impression of Severity (PGI-S), and Pt Global Impression of Change (PGIC) tools. PRO were assessed at baseline (BL; except the PGIC), D7 and D15 of cycle (Cyc) 1, D1 of each subsequent Cyc and at end of treatment. Data cutoff: Sept 11, 2019. Results: For the MDS (n=30, including 3 with CMML) and AML (n=30) cohorts, median (range) number of Cyc started was 5 (1–14) and 5 (1–15), respectively. HRQoL over time, as determined by MDASI-AML/MDS, is shown in the Table, with mean scores indicating low symptom burden over time. For the PGI-S, both cohorts showed similar trends in pt’s impression of current leukemia symptoms remaining constant over time (i.e. absent to mild). For the PGIC, pt’s impression of change of leukemia symptoms since starting study medication remained constant over time (i.e. no to minimal change) for the MDS cohort and showed improvement in the AML cohort (i.e. minimal change to much improved). Conclusions: Glasdegib + AZA is a promising first-line treatment option that does not negatively impact the HRQoL of pts with MDS, AML and CMML ineligible for intensive chemotherapy. Clinical trial information: NCT02367456 . [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Mikkael A. Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Heuser M, Robak T, Montesinos P, Leber B, Fiedler WM, Pollyea DA, Brown A, O'Connell A, Ma W, Chan G, Cortes JE. Glasdegib (GLAS) plus low-dose cytarabine (LDAC) in AML or MDS: BRIGHT AML 1003 final report and four-year overall survival (OS) follow-up. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7509 Background: In newly diagnosed AML or high-risk MDS, primary analysis of the randomized phase 2 BRIGHT AML 1003 trial (data cutoff Jan 2017) showed superior OS for GLAS+LDAC vs LDAC alone. The trial then continued to predefined completion 4 years from randomization of all patients (pts), reached in Mar 2019 and presented herein. Methods: Pts with newly diagnosed AML or high-risk MDS and unsuitable for intensive chemotherapy were randomized 2:1 to GLAS+LDAC (n=88) or LDAC alone (n=44). For these groups, median (range) treatment duration was 83 (3-1575) and 47 (6-239) days; median follow-up for survival 47.6 and 48.1 months; 4 (4.5%) and 1 pt (2.3%) completed ≥4 years’ follow-up. Results: Consistent with the primary findings (OS HR 0.51; 80% CI 0.39, 0.67 p=0.0004), GLAS+LDAC prolonged OS vs LDAC alone (table). Results were consistent in AML pts and cytogenetic risk/disease history subgroups (table), as were analyses by pt characteristics and baseline risk factors (not shown). Survival probability was 39.5% vs 9.5% at 1 year and 18.0% vs 2.4% at 2 years. GLAS+LDAC induced higher complete remission (CR) rates overall (16/88 vs 1/44; RR 8.12, 95% CI 1.05, 62.78, p=0.010) and across subgroups. Notably, fewer pts discontinued GLAS+LDAC due to AEs (38.1% and 46.3%) and there was no increased sepsis or bleeding vs LDAC alone despite longer glasdegib treatment. With GLAS+LDAC, SMO-inhibitor-associated AEs included dysgeusia (25.0%), muscle spasms (22.6%) and alopecia (10.7%), with only 1 pt discontinuing due to dysgeusia. Conclusions: Consistent with primary analyses, GLAS+LDAC continued to have an acceptable safety profile and improved OS vs LDAC alone. HRs were consistent across cytogenetic risk subgroups and support use of GLAS+LDAC in de novo and secondary AML. Clinical trial information: NCT01546038 . [Table: see text]
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Affiliation(s)
- Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Pau Montesinos
- Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Brian Leber
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Walter M. Fiedler
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | | | | | | | | | | | - Jorge E. Cortes
- Georgia Cancer Center, Medical College of Georgia, Augusta, GA
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Zeidan AM, Schuster M, Joris M, Krauter J, Maertens J, Gyan E, Kovacsovics T, Verma A, Vyas P, Wang ES, Ma W, Zeremski M, Kudla A, Chan G, Sekeres MA. Glasdegib in combination with azacitidine (AZA) in patients (pts) with untreated higher-risk myelodysplastic syndromes (MDS), acute myeloid leukemia (AML) and chronic myelomonocytic leukemia (CMML): Effects on marrow recovery and transfusion independence. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7526 Background: Glasdegib, an oral inhibitor of the Hedgehog signaling pathway, is approved in the USA in combination with low-dose cytarabine to treat pts with newly diagnosed AML unable to receive intensive chemotherapy due to comorbidities or age (≥75 years). Glasdegib + AZA showed promising remission rates and overall survival with a generally well-tolerated and manageable safety profile in an analysis of BRIGHT MDS & AML 1012 in pts with MDS, AML and CMML. Here we evaluate early hematopoietic recovery and transfusion independence with glasdegib + AZA in this ongoing Phase Ib study. Methods: Untreated pts with MDS, AML and CMML ineligible for intensive chemotherapy received glasdegib (100 mg QD) + AZA (75 mg/m2/D on D1–7 q28D). Data cutoff: Sept 11, 2019. Results: Among pts with MDS (n=30; including 3 with CMML), median duration of treatment was 5.0 months (range, 0.4–15.5). Recovery of absolute neutrophil count (ANC), hemoglobin (Hb) and platelets at 2 thresholds started in cycle (Cyc) 1 (Table). Early platelet recovery correlated with response to treatment; 54% (7/13) of pts with platelets ≥100,000/µL at Cyc 2, D1 achieved complete or partial remission vs 0% (0/13) of pts with <100,000/µL, P=0.002. Start of Cyc 2 was delayed due to AEs in 8% (2/26) of pts. 54% (7/13) of evaluable pts transfusion dependent at baseline (BL) became transfusion independent. Among pts with AML (n=30), median duration of treatment was 5.0 months (range, 0.3–14.9). ANC, Hb and platelet recoveries started in Cyc 1 (Table). 9% (2/23) of pts had Cyc 2 dose delays due to AEs. 64% (9/14) of evaluable pts transfusion dependent at BL became transfusion independent. Clinical trial information: NCT02367456 . Conclusions: Glasdegib + AZA shows promising rates of survival with early marrow recovery in the up-front treatment of pts with MDS, AML and CMML ineligible for intensive chemotherapy. The association between early hematopoietic recovery and efficacy in the MDS cohort merits further study. [Table: see text]
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Affiliation(s)
| | | | | | - Jurgen Krauter
- Medizinische Klinikum Braunschweig GmbH, Braunschweig, Germany
| | | | - Emmanuel Gyan
- CHU de Tours-Hôpital Bretonneau, Tours Cedex, France
| | | | | | - Paresh Vyas
- University of Oxford and Oxford University Hospitals, Oxford, United Kingdom
| | | | | | | | | | | | - Mikkael A. Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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