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Irani MZ, Eslick GD, Burns GL, Potter M, Halland M, Keely S, Walker MM, Talley NJ. Coeliac disease is a strong risk factor for Gastro-oesophageal reflux disease while a gluten free diet is protective: a systematic review and meta-analysis. EClinicalMedicine 2024; 71:102577. [PMID: 38659976 PMCID: PMC11039972 DOI: 10.1016/j.eclinm.2024.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Background Gastro-oesophageal reflux disease (GORD) mechanisms are well described, but the aetiology is uncertain. Coeliac disease (CD), a gluten enteropathy with increased duodenal eosinophils overlaps with GORD. Functional dyspepsia is a condition where duodenal eosinophilia is featured, and a 6-fold increased risk of incident GORD has been observed. Perturbations of the duodenum can alter proximal gastric and oesophageal motor function. We performed a systematic review and meta-analysis assessing the association between CD and GORD. Methods A systematic search of studies reporting the association of GORD and CD was conducted. CD was defined by combined serological and histological parameters. GORD was defined based on classical symptoms, oesophagitis (endoscopic or histologic) or abnormal 24-h pH monitoring; studies reporting oesophageal motility abnormalities linked with GORD were also included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effects model. Findings 31 papers were included. Individuals with CD on a gluten containing diet were 3 times more likely to have GORD than controls (OR: 3.37, 95% CI: 2.09-5.44), and over 10 times more likely when compared to those on a gluten free diet (GFD) (OR: 10.20, 95% CI: 6.49-16.04). Endoscopic oesophagitis was significantly associated with CD (OR: 4.96; 95% CI: 2.22-11.06). One year of a GFD in CD and GORD was more efficacious in preventing GORD symptom relapse than treatment with 8 weeks of PPI in non-CD GORD patients (OR: 0.18, 95% CI: 0.08-0.36). Paediatric CD patients were more likely to develop GORD (OR: 3.29, 95% CI: 1.46-7.43), compared to adult CD patients (OR: 2.55, 95% CI: 1.65-3.93). Interpretation CD is strongly associated with GORD but there was high heterogeneity. More convincingly, a GFD substantially improves GORD symptoms, suggesting a role for duodenal inflammation and dietary antigens in the aetiology of a subset with GORD. Ruling out CD in patients with GORD may be beneficial. Funding The study was supported by an Investigator Grant from the NHMRC to Dr. Talley.
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Affiliation(s)
- Mudar Zand Irani
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Guy D. Eslick
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Grace L. Burns
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Michael Potter
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Magnus Halland
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Simon Keely
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Marjorie M. Walker
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Nicholas J. Talley
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
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Jones MP, Koloski NA, Walker MM, Holtmann GJ, Shah A, Eslick GD, Talley NJ. A Minority of Childhood Disorders of Gut-Brain Interaction Persist Into Adulthood: A Risk-Factor Analysis. Am J Gastroenterol 2024:00000434-990000000-01071. [PMID: 38483301 DOI: 10.14309/ajg.0000000000002751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/06/2024] [Indexed: 04/24/2024]
Abstract
INTRODUCTION Disorders of gut-brain interaction (DGBIs) may originate in childhood. There are currently limited data on persistence of DGBI into adulthood and risk factors for persistence. Furthermore, there are no data on this question from general practice, where the majority of DGBIs are diagnosed and managed. This study documents the proportion of childhood-diagnosed DGBIs that persisted into adulthood and what factors were associated with persistence. METHODS General practice records were obtained for more than 60,000 patients whose medical record spanned both childhood and adulthood years. Patients with diagnosed organic gastrointestinal disorder were excluded. Medical records were also interrogated for potential risk factors. RESULTS Eleven percent of patients with irritable bowel syndrome (IBS) and 20% of patients with functional dyspepsia (FD) diagnosed in childhood had repeat diagnoses of the same condition in adulthood. Female sex (odds ratio [OR] 2.02) was associated with persistence for IBS, while a childhood diagnosis of gastritis (OR 0.46) was risk-protective. Childhood non-steroidal anti-inflammatory drug use (OR 1.31, 95% confidence interval [CI] 1.09-1.56) was a risk factor for persistence in IBS. For FD, a childhood diagnosis of asthma (OR 1.30, 95% CI 1.00-1.70) was a risk factor, as was anxiety for both IBS (OR 1.24, 95% CI 1.00-1.54) and FD (OR 1.48 95% CI 1.11-1.97) with a similar finding for depression for IBS (OR 1.34, 95% CI 1.11-1.62) and FD (OR 1.88 95% CI 1.47-2.42). DISCUSSION Childhood DGBIs persist into adulthood in 10%-20% of patients, suggesting that management monitoring should continue into adulthood. Those diagnosed with anxiety or mood disorders in childhood should receive particular attention, and prescription of non-steroidal anti-inflammatory drugs in children should be made judiciously.
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Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Natasha A Koloski
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia
| | - Marjorie M Walker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gerald J Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia
| | - Ayesha Shah
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia
| | - Guy D Eslick
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Crane H, Eslick GD, Gofton C, Shaikh A, Cholankeril G, Cheah M, Zhong JH, Svegliati-Baroni G, Vitale A, Kim BK, Ahn SH, Kim MN, Strasser S, George J. Global prevalence of MAFLD-related hepatocellular carcinoma: A systematic review and meta-analysis. Clin Mol Hepatol 2024:cmh.2024.0109. [PMID: 38623613 DOI: 10.3350/cmh.2024.0109] [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: 02/15/2024] [Accepted: 04/15/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND & AIMS The global proportion of hepatocellular carcinoma (HCC) attributable to metabolic dysfunction-associated fatty liver disease (MAFLD) is unclear. The MAFLD diagnostic criteria allows objective diagnosis in the presence of steatosis plus defined markers of metabolic dysfunction, irrespective of concurrent liver disease. We aimed to determine the total global prevalence of MAFLD in HCC cohorts (total-MAFLD), including the proportion with MAFLD as their sole liver disease (single-MAFLD), and the proportion of those with concurrent liver disease where MAFLD was a contributary factor (mixed-MAFLD). METHODS This systematic review and meta-analysis included studies systematically ascertaining MAFLD in HCC cohorts, defined using international expert panel criteria including ethnicity specific BMI cut-offs. A comparison of clinical and tumour characteristics was performed between single-MAFLD, mixed-MAFLD and non-MAFLD HCC. RESULTS 22 studies (56,565 individuals with HCC) were included. Total and single-MAFLD HCC prevalence was 48.7% (95% CI; 34.5% - 63.0%) and 12.4% (95% CI; 8.3% - 17.3%), respectively. In HCC due to chronic hepatitis B, C and alcohol-related liver disease, mixed-MAFLD prevalence was 40.0% (95% CI; 30.2% - 50.3%), 54.1% (95% CI; 40.4% - 67.6%) and 64.3% (95% CI; 52.7% - 75.0%), respectively. Mixed-MAFLD HCC had significantly higher likelihood of cirrhosis and lower likelihood of metastatic spread compared to single-MAFLD HCC, and a higher platelet count and lower likelihood of macrovascular invasion compared to non-MAFLD HCC. CONCLUSION MAFLD is common as a sole aetiology, but more so and as a co-factor in mixed-aetiology HCC, supporting the use of a positive diagnostic criteria.
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Affiliation(s)
- Harry Crane
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia
| | - Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive Diseases, Hunter Medical Research Institute (HMRI), The University of Newcastle, Newcastle, New South Wales, Australia
| | - Cameron Gofton
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia
- Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anjiya Shaikh
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - George Cholankeril
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mark Cheah
- Department of Gastroenterology and Hepatology, Singapore General Hospital
| | - Jian-Hong Zhong
- Hepatobiliary Surgery Department, Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Guangxi Medical University Cancer Hospital, Nanning, China
| | | | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mi Na Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Simone Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia
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Goh CQ, Kaur R, Ayeni FE, Eslick GD, Edirimanne S. Bidirectional association between breast cancer and meningioma: a systematic review and meta-analysis. ANZ J Surg 2024. [PMID: 38361312 DOI: 10.1111/ans.18898] [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: 08/07/2023] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND An association between breast cancer and meningioma has been suggested in cohort studies. We aimed to perform a systematic review and meta-analysis to determine whether there is an association between initial breast cancer and subsequent meningioma diagnosis and vice versa. METHODS A systematic literature search was performed on Medline, Embase, Scopus and Google scholar from inception up to April 2023. A meta-analysis of selected studies was performed using Review Manager 5.4. RESULTS There were eight studies included in the systematic review. Seven had reported Standardized Incidence Ratio (SIR) for female patients and were suitable for the meta-analysis. Only one study reported SIR for male patients. For the association between initial breast cancer and subsequent meningioma, in 795 000 female patients with follow-up ranging from 7 to 13 years, the SIR was 1.27 (95% CI: 1.20-1.34, P-value <0.00001). For the association between initial meningioma and subsequent breast cancer, in 28 000 female patients with follow-up ranging from 6 to 15 years, the SIR was 1.32 (95% CI: 1.21-1.45, P-value <0.00001). There were low heterogeneity and no significant publication bias. CONCLUSION There was a small but significant association between initial breast cancer and subsequent meningioma as well as initial meningioma and subsequent breast cancer in female patients. The potential underlying mechanisms and risk factors were unclear from current literature and would be a potential area for future research.
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Affiliation(s)
- Chia Qi Goh
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Rajneesh Kaur
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Femi E Ayeni
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Senarath Edirimanne
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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Phan J, Eslick GD, Elliott EJ. Demystifying the global outbreak of severe acute hepatitis of unknown aetiology in children: A systematic review and meta-analysis. J Infect 2024; 88:2-14. [PMID: 38007049 DOI: 10.1016/j.jinf.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The sudden outbreak of severe acute hepatitis of unknown aetiology (SAHUA) in the first half of 2022 affected more than 1010 children in 35 countries worldwide. Dire clinical outcomes, such as acute liver failure necessitating transplantation, neurological symptoms, long-term sequelae, and death, highlight the need to determine the pathogenesis of this condition. Hypotheses on the aetiology include adenovirus and SARS-CoV-2 infections and an aberrant immune response to multiple pathogen exposure following lifting of lockdown measures but further investigation is required to reach an informed consensus. METHODS A literature search was performed on MEDLINE and EMBASE in accordance with PRISMA guidelines for systematic reviews. Primary studies reporting data on severe acute hepatitis of unknown aetiology in children from the COVID-19 era were selected for inclusion in our review. Data on patient demographics, clinical presentation and outcomes, and diagnostic testing for coinfection were extracted. Meta-analysis used a random-effects model. RESULTS The 33 included studies (30 case series and 3 case-control studies) described a total of 3636 cases of SAHUA (reported 1 January, 2019-31 December, 2022), with a median age of 3.5 years. Of these, 214 children (5.9%) received a liver transplant and 66 (1.8%) died. Whilst data on diagnostic testing was incomplete, the most frequently detected coinfections were with adenovirus and/or adeno-associated virus 2 (AAV2). Other common childhood respiratory and enteric pathogens, such as enterovirus, rhinovirus, and herpesviruses (EBV and HHV-6), were also identified. CONCLUSION Coinfection with AAV2 and other common childhood pathogens may predispose children to develop this novel severe hepatitis. Altered susceptibility and response to such pathogens may be a consequence of immunological naivety following pandemic restrictions. Further investigations are needed to generate high-quality evidence on aetiology for different patient demographics and geographical areas.
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Affiliation(s)
- Julie Phan
- The Australian Paediatric Surveillance Unit [APSU], The Kids Research Institute, The Children's Hospital, Westmead, Westmead, New South Wales, Australia
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit [APSU], The Kids Research Institute, The Children's Hospital, Westmead, Westmead, New South Wales, Australia.
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit [APSU], The Kids Research Institute, The Children's Hospital, Westmead, Westmead, New South Wales, Australia
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Nieva C, Pryor J, Williams GM, Hoedt EC, Burns GL, Eslick GD, Talley NJ, Duncanson K, Keely S. The Impact of Dietary Interventions on the Microbiota in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis 2023:jjad204. [PMID: 38102104 DOI: 10.1093/ecco-jcc/jjad204] [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: 08/22/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND AIMS Diet plays an integral role in the modulation of the intestinal environment, with the potential to be modified for management of individuals with inflammatory bowel disease (IBD). It has been hypothesised that poor "Western-style" dietary patterns select for a microbiota that drives IBD inflammation and that through dietary intervention, a healthy microbiota may be restored. This study aimed to systematically review the literature and assess current available evidence regarding the influence of diet on the intestinal microbiota composition in IBD patients and how this may affect disease activity. METHODS MEDLINE, EMBASE, Scopus, Web of Science and Cochrane Library were searched from January 2013 to June 2023, to identify studies investigating diet and microbiota in IBD. RESULTS Thirteen primary studies met the inclusion criteria and were selected for narrative synthesis. Reported associations between diet and microbiota in IBD were conflicting due to the considerable degree of heterogeneity between studies. Nine intervention studies trialled specific diets and did not demonstrate significant shifts in the diversity and abundance of intestinal microbial communities or improvement in disease outcomes, whilst the remaining four cross-sectional studies did not find a specific microbial signature associated with habitual dietary patterns in IBD patients. CONCLUSIONS Diet modulates the gut microbiota, and this may have implications for IBD; however, the body of evidence does not currently support clear dietary patterns or food constituents that are associated with a specific microbiota profile or disease marker in IBD patients. Further research is required with a focus on robust and consistent methodology to achieve improved identification of associations.
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Affiliation(s)
- Cheenie Nieva
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jennifer Pryor
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Georgina M Williams
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Emily C Hoedt
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Grace L Burns
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Guy D Eslick
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Nicholas J Talley
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kerith Duncanson
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Simon Keely
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Vijayan K, Eslick GD. A meta-analysis of the risk of salivary gland tumors associated with mobile phone use: the importance of correct exposure assessment. Rev Environ Health 2023; 38:591-599. [PMID: 35822706 DOI: 10.1515/reveh-2022-0055] [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] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To investigate the risk of developing salivary gland tumors associated with the use of mobile phones. CONTENT There have been a number of epidemiological studies conducted to assess for a possible association between mobile phone usage and the development of intracranial tumours, however results have been conflicting. We conducted an extensive literature search across four different databases was conducted. After selecting the articles relevant to the area of study, a total of seven studies were included in this meta-analysis, with no restrictions set on publication date or language. Studies were qualitatively assessed using the Newcastle-Ottawa scale. No significant association between the use of mobile phones and salivary gland tumors was observed (OR=1.06, 95% CI=0.86-1.32). No evidence for publication bias was detected. SUMMARY AND OUTLOOK Our findings indicate no significant association between mobile phone usage and salivary gland tumours. However, there were many limitations encountered in these studies, suggesting that the observed result may not be an accurate estimate of the true carcinogenic risk of mobile phones, especially for heavy long-term users. In fact, the studies included in this meta-analysis highlight the need to correctly define exposure assessment in order to ascertain the risk of a certain variable.
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Affiliation(s)
| | - Guy D Eslick
- Westmead Clinical School, Westmead, NSW 2145, Australia
- Clinical Links Using Evidence-based Data (CLUED Pty Ltd), Sydney, Australia
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8
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Anees A, Ayeni FE, Eslick GD, Edirimanne S. TSH receptor autoantibody levels post-total thyroidectomy in Graves' ophthalmopathy: a meta-analysis. Langenbecks Arch Surg 2023; 408:415. [PMID: 37870639 PMCID: PMC10593610 DOI: 10.1007/s00423-023-03153-3] [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: 01/20/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND TSH receptor autoantibodies (TRAbs) are pathognomonic for Graves' disease and are thought to also underly the pathogenesis of Graves' ophthalmopathy (GO). A decline in TRAb levels has been documented post-total thyroidectomy (TTx) in GO, however with conflicting correlations with disease outcomes. The aim of the study was to compare the effectiveness of TTx to other treatment modalities of Graves' disease and examine whether the lowering of TRAbs is associated with GO improvements. METHOD We searched electronic databases including Medline, Embase, Scopus, and Web of Science until 31 September 2022 using a broad range of keywords. Patients with GO undergoing TTx with measurements of both TRAbs and progression of the disease using a validated GO scoring system were included. Fourteen studies encompassing data from 1047 patients with GO met our eligibility criteria. The PRISMA guidelines were followed, and five studies had comparable data that were suitable for a meta-analysis. RESULTS The Cochrane Risk of Bias tool for RCTs showed low risk of bias across most domains. The pooled odds ratio showed that more patients significantly had normalized TRAb levels post-TTx as compared to other interventions (OR: 1.36, 95% CI: 1.02-1.81, p = 0.035). But, there was no significant difference in GO improvement post-TTx as compared with other intervention groups. CONCLUSIONS This meta-analysis shows that TRAb levels may decline largely post-TTx, but may not predict added improvements to the progression of GO. Thus, future studies with uniform designs are required to assess the minimal significant GO improvements.
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Affiliation(s)
- Arsalan Anees
- Department of Surgery, Nepean Hospital, Penrith, 2750, Australia
| | - Femi E Ayeni
- Department of Surgery, Nepean Hospital, Penrith, 2750, Australia.
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby St, Penrith, NSW, 2750, Australia.
| | - Guy D Eslick
- Sydney Medical School, The University of Sydney, Sydney, Australia
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Teutsch SM, Nunez CA, Morris A, Eslick GD, Elliott EJ. Erratum to Commun Dis Intell (2018) 2023;47. (https://doi.org/10.33321/cdi.2023.47.46). Commun Dis Intell (2018) 2023; 47. [PMID: 37857553 DOI: 10.33321/cdi.2023.47.64] [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] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Indexed: 10/21/2023]
Abstract
The text within this report, as originally published, incorrectly stated that the two included cases of dengue had not recently travelled to a dengue-endemic country. A reexamination of the case data has shown that both cases had recently travelled to a country where dengue is endemic. The paragraph below provides the corrected text for the dengue case descriptions, and replaces the paragraph at the foot of the right-hand column of text on page 10 of the published report. In 2022, two cases of dengue were notified to the APSU, one confirmed and one probable (Table 1), and the incidence estimate for the surveillance period (1 February - 31 December 2022) is shown in Table 2. Neither child had a prior history of dengue; however, both had recently travelled to an endemic country. One had DENV2 serotype and the serotype was not recorded for the second child. Both children were hospitalised and symptoms included fever, rash, cough, severe abdominal pain, diarrhoea, fatigue, retro-orbital pain and myalgia/arthralagia joint pains. One child had respiratory co-infection with human metapneumovirus. Both children received supportive therapies (intravenous fluids, pain relief) and one child received ceftriaxone. On discharge, one child had ongoing problems including arthralgia, fatigue, thrombocytopaenia and hepatitis.
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Affiliation(s)
- Suzy M Teutsch
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia.
| | - Carlos A Nunez
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Anne Morris
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
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Eslick GD, Teutsch SM, Elliott EJ. Japanese encephalitis virus: changing the clinical landscape of encephalitis in Australia. Med J Aust 2023; 219:393. [PMID: 37640507 DOI: 10.5694/mja2.52090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Guy D Eslick
- University of Sydney, Sydney, NSW
- Australian Paediatric Surveillance Unit, Children's Hospital at Westmead, Sydney, NSW
| | - Suzy M Teutsch
- University of Sydney, Sydney, NSW
- Australian Paediatric Surveillance Unit, Children's Hospital at Westmead, Sydney, NSW
| | - Elizabeth J Elliott
- University of Sydney, Sydney, NSW
- Australian Paediatric Surveillance Unit, Children's Hospital at Westmead, Sydney, NSW
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Eslick GD, Fan K, Nair PM, Burns GL, Hoedt EC, Keely S, Talley NJ. Clinical and Pathologic Factors Associated With Colonic Spirochete (Brachyspira pilosicoli and Brachyspira aalborgi) Infection: A Comprehensive Systematic Review and Pooled Analysis. Am J Clin Pathol 2023; 160:335-340. [PMID: 37289435 PMCID: PMC10682506 DOI: 10.1093/ajcp/aqad063] [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: 02/21/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES This study aims to determine what pathologic and clinical factors differentiate Brachyspira species that may be useful to clinicians and pathologists. METHODS We identified 21 studies of Brachyspira infection with individual patient information (n = 113) and conducted a pooled analysis comparing each species. RESULTS There were differences in the pathologic and clinical profiles of each Brachyspira species. Patients infected with Brachyspira pilosicoli infection were more likely to have diarrhea, fever, HIV, and immunocompromised conditions. Those patients infected with Brachyspira aalborgi were more likely to have lamina propria inflammation. CONCLUSIONS Our novel data provide potential insights into the pathogenic mechanism(s) and the specific risk factor profile of Brachyspira species. This may be clinically useful when assessing and managing patients.
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Affiliation(s)
- Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Kening Fan
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Prema M Nair
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Grace L Burns
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Emily C Hoedt
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Simon Keely
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Nicholas J Talley
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
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Starcevic V, Eslick GD, Viswasam K, Billieux J, Gainsbury SM, King DL, Berle D. Problematic online behaviors and psychopathology in Australia. Psychiatry Res 2023; 327:115405. [PMID: 37557057 DOI: 10.1016/j.psychres.2023.115405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023]
Abstract
This study aimed to ascertain frequency rates and predictors of six problematic online behaviors (POBs) in an Australian sample. Participants (N = 1626) completed instruments measuring problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, problematic online gambling, anxiety, depression and attention deficit/hyperactivity disorder (ADHD). Each POB was presumed to be present based on the cut-off score on the corresponding instrument and at least one indicator of interference with functioning. Generalized linear model analyses were used to determine socio-demographic and psychopathological predictors of each POB. The most common POB was problematic online shopping (12.2%), followed by problematic online gambling (11.4%), problematic use of social networking sites (6.0%), problematic cybersex (5.3%), problematic online gaming (5.2%) and cyberchondria (4.6%). Age group 27-36 had the highest rates of POBs. The intensity of ADHD symptoms predicted all POBs, whereas younger age predicted all POBs except for problematic cybersex and online gambling. Female gender predicted lower scores on the measures of problematic online gaming and cybersex. These findings have implications for age- and gender-adapted education, prevention and treatment efforts and suggest that specific POBs should be investigated separately instead of lumping them together under the umbrella terms such as "Internet addiction".
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Affiliation(s)
- Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Specialty of Psychiatry, University of Sydney, Sydney, NSW, Australia; Nepean Hospital, Department of Psychiatry, PO Box 63, Penrith, NSW 2751, Australia.
| | - Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Kirupamani Viswasam
- Nepean Hospital, Department of Psychiatry, PO Box 63, Penrith, NSW 2751, Australia
| | - Joël Billieux
- Institute of Psychology, University of Lausanne (UNIL), Lausanne, Switzerland; Centre for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
| | - Sally M Gainsbury
- Faculty of Science, School of Psychology, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Daniel L King
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - David Berle
- School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia; Graduate School of Health, University of Technology Sydney, NSW, Australia
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13
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Teutsch SM, Nunez CA, Morris A, Eslick GD, Elliott EJ. Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2022. Commun Dis Intell (2018) 2023; 47. [PMID: 37817313 DOI: 10.33321/cdi.2023.47.46] [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] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 10/12/2023]
Abstract
For 30 years the Australian Paediatric Surveillance Unit (APSU) has conducted national surveillance of rare communicable diseases and rare complications of communicable diseases. In this report, we describe the results of thirteen such studies surveyed by the APSU in 2022, including reported case numbers and incidence estimates, demographics, clinical features, management and short-term outcomes. Conditions described are: acute flaccid paralysis (AFP); congenital cytomegalovirus (cCMV); neonatal and infant herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV) and paediatric HIV infection; severe complications of influenza; juvenile-onset recurrent respiratory papillomatosis (JoRRP); congenital rubella infection/syndrome; congenital varicella syndrome (CVS) and neonatal varicella infection (NVI); and the new conditions dengue; Q fever; and severe acute hepatitis. In 2022, cases of severe complications of influenza were reported to the APSU for the first time since 2019. This likely reflects the easing of government-mandated restrictions imposed in 2020-2021 to curb the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the re-emergence of a range of infectious diseases. As previously, AFP surveillance by the APSU contributed to Australia achieving a minimum target incidence of one AFP case per 105 children aged less than 15 years. Cases of JoRRP and NVI were reported in 2022. This indicates potential gaps in human papillomavirus (HPV) and varicella vaccination coverage respectively, especially in high-risk groups such as young migrant and refugee women of childbearing age from countries without universal vaccination programs. Paediatric HIV case numbers resulting from mother-to-child-transmission (MTCT) of HIV remain low in Australia due to use of effective intervention strategies. However, there has been an increase in the number of imported cases of HIV in children (mainly perinatally-acquired) from countries with a high HIV prevalence. Without effective vaccines, there has been no decline in the incidence of congenital CMV and neonatal HSV, indicating the importance of early identification and management to reduce morbidity and mortality. The first cases of dengue, Q fever and severe acute hepatitis were received by APSU in 2022, including two cases of acute hepatitis in which aetiology has not been confirmed to date. The APSU has an important ongoing role in monitoring rare childhood infections.
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Affiliation(s)
- Suzy M Teutsch
- The Australian Paediatric Surveillance Unit;The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia.
| | - Carlos A Nunez
- The Australian Paediatric Surveillance Unit;The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Anne Morris
- The Australian Paediatric Surveillance Unit;The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit;The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia; Director of the Australian Paediatric Surveillance Unit
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Cameron R, Walker MM, Jones M, Eslick GD, Keely S, Pockney P, Cosentino CC, Talley NJ. Increased mucosal eosinophils in colonic diverticulosis and diverticular disease. J Gastroenterol Hepatol 2023; 38:1355-1364. [PMID: 37415341 PMCID: PMC10946982 DOI: 10.1111/jgh.16278] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
AIMS Eosinophils contribute to tissue homeostasis, damage, and repair. The mucosa of colonic diverticula has not been evaluated for eosinophils by quantitative histology. We aimed to investigate whether mucosal eosinophils and other immune cells are increased in colonic diverticula. METHODS Hematoxylin and eosin stained sections from colonic surgical resections (n = 82) containing diverticula were examined. Eosinophils, neutrophils, and lymphocytes, in five high power fields in the lamina propria were counted at the base, neck, and ostia of the diverticulum and counts compared to non-diverticula mucosa. The cohort was further subgrouped by elective and emergency surgical indications. RESULTS Following an initial review of 10 surgical resections from patients with diverticulosis, a total of 82 patients with colonic resections containing diverticula from the descending colon were evaluated (median age 71.5, 42 M/40F). Eosinophil counts for the entire cohort were increased in the base and neck (median 99 and 42, both P = <0.001) compared with the control location (median 16). Eosinophil counts remained significantly increased in the diverticula base (both P = <0.001) and neck (P = 0.01 and <0.001, respectively) in both elective and emergency cases. Lymphocytes were also significantly increased at the diverticula base compared to controls in both elective and emergency subgroups. CONCLUSION Eosinophils are significantly and most strikingly increased within the diverticulum in resected colonic diverticula. While these observations are novel, the role of eosinophil and chronic inflammation is as yet unclear in the pathophysiology of colonic diverticulosis and diverticular disease.
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Affiliation(s)
- Raquel Cameron
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Marjorie M. Walker
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
| | - Michael Jones
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Department of PsychologyMacquarie UniversityNorth RydeAustralia
| | - Guy D. Eslick
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Simon Keely
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Peter Pockney
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | | | - Nicholas J. Talley
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
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15
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Cameron R, Duncanson K, Hoedt EC, Eslick GD, Burns GL, Nieva C, Keely S, Walker MM, Talley NJ. Does the microbiome play a role in the pathogenesis of colonic diverticular disease? A systematic review. J Gastroenterol Hepatol 2023; 38:1028-1039. [PMID: 36775316 PMCID: PMC10946483 DOI: 10.1111/jgh.16142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/10/2023] [Accepted: 02/03/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND AIMS The role of the microbiota in diverticulosis and diverticular disease is underexplored. This systematic review aimed to assess all literature pertaining to the microbiota and metabolome associations in asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease (SUDD), and diverticulitis pathophysiology. METHODS Seven databases were searched for relevant studies published up to September 28, 2022. Data were screened in Covidence and extracted to Excel. Critical appraisal was undertaken using the Newcastle Ottawa Scale for case/control studies. RESULTS Of the 413 papers screened by title and abstract, 48 full-text papers were reviewed in detail with 12 studies meeting the inclusion criteria. Overall, alpha and beta diversity were unchanged in diverticulosis; however, significant changes in alpha diversity were evident in diverticulitis. A similar Bacteroidetes to Firmicutes ratio compared with controls was reported across studies. The genus-level comparisons showed no relationship with diverticular disease. Butyrate-producing microbial species were decreased in abundance, suggesting a possible contribution to the pathogenesis of diverticular disease. Comamonas species was significantly increased in asymptomatic diverticulosis patients who later developed diverticulitis. Metabolome analysis reported significant differences in diverticulosis and SUDD, with upregulated uracil being the most consistent outcome in both. No significant differences were reported in the mycobiome. CONCLUSION Overall, there is no convincing evidence of microbial dysbiosis in colonic diverticula to suggest that the microbiota contributes to the pathogenesis of asymptomatic diverticulosis, SUDD, or diverticular disease. Future research investigating microbiota involvement in colonic diverticula should consider an investigation of mucosa-associated microbial changes within the colonic diverticulum itself.
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Affiliation(s)
- Raquel Cameron
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Emily C Hoedt
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Grace L Burns
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Cheenie Nieva
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Marjorie M Walker
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Nicholas J Talley
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
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16
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Crane H, Eslick GD, George J. Letter: for improved prognostic value, use MAFLD. Aliment Pharmacol Ther 2023; 58:147-148. [PMID: 37307558 DOI: 10.1111/apt.17558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/07/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Harry Crane
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, New South Wales, Australia
| | - Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive Diseases, Hunter Medical Research Institute (HMRI), The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, New South Wales, Australia
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17
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Zand Irani M, Eslick GD, Brown G, Talley NJ. Letter: eosinophilic duodenitis and increased intraepithelial lymphocytes in rumination syndrome - more evidence. Aliment Pharmacol Ther 2023; 57:1353-1354. [PMID: 37161636 DOI: 10.1111/apt.17481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Mudar Zand Irani
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute (HMRI), The University of Newcastle, Callaghan, New South Wales, Australia
| | - Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute (HMRI), The University of Newcastle, Callaghan, New South Wales, Australia
| | - Georgia Brown
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute (HMRI), The University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicholas J Talley
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute (HMRI), The University of Newcastle, Callaghan, New South Wales, Australia
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18
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Yu J, Kaur R, Ayeni FE, Eslick GD, Edirimanne S. Cardiovascular Outcomes of Differentiated Thyroid Cancer Patients on Long Term TSH Suppression: A Systematic Review and Meta-Analysis. Horm Metab Res 2023; 55:379-387. [PMID: 37295414 DOI: 10.1055/a-2084-3408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We performed a systematic review and meta-analysis of the literature regarding cardiovascular outcomes of differentiated thyroid cancer (DTC) patients who are on long term thyroid stimulating hormone suppression. Searches were carried out using Prisma guidelines in Medline, Embase, CENTRAL, CINAHL and Scopus databases. Eligible papers were those which investigated discrete cardiovascular clinical outcomes in TSH suppressed patients and meta-analysis of selected studies was performed using Revman 5.4.1. We found a total of 195 879 DTC patients with median length to follow up of 8.6 years (range 5-18.8 years). Analysis showed DTC patients to be at higher risk of atrial fibrillation (HR 1.58, 95% CI 1.40, 1.77), stroke (HR 1.14, 95% CI 1.09, 1.20) and all-cause mortality (HR 2.04, 95% CI 1.02, 4.07). However, there was no difference in risk of heart failure, ischemic heart disease or cardiovascular mortality. These findings suggest that degree of TSH suppression must be titrated to accommodate risk of cancer recurrence and cardiovascular morbidity.
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Affiliation(s)
- Jerry Yu
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Rajneesh Kaur
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Femi Emmanuel Ayeni
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, Sydney, Australia
| | - Guy D Eslick
- Sydney Medical School, The University of Sydney, Sydney, Australia
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19
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Eslick GD. Letter to the editor regarding could atmospheric temperature impact on adequate colon cleansing for colonoscopy? An observational, single-institution study. Int J Colorectal Dis 2023; 38:153. [PMID: 37258748 DOI: 10.1007/s00384-023-04458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Guy D Eslick
- Clinical Links Using Evidence-based Data (CLUED) Pty Ltd., Sydney, NSW, Australia.
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20
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Mishra G, Majeed A, Dev A, Eslick GD, Pinato DJ, Izumoto H, Hiraoka A, Huo TI, Liu PH, Johnson PJ, Roberts SK. Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis. J Gastrointest Cancer 2023; 54:420-432. [PMID: 35635637 DOI: 10.1007/s12029-022-00832-0] [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] [Accepted: 04/22/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Hepatic function is a key prognostic marker in patients with hepatocellular cancer (HCC) and central to patient selection for transarterial chemoembolization (TACE). We investigated the clinical utility of the Albumin-Bilirubin (ALBI) grade, an emerging prognostic model, in this heterogenous cohort via a meta-analysis of published studies. METHODS Publications including full text articles and abstracts regarding ALBI grade were sourced by two independent researchers from databases including PubMed, Embase, Medline and Cochrane Library. Studies analysing patients with HCC undergoing TACE treatment were systematically screened utilising the PRISMA tool for data extraction and synthesis, after exclusion of duplicates, irrelevant studies and overlapping cohorts. The primary outcome was overall survival (OS), as determined by ALBI grade and assessed by hazard ratio (HRs) with 95% confidence intervals (CIs), with analysis of collated data using comprehensive meta-analysis, version 3.0 software. RESULTS Eight studies were included, with a pooled population of 6538 patients with HCC that underwent TACE treatment. Higher pre-treatment grade was associated with poor OS, with median OS of 12.0 months (P < 0.001) in ALBI grade 3, compared to 33.5 months in ALBI grade 1 (P < 0.001). Significant heterogeneity within each ALBI grade was associated with age and tumour size (P < 0.001) in ALBI grades 1 and 2. In contrast, age and alcohol-related liver disease were significant in the ALBI grade 3 group (P < 0.001). CONCLUSIONS High pre-treatment ALBI grade is associated with poorer prognosis in patients with HCC undergoing TACE therapy. The ALBI grade demonstrates clinical utility for clinical prognostication and patient selection for TACE.
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Affiliation(s)
- Gauri Mishra
- Gastroenterology Department, Monash Medical Centre, Melbourne, Australia.
- School of Clinical Sciences, Monash University, Melbourne, Australia.
| | - Ammar Majeed
- School of Clinical Sciences, Monash University, Melbourne, Australia
- Gastroenterology Department, Alfred Health, Melbourne, Australia
| | - Anouk Dev
- Gastroenterology Department, Monash Medical Centre, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Sydney, Australia
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Atsushi Hiraoka
- Gastroenterology Centre, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Teh-Ia Huo
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Po-Hong Liu
- Internal Medicine, University of Texas Southwestern Medical Centre, Dallas, Texas, USA
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Stuart K Roberts
- School of Clinical Sciences, Monash University, Melbourne, Australia
- Gastroenterology Department, Alfred Health, Melbourne, Australia
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21
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Chithiramohan T, Eslick GD. Association Between Maternal Postnatal Depression and Offspring Anxiety and Depression in Adolescence and Young Adulthood: A Meta-Analysis. J Dev Behav Pediatr 2023; 44:e231-e238. [PMID: 36978235 DOI: 10.1097/dbp.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/29/2022] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Postnatal depression (PND) is common, with an incidence of 10% to 20% in new mothers. Studies have identified an association between maternal PND and adverse childhood effects. Fewer studies have explored the risk of psychiatric disorders in adolescence and adulthood. METHODS MEDLINE, PubMed, PsycINFO, Embase, and EmCare were searched. Studies evaluating the association between maternal PND and offspring anxiety or depression in adolescence or adulthood were included. Five prospective cohort studies met the inclusion criteria. The odds ratios were pooled using a random effects model, and heterogeneity and publication bias were assessed. RESULTS Anxiety: The 4 relevant studies were composed of 273 mothers with PND and 916 controls, followed up for 12 to 23 years. The pooled odds ratio (OR) was 2.19 (1.33-3.61), p = 0.002, with no heterogeneity (I2 = 0.00, p = 0.49). Depression: The 5 studies were composed of 937 mothers with PND and 3099 controls, followed up from 12 to 23 years. The pooled OR was 1.92 (1.08-3.42), p = 0.026, with heterogeneity (I2 = 62.89, p = 0.03). CONCLUSION Offspring of mothers with PND are twice as likely to suffer from anxiety and almost twice as likely to suffer from depression than those without exposure. This evidence heightens the importance of detection and treatment of postnatal depression. Furthermore, early assessment and support could be provided to the high-risk group of offspring.
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Affiliation(s)
| | - Guy D Eslick
- The Australian Pediatric Surveillance Unit (APSU), Children's Hospital Westmead, The University of Sydney, Sydney, New South Wales, Australia
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Nunez C, Eslick GD, Elliott EJ. Toppling television injuries in children and adolescents: a systematic review and meta-analysis. Inj Prev 2023; 29:195-199. [PMID: 36690352 DOI: 10.1136/ip-2022-044773] [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: 09/23/2022] [Accepted: 11/18/2022] [Indexed: 01/24/2023]
Abstract
CONTEXT Toppling televisions (TVs) are a source of childhood injury but meta-analysis has not assessed the likelihood of TV injuries in children. OBJECTIVE To present pooled results for injuries, following a systematic review. DATA SOURCES MEDLINE, Scopus, Google Scholar and EMBASE databases were searched to 5 December 2022. STUDY SELECTION Included studies met the following criteria: (1) assessed toppling TV injuries in paediatric populations; (2) reported point estimates as an OR or enabled its calculation and (3) used a comparison group. DATA EXTRACTION A standardised form was used to include information on publication year, study design, population type, country, sample size, mean age, risk factors, point estimates or data used to calculate ORs. RESULTS A total of 12 803 TV injuries were identified (five studies). Head and neck injuries (OR: 2.13, 95% CI: 1.21 to 3.75) and hospital admission (OR: 2.28, 95% CI: 1.80 to 2.90) were more likely in children aged under 6 years than over 6 years. Conversely, torso injuries were less likely in younger children (OR: 0.60, 95% CI: 0.51 to 0.70). Children under 6 were two and a half times more likely to die or be admitted to an intensive care unit (ICU) as a result of toppling TVs, although this was not statistically significant. Males did not sustain more TV injuries than females. CONCLUSIONS Children aged under 6 years are more likely to die, sustain head injuries and require hospital treatment from toppling TVs. Strategies for injury prevention must go beyond warning labels to include community education, promotion and use of tip restraint devices, mandatory safety standards and a commitment from manufacturers to improve TV sets stability.
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Affiliation(s)
- Carlos Nunez
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
- Kid's Research, Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia
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23
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Walker J, Teutsch S, Morris A, Eslick GD, Hassan Al Imam M, Khan A, Booy R, Elliott EJ, Khandaker G. Active prospective national surveillance for congenital and neonatal varicella in Australia shows potential prevention opportunities. Vaccine X 2023; 13:100278. [PMID: 36874633 PMCID: PMC9978842 DOI: 10.1016/j.jvacx.2023.100278] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
To compare the incidence and outcomes of congenital and neonatal varicella in Australia in the pre-vaccination (1995-1997) and post-vaccination era (after 2005 to November 2020), active prospective national surveillance for congenital varicella syndrome (CVS) and neonatal varicella infection (NVI) was conducted through the Australian Paediatric Surveillance Unit (APSU). Compared with 1995-1997, there was a 91.5% reduction in the incidence of CVS and a 91.3% reduction in the incidence of NVI in 2009-2020. However, almost half of the mothers in 2009-2020 were born overseas and came from countries without a vaccination program. Although there has been a substantial and sustained decrease in the reported incidence of CVS and NVI in Australia since 2006, congenital and neonatal varicella infections persist. Thus, there is an opportunity for targeted screening of varicella in young migrant, asylum seeker and refugee women at risk of varicella infection and prioritisation for vaccination to prevent CVS and NVI.
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Affiliation(s)
- Jacina Walker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Suzy Teutsch
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia
| | - Anne Morris
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Guy D Eslick
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia
| | - Mahmudul Hassan Al Imam
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Arifuzzaman Khan
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Robert Booy
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,School Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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24
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Cook P, Yin G, Ayeni FE, Eslick GD, Edirimanne S. Does Immediate Breast Reconstruction Lead to a Delay in Adjuvant Chemotherapy for Breast Cancer? A Meta-Analysis and Systematic Review. Clin Breast Cancer 2023:S1526-8209(23)00083-6. [PMID: 37127453 DOI: 10.1016/j.clbc.2023.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/01/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Timely delivery of adjuvant chemotherapy is crucial. With an increasing frequency of immediate breast reconstructions (IBR) following mastectomy (MAS), concerns have arisen regarding its complication rates and effects on time to chemotherapy. The aim was to conduct a systematic review and meta-analysis to determine if there is a prolonged time to chemotherapy (TTC) after IBR and MAS. Electronic databases, reference lists and relevant articles were searched systematically. Eligibility criteria included women receiving adjuvant chemotherapy who underwent either MAS only or MAS and IBR. Random-effects models were used in the analysis. A total of 29 studies were included in qualitative analysis, comprising of 156,000 patients (IBR: 57,159; MAS: 98,841). But 23 studies had sufficient data to be included in the meta-analysis. Sixteen papers concluded there was no difference in TTC compared to MAS. There was a difference of 3.50 days between TTC in IBR versus MAS (95% CI [0.42, 6.57], P value = .0256; IBR = 43.56 days, MAS = 40.38 days). The rate of patients being delayed past 90 days was not significantly higher in IBR (OR = 1.34, 95% CI [0.76, 2.38], P = .310). IBR patients were more likely to have complications compared to the MAS group (OR = 2.04, 95% CI [1.04-4.01], P < .01). We concluded that there is a statistically significant longer time to chemotherapy following IBR of 3.50 days, yet there is no difference in delays past 90 days. Therefore, the longer TTC in IBR is unlikely to be of any clinical significance.
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25
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Eslick GD, Nunez C, Elliott EJ. Severe and traumatic injuries associated with home trampoline use in children and adolescents: A systematic review. Acad Emerg Med 2023; 30:209-213. [PMID: 36070198 DOI: 10.1111/acem.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Guy D Eslick
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carlos Nunez
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
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26
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Teutsch S, Zurynski Y, Eslick GD, Deverell M, Christodoulou J, Leonard H, Dalkeith T, Johnson SLJ, Elliott EJ. Australian children living with rare diseases: health service use and barriers to accessing care. World J Pediatr 2023:10.1007/s12519-022-00675-6. [PMID: 36653598 PMCID: PMC9848027 DOI: 10.1007/s12519-022-00675-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Children with rare diseases experience challenges at home and school and frequently require multi-disciplinary healthcare. We aimed to determine health service utilization by Australian children with rare diseases and barriers to accessing healthcare. METHODS Parents completed an online survey on health professional and emergency department (ED) presentations, hospitalization, and barriers to accessing services. Potential barriers to service access included residential location (city, regional, remote) and child health-related functioning, determined using a validated, parent-completed measure-of-function tool. RESULTS Parents of 462 children with over 240 rare diseases completed the survey. Compared with the general population, these children were more likely to be hospitalized [odds ratio (OR) = 17.25, 95% confidence interval (CI) = 15.50-19.20] and present to the ED (OR = 4.15, 95% CI = 3.68-4.68) or a family physician (OR = 4.14, 95% CI = 3.72-4.60). Child functional impairment was nil/mild (31%), moderate (48%) or severe (22%). Compared to children with nil/mild impairment, those with severe impairment were more likely to be hospitalized (OR = 13.39, 95% CI = 7.65-23.44) and present to the ED (OR = 11.16, 95% CI = 6.46-19.27). Most children (75%) lived in major cities, but children from regional (OR = 2.78, 95% CI = 1.72-4.55) and remote areas (OR = 9.09, 95% CI = 3.03-25.00) experienced significantly more barriers to healthcare access than children from major cities. Barriers included distance to travel, out-of-pocket costs, and lack of specialist medical and other health services. CONCLUSIONS Children with rare diseases, especially those with severe functional impairment have an enormous impact on health services, and better integrated multidisciplinary services with patient-centered care are needed. Access must be improved for children living in rural and remote settings.
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Affiliation(s)
- Suzy Teutsch
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia.
| | - Yvonne Zurynski
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Australian Institute of Health Innovation, Center for Healthcare Resilience and Implementation Science, and NHMRC Partnership Centre in Health System Sustainability, Macquarie University, Sydney, NSW, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Marie Deverell
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Government Department of Health Western Australia, Perth, WA, Australia
| | - John Christodoulou
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Murdoch Children's Research Institute and Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Troy Dalkeith
- Genetic Metabolic Disorders Service, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Sandra L J Johnson
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
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27
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Eslick GD, Eslick EG. The Paediatric Aussie Chocolate Poo Scale. Med J Aust 2022; 217:591-592. [PMID: 36478580 DOI: 10.5694/mja2.51779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Guy D Eslick
- Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW.,Clued (Clinical Links using Evidence-based Data), Sydney, NSW
| | - Eloise G Eslick
- Clued (Clinical Links using Evidence-based Data), Sydney, NSW
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28
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Ma Y, Zhao W, Sun P, Deng W, Deng J, Zong H, Wang J, Guo Y, Liu H, Cang S, Shang K, Chen X, Wang J, He D, Wu G, Zhang Z, Zhang L, Xu F, Tian C, Qiao C, Chen G, Zhang G, Ma T, Gao L, Zhang G, Liu J, Eslick GD, Almhanna K, Lino-Silva LS, Aprile G, Li N, Luo S. Apatinib in the treatment of gastric cancer in Henan Province: a multicenter prospective real-world observational study (Ahead-HAP01). Ann Transl Med 2022; 10:1372. [PMID: 36660622 PMCID: PMC9843423 DOI: 10.21037/atm-22-5995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023]
Abstract
Background Apatinib is approved in China for the treatment of advanced gastric adenocarcinoma that had progressed or relapsed after standard systemic chemotherapy treatments. However, the effectiveness of Apatinib under real-world condition has not been evaluated and the drug performance under ideal and controlled circumstances has not been validated. In fact, genetic factors, poor healthcare access, social economic status, comorbidities compliance and other factors play significant role in drug performance under "real-world" conditions. Real-world experience can help validate the safety and efficacy of apatinib. Methods In this observational, prospective study we evaluated the safety and efficacy of Apatinib in patient treated in China. Between March 2018 and March 2019, a total of 943 patients with gastric cancer treated with Apatinib were enrolled. Response Evaluation Criteria in Solid Tumors, version 1.1 and Common Terminology Criteria for Adverse Events, version 4.0 were used to evaluate efficacy and adverse effects. Results The median progression-free survival (PFS) was 5.65 months (5.22-6.05 months), and the median overall survival (OS) was 11.47 months (10.41-12.52 months). Apatinib in combination with more than two agents was superior to single agent apatinib in overall response rate (ORR) [18.18% vs. 9.43%, 95% confidence interval (CI): 1.03-5.90] and disease control rate (DCR) (82.82% vs. 77.87%, 95% CI: 1.21-2.59). Apatinib in combination with single agent chemotherapy was also superior to apatinib alone with DCR (86.29% vs. 77.87%, 95% CI: 1.47-2.99) irrespective of the dose (250 or 500 mg). In the patient cohort who received a starting dose of 250 mg, the DCRs of the combined treatment and monotherapy groups were 86.22% vs. 80.00% (95% CI: 1.18-3.09), respectively. The most common treatment-emergent adverse events were anemia, anorexia and thrombocytopenia (66.28%, 37.75%, 36.06%, respectively). Conclusions Efficacy of Apatinib in this observational study is promising and toxicities are manageable. Combination of Apatinib with chemotherapy agents has a higher response rate and better disease control at the expense of increased serious adverse events. Better OS can be achieved by receiving apatinib treatment earlier. As a supplement and further validation of explanatory randomized controlled trials, the real-world study reflects the real efficacy of apatinib in practical application.
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Affiliation(s)
- Yijie Ma
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Weijie Zhao
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Peichun Sun
- Department of Gastrointestinal Surgery, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Wenying Deng
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Junli Deng
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Hong Zong
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junsheng Wang
- Department of Medical Oncology, Anyang Cancer Hospital, Anyang, China
| | - Yanzhen Guo
- Department of Medical Oncology, The First Affiliated Hospital of Henan University of science and technology, Luoyang, China
| | - Huaimin Liu
- Integrated TCM & Western Medicine Department, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Shundong Cang
- Department of Medical Oncology, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Ke Shang
- Department of Medical Oncology, Xinyang Central Hospital, Xinyang, China
| | - Xiaobing Chen
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jin Wang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dezhi He
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Wu
- Department of general surgury, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Zhen Zhang
- Department of Medical Oncology, Nanyang First People’s Hospital, Nanyang, China
| | - Liguo Zhang
- Department of Medical Oncology, Xinxiang Central Hospital, Xinxiang, China
| | - Feng Xu
- Department of Internal Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chuntao Tian
- Department of Medical Oncology, Sanmenxia Central Hospital, Sanmenxia, China
| | - Chaofeng Qiao
- Department of general surgury, Jiaozuo Second People’s Hospital, Jiaozuo, China
| | - Gongbin Chen
- Department of Medical Oncology, Shangqiu First People’s Hospital, Shangqiu, China
| | - Guifang Zhang
- Department of Medical Oncology, Xinxiang Central Hospital, Xinxiang, China
| | - Tianjiang Ma
- Department of Medical Oncology, Luohe Central Hospital, Luohe, China
| | - Liwei Gao
- Department of Medical Oncology, Pingdingshan Coal General Hospital, Pinigdingshan, China
| | - Guozheng Zhang
- Department of Medical Oncology, Hebi People’s Hospital, Hebi, China
| | - Jing Liu
- Department of Medical Oncology, Hebi People’s Hospital, Hebi, China
| | - Guy D. Eslick
- The Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Khaldoun Almhanna
- Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA
| | - Leonardo S. Lino-Silva
- Department of Surgical Pathology, Oncology Center Tula’s General Hospital, Tula de Allende, Hidalgo, Mexico
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, AULSS8 Berica, Vicenza, Italy
| | - Ning Li
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Suxia Luo
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Teutsch SM, Nunez CA, Morris A, Eslick GD, Berkhout A, Novakovic D, Brotherton JM, McGregor S, Khawar L, Khandaker G, Booy R, Jones CA, Rawlinson W, Thorley BR, Elliott EJ. Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2021. Commun Dis Intell (2018) 2022; 46. [PMID: 36303401 DOI: 10.33321/cdi.2022.46.66] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Australian Paediatric Surveillance Unit (APSU) has been conducting surveillance of rare communicable and non-communicable conditions in children since its inception in 1993. In this report, the results are described of surveillance of ten communicable diseases (and complications) for 2021, including the numbers of cases and incidence estimates; demographics; clinical features; and management and short-term outcomes. The included diseases are: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV); neonatal herpes simplex virus (HSV) infection; paediatric human immunodeficiency virus (HIV) infection; perinatal exposure to HIV; severe complications from influenza; juvenile-onset respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. In 2021, cases of JoRRP were reported to the APSU for the first time since 2017, indicating potential gaps in HPV vaccination. AFP surveillance by APSU again contributed to Australia achieving a minimum target incidence of one AFP case per 100,000 children aged < 15 years. There were no cases of children with severe complications of influenza. No cases of varicella or congenital rubella were reported; however, at-risk populations, especially young migrant and refugee women from countries without universal vaccination programs, need to be screened and prioritised for vaccination prior to pregnancy. Cases of perinatal exposure to HIV continue to increase; however, the rate of mother-to-child-transmission remains at low levels due to the use of effective intervention strategies. Case numbers of congenital CMV and neonatal HSV remain steady in the absence of vaccines, prompting the need for greater awareness and education, with recent calls for target screening of at-risk infants for congenital CMV.
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Affiliation(s)
- Suzy M Teutsch
- The Australian Paediatric Surveillance Unit
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Carlos A Nunez
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
- The Australian Paediatric Surveillance Unit
| | - Anne Morris
- The Australian Paediatric Surveillance Unit
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Angela Berkhout
- Infection Management & Prevention Service, The Queensland Children's Hospital
- The University of Queensland, Faculty of Medicine, Brisbane, Queensland, AUSTRALIA
| | - Daniel Novakovic
- Dr Liang Voice Program, The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, New South Wales, AUSTRALIA
| | - Julia Ml Brotherton
- Australian Centre for the Prevention of Cervical Cancer
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, AUSTRALIA
| | - Skye McGregor
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales, AUSTRALIA
| | - Laila Khawar
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales, AUSTRALIA
| | - Gulam Khandaker
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, AUSTRALIA
| | - Robert Booy
- The University of Sydney, Faculty of Medicine and Health
- The National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, AUSTRALIA
| | - Cheryl A Jones
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, AUSTRALIA
| | - William Rawlinson
- Virology and OTDS Laboratories, NSW Health Pathology Randwick and UNSW Sydney, New South Wales, AUSTRALIA
| | - Bruce R Thorley
- National Enterovirus Reference Laboratory and WHO Polio Regional Reference Laboratory, Victorian Infectious Disease Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, AUSTRALIA
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
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El Jamaly H, Eslick GD, Weltman M. Meta-analysis: hepatitis B reactivation in patients receiving biological therapy. Aliment Pharmacol Ther 2022; 56:1104-1118. [PMID: 35975904 DOI: 10.1111/apt.17155] [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: 03/21/2022] [Revised: 04/12/2022] [Accepted: 07/11/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND The use of biologics poses a moderate to high risk for hepatitis B virus reactivation (HBVr) in chronic carriers. AIM To determine the prevalence of HBVr with TNF alpha inhibitors, ustekinumab and vedolizumab METHOD: We followed the MOOSE guidelines and conducted a comprehensive literature search. We conducted a systematic search of EMBASE (Ovid), MEDLINE (Ovid) and PubMed. The studies included patients who were chronic and occult HBV carriers with various rheumatological, dermatological or gastroenterological conditions. We used a random effects model using pooled estimates (prevalence of HBVr with 95% confidence intervals (CI)). RESULTS We included 29 studies with 1409 patients infected with HBV. The prevalence of HBVr in chronic carriers of HBV was 17.1% (95% CI: 7.0-35.9, n = 5), 16.6% (95% CI: 9.5-27.5%, n = 6), 40.5% (95% CI: 20.3-64.5%, n = 4) and 19.1% (95% CI: 7.3-41.2%, n = 2), respectively, for adalimumab, etanercept, infliximab and ustekinumab. The respective prevalence for reactivation in patients with occult HBV infection was 5.0% (95% CI: 2.8-8.7%, number of studies: n = 18), 2.6% (95% CI: 1.4-4.7%, n = 18), 4.4% (95% CI: 2.2-8.7%, n = 12) and 6.4% (95% CI: 2.2-16.8, n = 5). There were 39 HBVr (26 in chronic HBV and 13 in the occult group) without any hepatic failure or death. In the chronic HBVr group, only three of 24 patients received antiviral prophylaxis. CONCLUSIONS HBVr prevalence rates differ between the chronic carrier state and the occult carrier state. The uptake of prophylactic antiviral therapy in high-risk groups was low, contrary to clinical practice guidelines.
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Affiliation(s)
- Hydar El Jamaly
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, New South Wales, Australia.,Nepean Clinical School, The University of Sydney, Penrith, New South Wales, Australia
| | - Guy D Eslick
- The NHMRC Centre for Research Excellence for Digestive Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, New South Wales, Australia.,Nepean Clinical School, The University of Sydney, Penrith, New South Wales, Australia
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Tang MJ, Eslick GD, Lubel JS, Majeed A, Majumdar A, Kemp W, Roberts SK. Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma: A systematic review and meta-analysis. World J Meta-Anal 2022; 10:220-237. [DOI: 10.13105/wjma.v10.i4.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies to date comparing outcomes of microwave ablation (MWA) with radiofrequency ablation (RFA) on patients with hepatocellular carcinoma have yielded conflicting results, with no clear superiority of one technique over the other. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of MWA with RFA.
AIM To perform a systematic review and meta-analysis comparing the efficacy and safety of MWA with RFA.
METHODS A systematic literature search was performed using Ovid Medline, Embase, PubMed, Reference Citation Analysis, Cochrane Central and Cochrane Systematic Review databases, and Web of Science. Abstracts and full manuscripts were screened for inclusion utilising predefined inclusion and exclusion criteria comparing outcomes of MWA and RFA. A random-effects model was used for each outcome. Meta-regression analysis was performed to adjust for the difference in follow-up period between the studies. Primary outcome measures included complete ablation (CA) rate, local recurrence rate (LRR), survival [local recurrence-free survival (LRFS), overall survival (OS)] and adverse events.
RESULTS A total of 42 published studies [34 cohort and 8 randomised controlled trials (RCT)] with 6719 patients fulfilled the selection criteria. There was no significant difference in tumour size between the treatment groups. CA rates between MWA and RFA groups were similar in prospective cohort studies [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.28–3.23] and RCTs (OR 1.18, 95%CI 0.64–2.18). However, retrospective studies reported higher rates with MWA (OR 1.29, 95%CI 1.06–1.57). Retrospective cohort studies reported higher OS (OR 1.54, 95%CI 1.15–2.05 and lower LRR (OR 0.67, 95%CI 0.51–0.87). No difference in terms of LRFS or 30-d mortality was observed between both arms. MWA had an increased rate of adverse respiratory events when compared to RFA (OR 1.99, 95%CI 1.07–3.71, P = 0.03).
CONCLUSION MWA achieves similar CA rates and as good or better longer-term outcomes in relation to LRR and OS compared to RFA. Apart from an increased rate of respiratory events post procedure, MWA is as safe as RFA.
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Affiliation(s)
- Myo Jin Tang
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Monash Medical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Guy D Eslick
- Department of Statistics, Clued Pty Ltd, Sydney 2006, New South Wales, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Avik Majumdar
- Department of Gastroenterology, Austin Hospital, Heidelberg 3084, Victoria, Australia
- Department of Medicine, Austin Campus, University of Medicine, Melbourne 3084, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
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Baggio S, Starcevic V, Billieux J, King DL, Gainsbury SM, Eslick GD, Berle D. Testing the spectrum hypothesis of problematic online behaviors: A network analysis approach. Addict Behav 2022; 135:107451. [DOI: 10.1016/j.addbeh.2022.107451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/24/2022]
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Eslick IG, Reid K, Eslick GD, Reid C. Diagnosing a fracture using a smartphone during the COVID-19 pandemic. J Paediatr Child Health 2022; 58:1272-1273. [PMID: 35775717 DOI: 10.1111/jpc.16036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Isaac G Eslick
- Australian Paedaitric Surveillance Unit (APSU), The University of Sydney, Sydney Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Kal Reid
- Department of Emergency Medicine, Northern Beaches Hospital, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Australian Paedaitric Surveillance Unit (APSU), The University of Sydney, Sydney Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Cliff Reid
- Department of Emergency Medicine, Northern Beaches Hospital, Sydney, New South Wales, Australia
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Fan K, Eslick GD, Nair PM, Burns GL, Walker MM, Hoedt EC, Keely S, Talley NJ. Human intestinal spirochetosis, irritable bowel syndrome, and colonic polyps: A systematic review and meta-analysis. J Gastroenterol Hepatol 2022; 37:1222-1234. [PMID: 35385602 PMCID: PMC9545717 DOI: 10.1111/jgh.15851] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/24/2022] [Indexed: 12/09/2022]
Abstract
Human colonic spirochetosis (CS) is usually due toBrachyspira pilosicolior Brachyspira aalborgiinfection. While traditionally considered to be commensal bacteria, there are scattered case reports and case series of gastrointestinal (GI) symptoms in CS and reports of colonic polyps with adherent spirochetes. We performed a systematic review and meta-analysis investigating the association between CS and GI symptoms and conditions including the irritable bowel syndrome (IBS) and colonic polyps. Following PRISMA 2020 guidelines, a systematic search of Medline, CINAHL, EMBASE, and Web of Science was performed using specific keywords for CS and GI disease. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Of 75 studies identified in the search, 8 case-control studies met the inclusion criteria for meta-analysis and 67 case series studies met the inclusion criteria for pooled prevalence analysis. CS was significantly associated with diarrhea (n = 141/127, cases/controls, OR: 4.19, 95% CI: 1.72-10.21, P = 0.002) and abdominal pain (n = 64/65, OR: 3.66, 95% CI: 1.43-9.35, P = 0.007). CS cases were significantly more likely to have Rome III-diagnosed IBS (n = 79/48, OR: 3.84, 95% CI: 1.44-10.20, P = 0.007), but not colonic polyps (n = 127/843, OR: 8.78, 95% CI: 0.75-103.36, P = 0.084). In conclusion, we found evidence of associations between CS and both diarrhea and IBS, but not colonic polyps. CS is likely underestimated due to suboptimal diagnostic methods and may be an overlooked risk factor for a subset of IBS patients with diarrhea.
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Affiliation(s)
- Kening Fan
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Guy D Eslick
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Prema M Nair
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Grace L Burns
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Marjorie M Walker
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Emily C Hoedt
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Nicholas J Talley
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
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Nunez C, Eslick GD, Elliott EJ. Trampoline centre injuries in children and adolescents: a systematic review and meta-analysis. Inj Prev 2022; 28:440-445. [PMID: 35697515 DOI: 10.1136/injuryprev-2022-044530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/18/2022] [Accepted: 04/01/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT No evidence-based review has compared injury risks sustained on trampolines at home and in trampoline centres. OBJECTIVE To present pooled results for injury type, site and treatment from studies reporting injuries that occurred on trampolines at home and in trampoline centres. DATA SOURCES MEDLINE, Scopus, Google Scholar and Embase databases were searched to 31 December 2021. STUDY SELECTION Inclusion criteria: (1) assessment of trampoline injuries (home and trampoline centres); (2) children and adolescents; (3) the point estimate was reported as an odds ratio (OR); and (4) an internal comparison was used. DATA EXTRACTION Data were reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used to estimate effect. RESULTS There were 1 386 843 injuries (n=11 studies). There was an increased likelihood of musculoskeletal and/or orthopaedic injuries (OR 2.45, 95% CI 1.66 to 3.61, p<0.001), lower extremity injury (OR 2.81, 95% CI 1.99 to 3.97, p<0.001), sprains (OR 1.64, 95% CI 1.36 to 1.97, p<0.001) and a need for surgery (OR 1.89, 95% CI 1.37 to 2.60, p<0.001) at trampoline centres compared with home trampolines. Conversely, upper extremity injury (OR 0.49, 95% CI 0.25 to 0.95, p=0.03), concussion (OR 0.48, 95% CI 0.35 to 0.65, p<0.001) and lacerations (OR 0.46, 95% CI 0.35 to 0.59, p<0.001) were less likely to occur at trampoline centres than at home. CONCLUSIONS Children using trampoline centres are more likely to suffer severe trauma and require surgical intervention than children using home trampolines. Development and implementation of preventative strategies, public awareness, and mandatory safety standards are urgently required for trampoline centres.
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Affiliation(s)
- Carlos Nunez
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia .,The Australian Paediatric Surveillance Unit, The Sydney Children's Hospital Network (Westmead), Sydney, New South Wales, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Australian Paediatric Surveillance Unit, The Sydney Children's Hospital Network (Westmead), Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Australian Paediatric Surveillance Unit, The Sydney Children's Hospital Network (Westmead), Sydney, New South Wales, Australia
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El Jamaly H, Eslick GD, Weltman M. Primary biliary cholangitis in pregnancy: A systematic review with meta-analysis. Hepatobiliary Pancreat Dis Int 2022; 21:218-225. [PMID: 35361530 DOI: 10.1016/j.hbpd.2022.03.005] [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: 07/26/2021] [Accepted: 03/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The outcomes and disease associations in pregnant women with primary biliary cholangitis (PBC) have not been largely explored. This study aimed to determine the level of evidence associated with maternal and fetal outcomes and other disease associations in female patients with PBC. DATA SOURCES A comprehensive literature search was conducted. Maternal and fetal outcomes were obtained from patients with a previous, current or subsequent diagnosis of PBC. A random-effects model was employed, using odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Eleven studies, with 2179 female PBC patients were included. Pregnant women with PBC were significantly more likely to have a miscarriage (OR = 1.27, 95% CI: 1.02-1.58; P = 0.03), and a history of abortion (OR = 1.50, 95% CI: 1.09-2.07; P = 0.01), with absent heterogeneity (I2 = 0%). PBC pregnant women were significantly more likely to deliver via vaginal birth (OR = 1.69, 95% CI: 1.33-2.14; P < 0.001) with low level heterogeneity (I2 < 0.001%). Patients had a statistically significant increased likelihood of lifetime smoking (OR = 1.95, 95% CI: 1.17-3.23; P = 0.01). Egger's regression revealed no evidence of publication bias. CONCLUSIONS This meta-analysis provides pooled evidence that a PBC pregnancy is associated with fetal morbidity and maternal lifestyle associations that may influence pregnancy outcomes. More studies are needed to establish disease associations that may directly affect pregnancy outcomes. These data are essential for clinicians managing these patients before, during or after pregnancy.
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Affiliation(s)
- Hydar El Jamaly
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, New South Wales, Australia; Nepean Clinical School, The University of Sydney, Penrith, New South Wales, Australia.
| | - Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, New South Wales, Australia; Nepean Clinical School, The University of Sydney, Penrith, New South Wales, Australia
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Kolka CM, Webster J, Lepletier A, Winterford C, Brown I, Richards RS, Zelek WM, Cao Y, Khamis R, Shanmugasundaram KB, Wuethrich A, Trau M, Brosda S, Barbour A, Shah AK, Eslick GD, Clemons NJ, Morgan BP, Hill MM. C5b-9 Membrane Attack Complex Formation and Extracellular Vesicle Shedding in Barrett's Esophagus and Esophageal Adenocarcinoma. Front Immunol 2022; 13:842023. [PMID: 35345676 PMCID: PMC8957096 DOI: 10.3389/fimmu.2022.842023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
The early complement components have emerged as mediators of pro-oncogenic inflammation, classically inferred to cause terminal complement activation, but there are limited data on the activity of terminal complement in cancer. We previously reported elevated serum and tissue C9, the terminal complement component, in esophageal adenocarcinoma (EAC) compared to the precursor condition Barrett’s Esophagus (BE) and healthy controls. Here, we investigate the level and cellular fates of the terminal complement complex C5b-9, also known as the membrane attack complex. Punctate C5b-9 staining and diffuse C9 staining was detected in BE and EAC by multiplex immunohistofluorescence without corresponding increase of C9 mRNA transcript. Increased C9 and C5b-9 staining were observed in the sequence normal squamous epithelium, BE, low- and high-grade dysplasia, EAC. C5b-9 positive esophageal cells were morphologically intact, indicative of sublytic or complement-evasion mechanisms. To investigate this at a cellular level, we exposed non-dysplastic BE (BAR-T and CP-A), high-grade dysplastic BE (CP-B and CP-D) and EAC (FLO-1 and OE-33) cell lines to the same sublytic dose of immunopurified human C9 (3 µg/ml) in the presence of C9-depleted human serum. Cellular C5b-9 was visualized by immunofluorescence confocal microscopy. Shed C5b-9 in the form of extracellular vesicles (EV) was measured in collected conditioned medium using recently described microfluidic immunoassay with capture by a mixture of three tetraspanin antibodies (CD9/CD63/CD81) and detection by surface-enhanced Raman scattering (SERS) after EV labelling with C5b-9 or C9 antibody conjugated SERS nanotags. Following C9 exposure, all examined cell lines formed C5b-9, internalized C5b-9, and shed C5b-9+ and C9+ EVs, albeit at varying levels despite receiving the same C9 dose. In conclusion, these results confirm increased esophageal C5b-9 formation during EAC development and demonstrate capability and heterogeneity in C5b-9 formation and shedding in BE and EAC cell lines following sublytic C9 exposure. Future work may explore the molecular mechanisms and pathogenic implications of the shed C5b-9+ EV.
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Affiliation(s)
- Cathryn M Kolka
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Julie Webster
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Ailin Lepletier
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Clay Winterford
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Ian Brown
- Envoi Pathology, Herston, QLD, Australia
| | - Renee S Richards
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Wioleta M Zelek
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Yilang Cao
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Ramlah Khamis
- Centre for Personalised Nanomedicine, Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, St Lucia, QLD, Australia
| | - Karthik B Shanmugasundaram
- Centre for Personalised Nanomedicine, Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, St Lucia, QLD, Australia
| | - Alain Wuethrich
- Centre for Personalised Nanomedicine, Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, St Lucia, QLD, Australia
| | - Matt Trau
- Centre for Personalised Nanomedicine, Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, St Lucia, QLD, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia
| | - Sandra Brosda
- University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Andrew Barbour
- University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Alok K Shah
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Guy D Eslick
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Digestive Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Nicholas J Clemons
- Cancer Research Division, Peter MaCallum Cancer Centre, Melbourne VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - B Paul Morgan
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Michelle M Hill
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
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Nesvaderani M, Dhillon BK, Chew T, Tang B, Baghela A, Hancock RE, Eslick GD, Cox M. Gene Expression Profiling: Identification of Novel Pathways and Potential Biomarkers in Severe Acute Pancreatitis. J Am Coll Surg 2022; 234:803-815. [PMID: 35426393 DOI: 10.1097/xcs.0000000000000115] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Indexed: 12/26/2022]
Abstract
BACKGROUND Determining the risk of developing severe acute pancreatitis (AP) on presentation to hospital is difficult but vital to enable early management decisions that reduce morbidity and mortality. The objective of this study was to determine global gene expression profiles of patients with different acute pancreatitis severity to identify genes and molecular mechanisms involved in the pathogenesis of severe AP. STUDY DESIGN AP patients (n = 87) were recruited within 24 hours of admission to the Emergency Department and were confirmed to exhibit at least 2 of the following features: (1) abdominal pain characteristic of AP, (2) serum amylase and/or lipase more than 3-fold the upper laboratory limit considered normal, and/or (3) radiographically demonstrated AP on CT scan. Severity was defined according to the Revised Atlanta classification. Thirty-two healthy volunteers were also recruited and peripheral venous blood was collected for performing RNA-Seq. RESULTS In severe AP, 422 genes (185 upregulated, 237 downregulated) were significantly differentially expressed when compared with moderately severe and mild cases. Pathway analysis revealed changes in specific innate and adaptive immune, sepsis-related, and surface modification pathways in severe AP. Data-driven approaches revealed distinct gene expression groups (endotypes), which were not entirely overlapping with the clinical Atlanta classification. Importantly, severe and moderately severe AP patients clustered away from healthy controls, whereas mild AP patients did not exhibit any clear separation, suggesting distinct underlying mechanisms that may influence severity of AP. CONCLUSION There were significant differences in gene expression affecting the severity of AP, revealing a central role of specific immunological pathways. Despite the existence of patient endotypes, a 4-gene transcriptomic signature (S100A8, S100A9, MMP25, and MT-ND4L) was determined that can predict severe AP with an accuracy of 64%.
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Affiliation(s)
- Maryam Nesvaderani
- From the Department of Surgery, The Centre for Evidence Based Surgery (Nesvaderani, Eslick, Cox), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
| | - Bhavjinder K Dhillon
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, Canada (Dhillon, Baghela, Hancock)
| | - Tracy Chew
- Intensive Care Medicine (Chew, Tang), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
- Sydney Informatics Hub, University of Sydney, Sydney, Australia (Chew)
| | - Benjamin Tang
- Intensive Care Medicine (Chew, Tang), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
| | - Arjun Baghela
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, Canada (Dhillon, Baghela, Hancock)
| | - Robert Ew Hancock
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, Canada (Dhillon, Baghela, Hancock)
| | - Guy D Eslick
- From the Department of Surgery, The Centre for Evidence Based Surgery (Nesvaderani, Eslick, Cox), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
| | - Michael Cox
- From the Department of Surgery, The Centre for Evidence Based Surgery (Nesvaderani, Eslick, Cox), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
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Deverell M, Phu A, Elliott EJ, Teutsch SM, Eslick GD, Stuart C, Murray S, Davis R, Dalkeith T, Christodoulou J, Zurynski YA. Health-related out-of-pocket expenses for children living with rare diseases - tuberous sclerosis and mitochondrial disorders: A prospective pilot study in Australian families. J Paediatr Child Health 2022; 58:611-617. [PMID: 34704652 DOI: 10.1111/jpc.15784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
AIM We aimed to describe health-related out-of-pocket (OOP) expenses incurred by Australian families living with children with chronic and complex diseases. METHODS A prospective pilot study of OOP expenses in families with children with tuberous sclerosis (TS) or mitochondrial disorders (MD) in 2016-2017. An initial survey assessed the family's financial situation, child's health functioning and estimated previous 6 months' and lifetime OOP expenses. Thereafter, families completed a survey each month for 6 months, prospectively tracking OOP expenses. RESULTS Initial surveys were completed by 13 families with 15 children; median age 7 years (range: 1-12); 5 with MD, 10 with TS. All families reported OOP expenses: 38% paid $2000 per annum, more than double the annual per-capita OOP costs reported for Australia by the Organisation for Economic Co-operation and Development. Eight families estimated $5000-$25 000 in OOP expenses over their child's lifetime and 62% of mothers reduced or stopped work due to caring responsibilities. Eleven families paid annual private health insurance premiums of $2000-$5122, but 72% said this was poor value-for-money. Prospective tracking by eight families (9 children) identified the median OOP expenditure was $863 (range $55-$1398) per family for 6 months. OOP spending was associated with visits to allied health professionals, non-prescription medicines, special foods, supplements and disposable items. Eight families paid for 91 prescription medications over 6 months. CONCLUSION All families caring for children with TS or MD reported OOP expenses. A larger study is needed to explore the affordability of health care for children living with a broader range of chronic diseases.
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Affiliation(s)
- Marie Deverell
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,Clinical Excellence Division, Government Department of Health Western Australia, Perth, Western Australia, Australia
| | - Amy Phu
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Suzy M Teutsch
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Clare Stuart
- Tuberous Sclerosis Australia, Sydney, New South Wales, Australia
| | - Sean Murray
- Australian Mitochondrial Disorders Foundation, Sydney, New South Wales, Australia
| | - Rebecca Davis
- Australian Mitochondrial Disorders Foundation, Sydney, New South Wales, Australia
| | - Troy Dalkeith
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - John Christodoulou
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mitochondrial Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne A Zurynski
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Eslick GD, Nunez C, Elliott EJ. Injury and death associated with jumping castles: A public health issue. J Paediatr Child Health 2022; 58:546-548. [PMID: 35244303 DOI: 10.1111/jpc.15898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Guy D Eslick
- The Australian Paediatric Surveillance Unit (APSU), The Sydney Children's Hospital Network Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Carlos Nunez
- The Australian Paediatric Surveillance Unit (APSU), The Sydney Children's Hospital Network Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit (APSU), The Sydney Children's Hospital Network Westmead, The University of Sydney, Sydney, New South Wales, Australia
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El Jamaly H, Eslick GD, Weltman M. Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes. Clin Mol Hepatol 2022; 28:52-66. [PMID: 34530527 PMCID: PMC8755467 DOI: 10.3350/cmh.2021.0205] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIMS Maternal and fetal outcomes in pregnant patients with Non-alcoholic fatty liver disease (NAFLD) have been largely unexplored. To determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD. METHODS We conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI). RESULTS Twenty-two studies, with 13,641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline diabetes mellitus (OR, 6.00; 95% CI, 2.21-16.31; P<0.001; n=7), baseline Hypertension (OR, 3.75; 95% CI, 2.13-6.59; P<0.001; n=4), gestational hypertension (OR, 1.83; 95% CI, 1.03-3.26; P=0.041; n=2), and pre-eclampsia (OR, 2.43; 95% CI, 1.46-4.04; P=0.001; n=3). The odds for a past and current history of gestational diabetes mellitus were OR, 3.78; 95% CI, 2.21-6.44; P<0.001; n=5 and OR, 3.23; 95% CI, 1.97- 5.31; P<0.001; n=6, respectively. As for fetal outcomes, pregnant NAFLD patients were significantly more likely to have a premature birth (OR, 2.02; 95% CI, 1.44-2.85; P<0.001; n=4), large for gestational age birth (OR, 2.01; 95% CI, 1.72-2.37; P<0.001; n=2) or a history of prior miscarriage or abortion (OR, 1.15; 95% CI, 1.02-1.30; P=0.02; n=2). Egger's regression revealed no evidence of publication bias (P>0.05). CONCLUSION This meta-analysis provides pooled evidence that NAFLD is associated with a substantial increase in maternal diabetic and hypertensive complications and multiple adverse fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy.
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Affiliation(s)
- Hydar El Jamaly
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, Australia
- Nepean Clinical School, The University of Sydney, Penrith, Australia
| | - Guy D Eslick
- The Centre for Digestive Health and Neurogastroenterology, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, Australia
- Nepean Clinical School, The University of Sydney, Penrith, Australia
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42
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Yadav YS, Eslick GD, Talley NJ. Review article: irritable bowel syndrome: natural history, bowel habit stability and overlap with other gastrointestinal disorders. Aliment Pharmacol Ther 2021; 54 Suppl 1:S24-S32. [PMID: 34927758 DOI: 10.1111/apt.16624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/29/2021] [Accepted: 09/18/2021] [Indexed: 12/09/2022]
Abstract
Symptoms of irritable bowel syndrome (IBS) characteristically fluctuate over time. We aimed to review the natural history of IBS and IBS subgroups including bowel habit disturbances, and the overlap of IBS with other gastrointestinal disorders. The community incidence of IBS is approximately 67 per 1000 person years. The prevalence of IBS is stable over time because symptoms fluctuate and there is a portion who experience resolution of their GI symptoms similar in number to those developing new-onset IBS. The proportion who report resolution of symptoms varies amongst population-based studies from 17% to 55%. There is evidence of substantial movement between subtypes of IBS. For example in a clinical trial cohort, only one in four patients retained their baseline classification throughout the study periods, two in three moved between IBS-C (constipation) and IBS-M (mixed), while over half switched between IBS-D (diarrhoea) and IBS-M. The least stable group was IBS-M. There are very limited data on drivers of bowel habit change in IBS. There are emerging evidence fluctuations in intestinal immune activity might account for symptom variability over time. It is of clinical importance to recognise the substantial overlap of IBS symptoms with other gastrointestinal syndromes including gastro-oesophageal reflux disease. This is important to ensure the correct clinical diagnosis of IBS is made and patients are not over investigated. Knowledge of the natural history, stability of subgroups and overlap of IBS with other gastrointestinal conditions should be considered in therapeutic decision making.
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Affiliation(s)
- Yamini S Yadav
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Guy D Eslick
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, Newcastle, NSW, Australia
| | - Nicholas J Talley
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, Newcastle, NSW, Australia
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Abstract
OBJECTIVES Venous thromboembolism (VTE) prophylaxis regimes frequently have a wide variation in application. Nepean acute surgical unit was established in 2006 as a novel model for emergency surgical care. As part of the model's rollout, there were several areas of clinical management targeted for improvement, one being VTE prophylaxis compliance. It was decided all patients older than 18 years treated for a variety of acute surgical conditions within the acute surgical unit should be administered routine VTE prophylaxis with heparin and compression stockings. A novel multifaceted intervention was implemented at the time to achieve this goal. The primary aim of this study was to determine VTE prophylaxis administration rates before and after this intervention. METHODS A before-after study conducted as a retrospective review of medical records of all patients 18 years or older, having an appendicectomy in 3 periods: Before acute surgical unit (ASU) (November 2004 to October 2006), Early ASU (November 2006 to October 2008), and Established ASU (January 2012 to December 2013). Outcomes were mechanical and pharmacological VTE prophylaxis administration rates for each group. RESULTS There were 1149 patients included in the study: Before ASU, 167; Early ASU, 375; and Established ASU, 607. There was a significant stepwise increase in parmacological VTE prophylaxis administration: Before ASU, 54.5%; Early ASU, 74.7%; and Established ASU, 96.9% (Before versus Early: odds ratio [OR], 2.46; 95% confidence interval [CI], 1.68-3.61; P < 0.001; Early versus Established: OR, 10.500; 95% CI, 6.29-17.53; P < 0.001). Mechanical VTE prophylaxis was significantly increased in the established group (Before versus Established: OR, 47.18; 95% CI, 25.61-86.91; P < 0.001). CONCLUSIONS There was a significant increase in VTE prophylaxis administration after the implementation of our multifaceted intervention. Allocating a responsible provider dedicated to VTE prophylaxis prescription and compliance checking was a key component to this intervention.
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Affiliation(s)
- Matthew G R Allaway
- From the Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | | | - Grace T Y Kwok
- From the Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Pryor J, Eslick GD, Talley NJ, Duncanson K, Keely S, Hoedt EC. Clinical medicine journals lag behind science journals with regards to "microbiota sequence" data availability. Clin Transl Med 2021; 11:e656. [PMID: 34870904 PMCID: PMC8647683 DOI: 10.1002/ctm2.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/10/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jennifer Pryor
- School of Biomedical Sciences and PharmacyCollege of HealthMedicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Guy D. Eslick
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- School of Medicine and Public HealthCollege of HealthMedicine and WellbeingUniversity of NewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Nicholas J. Talley
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- School of Medicine and Public HealthCollege of HealthMedicine and WellbeingUniversity of NewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Kerith Duncanson
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- School of Medicine and Public HealthCollege of HealthMedicine and WellbeingUniversity of NewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Simon Keely
- School of Biomedical Sciences and PharmacyCollege of HealthMedicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Emily C. Hoedt
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- School of Medicine and Public HealthCollege of HealthMedicine and WellbeingUniversity of NewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
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45
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Le QA, Eslick GD, Coulton KM, Akhter R, Lain S, Nassar N, Yaacoub A, Condous G, Leonardi M, Eberhard J, Nanan R. DIFFERENTIAL IMPACT OF PERIODONTAL TREATMENT STRATEGIES DURING PREGNANCY ON PERINATAL OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2021; 22:101666. [DOI: 10.1016/j.jebdp.2021.101666] [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] [Received: 02/13/2021] [Revised: 10/12/2021] [Accepted: 11/06/2021] [Indexed: 01/12/2023]
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46
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Teutsch SM, Nunez CA, Morris A, Eslick GD, Khandaker G, Berkhout A, Novakovic D, Brotherton JML, McGregor S, King J, Egilmezer E, Booy R, Jones CA, Rawlinson W, Thorley BR, Elliott EJ. Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2020. ACTA ACUST UNITED AC 2021; 45. [PMID: 34711146 DOI: 10.33321/cdi.2021.45.59] [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: 11/20/2022]
Abstract
Abstract For 27 years, national prospective data on selected rare childhood diseases have been collected monthly by the Australian Paediatric Surveillance Unit (APSU) from paediatricians and other clinical specialists who report cases in children aged up to 16 years. We report here the annual results of APSU surveillance in 2020 for ten rare communicable diseases and complications of communicable diseases, namely: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV) infection; neonatal herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection; severe complications of seasonal influenza; juvenile onset recurrent respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. We describe the results for each disease in the context of the total period of study, including demographics, clinical characteristics, treatment and short-term outcomes. Despite challenges presented by the coronavirus disease 2019 (COVID-19) pandemic in 2020, more than 1,400 paediatricians reported regularly to the APSU and an overall monthly reporting rate of > 90% was achieved. The minimum AFP target of 1 case per 100,000 children aged less than 15 years was achieved and there were few cases of vaccine-preventable diseases (JoRRP, rubella, varicella). However, high cases of congenital CMV, neonatal HSV and perinatal exposure to HIV persist. There were no severe complications of seasonal influenza reported for the first time in 13 years. This is consistent with other surveillance data reporting a decline of influenza and other communicable diseases in 2020, and likely reflects the wider effects of public health measures to reduce transmission of SARS-CoV-2 in the Australian community.
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Affiliation(s)
- Suzy M Teutsch
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Carlos A Nunez
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Anne Morris
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Gulam Khandaker
- Director of Public Health/Public Health Physician and Director of Medical Research, Central Queensland Hospital and Health Service, Rockhampton, Queensland, AUSTRALIA
| | - Angela Berkhout
- Microbiology Registrar, Microbiology and laboratory services, The Royal Children's Hospital, Melbourne, Victoria, AUSTRALIA
| | - Daniel Novakovic
- ENT, Head and Neck Surgeon, Laryngologist, and Director, Dr Liang Voice Program, The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, New South Wales, AUSTRALIA
| | - Julia M L Brotherton
- Medical Director, VCS Population Health, VCS Foundation, Melbourne, Victoria, AUSTRALIA.,Honorary Principal Fellow, Melbourne School of Population and Global Health, University of Melbourne, Victoria, AUSTRALIA
| | - Skye McGregor
- Epidemiologist, The Kirby Institute, UNSW Sydney, New South Wales, AUSTRALIA
| | - Jonathan King
- Epidemiologist, The Kirby Institute, UNSW Sydney, New South Wales, AUSTRALIA
| | - Ece Egilmezer
- Virology Research Laboratory, Prince of Wales Hospital, Randwick, Sydney, New South Wales, AUSTRALIA.,UNSW Sydney, New South Wales, AUSTRALIA
| | - Robert Booy
- Senior Professorial Fellow, National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, AUSTRALIA
| | - Cheryl A Jones
- Dean and Head of Sydney Medical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, AUSTRALIA
| | - William Rawlinson
- Senior Medical Virologist, Director of Serology, Virology and OTDS Laboratories, NSW Health Pathology Randwick, Sydney, New South Wales, AUSTRALIA.,UNSW Sydney, New South Wales, AUSTRALIA
| | - Bruce R Thorley
- Head, National Enterovirus Reference Laboratory and WHO Polio Regional Reference Laboratory, Victorian Infectious Disease Reference Laboratory, Melbourne, Victoria, AUSTRALIA.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, AUSTRALIA
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
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Abstract
Acral melanomas are a unique subset of melanomas occurring on the palms, soles, and nails. There is poor prognosis with surgery alone and no specific guidelines for the treatment of metastatic acral melanoma. This meta-analysis explored the systemic therapy outcomes for metastatic acral melanoma. Medline, Pubmed, EMBASE, and the grey literature were searched from 2010 to August 2020 for studies specifying the treatment outcome of metastatic acral melanoma. Studies were assessed by two investigators. A random-effects meta-analysis was performed and pooled Kaplan-Meier curves for progression-free survival and overall survival were created. Critical appraisal was performed using the Newcastle-Ottawa Scale. Nineteen nonrandomized studies were included, comprising 646 patients with acral melanomas and 1609 patients with nonacral melanomas treated with systemic therapy including chemotherapy, KIT-targeted drugs, as well as anti-CTLA-4 and anti-PD-1 checkpoint inhibitor therapy. Thirteen studies included Kaplan-Meier curves for progression-free survival or overall survival and 11 studies reported treatment responses. Patients with acral melanomas had worse prognosis than nonacral cutaneous melanoma (acral overall survival: median 15 months, 95% CI, 13.7-16.3 months; nonacral cutaneous: median 24 months, 95% CI, 22.6-25.4 months, P < 0.001). Acral melanoma patients treated with anti-PD-1 monotherapy had higher overall survival at 12 months (53%) compared with anti-CTLA-4 monotherapy (34%; P < 0.001). This study provides estimates of treatment response for metastatic acral melanoma, demonstrating low activity across a breadth of approved drug therapies, including anti-PD-1, the most active therapy in melanoma to date. Further research into treatments for metastatic acral melanoma is needed.
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Affiliation(s)
- Kenneth K Cho
- Department of Surgery, The Whiteley-Martin Research Centre, Nepean Clinical School, University of Sydney, Penrith
- School of Medicine, Western Sydney University, Campbelltown
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW
- Melanoma Institute Australia, The University of Sydney
| | - Yun Megan Foo
- School of Medicine, Western Sydney University, Campbelltown
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney
- Royal North Shore and Mater Hospitals
- Sydney Medical School, The University of Sydney
- Charles Perkins Centre, The University of Sydney
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney
- Royal North Shore and Mater Hospitals
- Sydney Medical School, The University of Sydney
| | - Guy D Eslick
- Department of Surgery, The Whiteley-Martin Research Centre, Nepean Clinical School, University of Sydney, Penrith
- Centre for Digestive Health, Hunter Medical Research Institute, The University of Newcastle, Sydney, NSW, Australia
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Abstract
BACKGROUND Maternal and fetal outcomes in pregnant patients with autoimmune hepatitis (AIH) has been largely unexplored. AIM This meta-analysis aims to determine the level of evidence associated with both maternal and fetal outcomes in patients with AIH. METHODS We conducted a comprehensive literature search. The studies included AIH patients who had at least one pregnancy with a previously known or index presentation diagnosis of AIH. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI). RESULTS Fourteen studies with 1452 AIH patients and with a total of 1556 gestations were included. Analysis revealed statistically significant increased likelihood of diabetes mellitus in the AIH group (OR: 5.73, 95% CI: 2.73-12.02; p < .001, n = 2) compared to controls. Fetal outcomes that indicated a statistically significant association with AIH included premature birth (OR: 2.20, 95% CI:1.66-2.91; p < .001, n = 3), small for gestational age (SGA) births (OR: 2.48, 95% CI:1.37-4.51; p = .003, n = 2) and low birth weight (LBW) (OR: 3.04, 95% CI:1.85-5.01; p < .001, n = 1). AIH pregnancies were significantly less likely to have a full-term birth (OR: 0.32, 95% CI:0.21-0.49; p < .001, n = 2). CONCLUSIONS This meta-analysis provides the first pooled evidence that autoimmune hepatitis is associated with a substantial increase in maternal Pre-pregnancy and gestational diabetes mellitus, and that AIH females are more likely to have premature births, small for gestational age (SGA) births, and low birth weight (LBW) babies and a substantial decrease in full term birth compared to normal controls. This data is important for clinicians managing these patients before, during and after pregnancy.
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Affiliation(s)
- Hydar El Jamaly
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, Australia.,Nepean Clinical School, The University of Sydney, Penrith, Australia
| | - Guy D Eslick
- NHMRC Centre for Digestive Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, Australia.,Nepean Clinical School, The University of Sydney, Penrith, Australia
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49
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Paramaesvaran S, Ahmadzada S, Eslick GD. Corrigendum to "Incidence and potential risk factors for adenoid regrowth and revision adenoidectomy: A meta-analysis" [Int. J. Pediatr. Otorhinolaryngol. 137 (2020), Start page (1) -End page (9)/110220]. Int J Pediatr Otorhinolaryngol 2021; 149:110885. [PMID: 34412898 DOI: 10.1016/j.ijporl.2021.110885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Suchitra Paramaesvaran
- Department of Otolaryngology Head and Neck Surgery, Nepean Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, Australia.
| | - Sejad Ahmadzada
- Department of Otolaryngology Head and Neck Surgery, Nepean Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, Australia
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50
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Na R, Miura K, O'Brien S, Eslick GD, Kendall BJ, Hourigan LF, Bourke M, Cox MR, Farrokhzadi L, Levert-Mignon AJ, Barbour AP, Clemons NJ, Duong CP, Lord RV, Phillips WA, Watson DI, Whiteman DC. Clinical pathways and outcomes of patients with Barrett's esophagus in tertiary care settings: a prospective longitudinal cohort study in Australia, 2008-2016. Dis Esophagus 2021; 34:6031238. [PMID: 33306781 DOI: 10.1093/dote/doaa119] [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: 05/02/2020] [Revised: 08/03/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical services for Barrett's esophagus have been rising worldwide including Australia, but little is known of the long-term outcomes of such patients. Retrospective studies using data at baseline are prone to both selection and misclassification bias. We investigated the clinical characteristics and outcomes of Barrett's esophagus patients in a prospective cohort. METHODS We recruited patients diagnosed with Barrett's esophagus in tertiary settings across Australia between 2008 and 2016. We compared baseline and follow-up epidemiological and clinical data between Barrett's patients with and without dysplasia. We calculated age-adjusted incidence rates and estimated minimally and fully adjusted hazard ratios (HR) to identify those clinical factors related to disease progression. RESULTS The cohort comprised 268 patients with Barrett's esophagus (median follow-up 5 years). At recruitment, 224 (84%) had no dysplasia, 44 (16%) had low-grade or indefinite dysplasia (LGD/IND). The age-adjusted incidence of esophageal adenocarcinoma (EAC) was 0.5% per year in LGD/IND compared with 0.1% per year in those with no dysplasia. Risk of progression to high-grade dysplasia/EAC was associated with prior LGD/IND (fully adjusted HR 6.55, 95% confidence interval [CI] 1.96-21.8) but not long-segment disease (HR 1.03, 95%CI 0.29-3.58). CONCLUSIONS These prospective data suggest presence of dysplasia is a stronger predictor of progression to cancer than segment length in patients with Barrett's esophagus.
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Affiliation(s)
- Renhua Na
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Kyoko Miura
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Suzanne O'Brien
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - Bradley J Kendall
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Luke F Hourigan
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Gallipoli Medical Research Institute, School of Medicine, The University of Queensland, Greenslopes Private Hospital, Brisbane QLD, Australia
| | - Michael Bourke
- Endoscopy Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Michael R Cox
- The Whiteley-Martin Research Centre, Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - Laal Farrokhzadi
- The Whiteley-Martin Research Centre, Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - Angelique J Levert-Mignon
- Gastro-Oesophageal Cancer Research Program, St. Vincent's Centre for Applied Medical Research and University of Notre Dame School of Medicine, Darlinghurst, Sydney, NSW, Australia
| | - Andrew P Barbour
- Diamantina Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | - Nicholas J Clemons
- Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Cuong P Duong
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.,Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Reginald V Lord
- Gastro-Oesophageal Cancer Research Program, St. Vincent's Centre for Applied Medical Research and University of Notre Dame School of Medicine, Darlinghurst, Sydney, NSW, Australia
| | - Wayne A Phillips
- Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - David I Watson
- Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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