1
|
Ghandi V, Li D, Weinkauf J, Lien D, Hirji A, Varughese R, Weatherald J, Sligl W, Kabbani D, Schwartz I, Doucette K, Cervera C, Halloran K. Systemic corticosteroids for outpatient respiratory viral infections in lung transplant recipients. Transpl Infect Dis 2023; 25:e14181. [PMID: 37922374 DOI: 10.1111/tid.14181] [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: 06/26/2023] [Revised: 09/22/2023] [Accepted: 10/15/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION Respiratory viral infections (RVI) in lung transplant recipients (LTR) have variably been associated with rejection and chronic lung allograft dysfunction. Our center has used systemic corticosteroids to treat outpatient RVI in some cases, but evidence is limited. We reviewed all adult LTR diagnosed with outpatient RVI January 2017 to December 2019. The primary outcome was recovery of lung function (forced expiratory volume in 1 s [FEV1]) at next stable visit between 1 and 12 months postinfection, expressed as a ratio over stable preinfection FEV1 (FEV1 recovery ratio). METHODS We identified 100 adult LTR with outpatient RVI diagnoses eligible for study, 36% of whom received corticosteroids. We modelled the adjusted association between corticosteroid use and FEV1 recovery ratio using linear regression. RESULTS Steroid-treated patients had a lower FEV1 presentation ratio (0.92 vs. 1.04, p = .0070) and were more likely to have chronic lung allograft dysfunction at time of infection (25% vs. 5%, p = .0077). Mean FEV1 recovery ratio was 1.02 (SD 0.19) with no association with corticosteroid therapy via multivariable linear regression (p = .5888). CONCLUSIONS Steroid treatment was not associated with FEV1 recovery. This suggests corticosteroids may not have a role in the management of RVI in this population.
Collapse
Affiliation(s)
- Vardhil Ghandi
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - David Li
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Justin Weinkauf
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dale Lien
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Alim Hirji
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Rhea Varughese
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Wendy Sligl
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dima Kabbani
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ilan Schwartz
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Karen Doucette
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Carlos Cervera
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kieran Halloran
- Department of Medicine, University of Alberta, Edmonton, Canada
| |
Collapse
|
2
|
Mitjà O, Reis G, Boulware DR, Spivak AM, Sarwar A, Johnston C, Webb B, Hill MD, Smith D, Kremsner P, Curran M, Carter D, Alexander J, Corbacho M, Lee TC, Hullsiek KH, McDonald EG, Hess R, Hughes M, Baeten JM, Schwartz I, Metz L, Richer L, Chew KW, Daar E, Wohl D, Dunne M. Hydroxychloroquine for treatment of non-hospitalized adults with COVID-19: A meta-analysis of individual participant data of randomized trials. Clin Transl Sci 2023; 16:524-535. [PMID: 36601684 PMCID: PMC10014689 DOI: 10.1111/cts.13468] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023] Open
Abstract
Hydroxychloroquine (HCQ) was initially promoted as an oral therapy for early treatment of coronavirus disease 2019 (COVID-19). Conventional meta-analyses cannot fully address the heterogeneity of different designs and outcomes of randomized controlled trials (RCTs) assessing the efficacy of HCQ in outpatients with mild COVID-19. We conducted a pooled analysis of individual participant data from RCTs that evaluated the effect of HCQ on hospitalization and viral load reduction in outpatients with confirmed COVID-19. We evaluated the overall treatment group effect by log-likelihood ratio test (-2LL) from a generalized linear mixed model to accommodate correlated longitudinal binary data. The analysis included data from 11 RCTs. The outcome of virological effect, assessed in 1560 participants (N = 795 HCQ, N = 765 control), did not differ significantly between the two treatment groups (-2LL = 7.66; p = 0.18) when adjusting for cohort, duration of symptoms, and comorbidities. The decline in polymerase chain reaction positive tests from day 1 to 7 was 42.0 and 41.6 percentage points in the HCQ and control groups, respectively. Among the 2037 participants evaluable for hospitalization (N = 1058 HCQ, N = 979 control), we found no significant differences in hospitalization rate between participants receiving HCQ and controls (odds ratio 0.995; 95% confidence interval 0.614-1.610; -2LL = 0.0; p = 0.98) when adjusting for cohort, duration of symptoms, and comorbidities. This individual participant data meta-analysis of 11 HCQ trials that evaluated severe acute respiratory syndrome-coronavirus 2 viral clearance and COVID-19 hospitalization did not show a clinical benefit of HCQ. Our meta-analysis provides evidence to support the interruption in the use of HCQ in mild COVID-19 outpatients to reduce progression to severe disease.
Collapse
Affiliation(s)
- Oriol Mitjà
- Fight AIDS and Infectious Diseases Foundation, Barcelona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Lihir Medical Center-International SOS, Lihir Island, Papua New Guinea
| | - Gilmar Reis
- Research Division, Cardresearch Cardiologia Assistencial e de Pesquisa, Pontifícia Universidade Católica de Minas Gerais, Bello Horizonte, Brazil
- Cytel Inc., Vancouver, British Columbia, Canada
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Ammar Sarwar
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Johnston
- Department of Medicine and Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Brandon Webb
- Intermountain Health Care, University of Utah, Salt Lake City, Utah, USA
| | | | - Davey Smith
- Division of Infectious Diseases & Global Public Health, UC San Diego School of Medicine, San Diego, California, USA
| | - Peter Kremsner
- University Hospital of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Marla Curran
- Bill & Melinda Gates Medical Research Institute, Cambridge, Massachusetts, USA
| | | | - Jim Alexander
- Bill & Melinda Gates Medical Research Institute, Cambridge, Massachusetts, USA
| | - Marc Corbacho
- Fight AIDS and Infectious Diseases Foundation, Barcelona, Spain
| | - Todd C Lee
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katherine Huppler Hullsiek
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emily G McDonald
- Division of General Internal Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Rachel Hess
- University of Utah, Salt Lake City, Utah, USA
| | | | - Jared M Baeten
- Department of Medicine and Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | | | - Luanne Metz
- University of Calgary, Calgary, Alberta, Canada
| | | | - Kara W Chew
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Eric Daar
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - David Wohl
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Dunne
- Bill & Melinda Gates Medical Research Institute, Cambridge, Massachusetts, USA
| |
Collapse
|
3
|
Azar MM, Turbett S, Gaston D, Gitman M, Razonable R, Koo S, Hanson K, Kotton C, Silveira F, Banach DB, Basu SS, Bhaskaran A, Danziger-Isakov L, Bard JD, Gandhi R, Hanisch B, John TM, Odom John AR, Letourneau AR, Luong ML, Maron G, Miller S, Prinzi A, Schwartz I, Simner P, Kumar D. A consensus conference to define the utility of advanced infectious disease diagnostics in solid organ transplant recipients. Am J Transplant 2022; 22:3150-3169. [PMID: 35822346 DOI: 10.1111/ajt.17147] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023]
Abstract
The last decade has seen an explosion of advanced assays for the diagnosis of infectious diseases, yet evidence-based recommendations to inform their optimal use in the care of transplant recipients are lacking. A consensus conference sponsored by the American Society of Transplantation (AST) was convened on December 7, 2021, to define the utility of novel infectious disease diagnostics in organ transplant recipients. The conference represented a collaborative effort by experts in transplant infectious diseases, diagnostic stewardship, and clinical microbiology from centers across North America to evaluate current uses, unmet needs, and future directions for assays in 5 categories including (1) multiplex molecular assays, (2) rapid antimicrobial resistance detection methods, (3) pathogen-specific T-cell reactivity assays, (4) next-generation sequencing assays, and (5) mass spectrometry-based assays. Participants reviewed and appraised available literature, determined assay advantages and limitations, developed best practice guidance largely based on expert opinion for clinical use, and identified areas of future investigation in the setting of transplantation. In addition, attendees emphasized the need for well-designed studies to generate high-quality evidence needed to guide care, identified regulatory and financial barriers, and discussed the role of regulatory agencies in facilitating research and implementation of these assays. Findings and consensus statements are presented.
Collapse
Affiliation(s)
- Marwan M Azar
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sarah Turbett
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Gaston
- John's Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Melissa Gitman
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sophia Koo
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Hanson
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Camille Kotton
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fernanda Silveira
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David B Banach
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Sankha S Basu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Lara Danziger-Isakov
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Jennifer Dien Bard
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Ronak Gandhi
- Department of Pharmacy Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Hanisch
- Children's National Hospital, Washington, District of Columbia, USA
| | - Teny M John
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Audrey R Odom John
- Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alyssa R Letourneau
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Me-Linh Luong
- Department of Microbiology, University of Montreal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Gabriela Maron
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Steve Miller
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrea Prinzi
- Infectious Disease Medical Science Liaison, Denver, Colorado, USA
| | - Ilan Schwartz
- Faculty of Medicine and Dentistry, University of Alberta, University of Alberta, Alberta, Canada
| | - Patricia Simner
- John's Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | |
Collapse
|
4
|
Lim RK, Rosentreter R, Chen Y, Mehta R, McLeod G, Wan M, Krett JD, Mahjoub Y, Lee A, Schwartz I, Metz L, Richer L, Smith E, Hill MD, Ganesh A. Quality of life, respiratory symptoms, and health care utilization 1 year following outpatient management of COVID-19: a prospective cohort study. Sci Rep 2022; 12:12988. [PMID: 35906362 PMCID: PMC9334740 DOI: 10.1038/s41598-022-17243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/22/2022] [Indexed: 11/12/2022] Open
Abstract
The long-term impact of COVID-19 among those with mild infections is not well characterized. Among 81 adults who completed online assessments at 3- and 12-months following infection, quality of life scores did not significantly improve over time. Among 62 subjects who also completed telephone interviews, respiratory symptoms or exercise limitation were reported by 42% at a median follow-up of 387 days (IQR 251–402 days). Those with persistent respiratory symptoms scored lower on the EQ-5D visual analog score compared to those without. Persistent respiratory symptoms were associated with a lower likelihood of full-time employment at 1 year (aOR 0.09, 95%CI 0.01–0.91; P = 0.041). In an adjusted linear regression, persistent respiratory symptoms (P = 0.037) and female sex (P = 0.016) were both independent risks for increased visits to a primary care provider. This cohort study demonstrates that respiratory symptoms are frequent at 1 year following COVID-19 and more importantly, are associated with negative impacts on employment, quality of life, and health care utilization. Further research is needed to determine the pathophysiology and risk factors for persistent symptoms as well as optimal management strategies to improve the level of functioning and quality of life.
Collapse
Affiliation(s)
- Rachel K Lim
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ryan Rosentreter
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Yushi Chen
- Department of Dentistry and Dental Hygiene, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rahul Mehta
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Graham McLeod
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Miranda Wan
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Jonathan D Krett
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Yasamin Mahjoub
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Angela Lee
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Ilan Schwartz
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Luanne Metz
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Lawrence Richer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Eric Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | | | - Aravind Ganesh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 103, Heritage Medical Research Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.
| |
Collapse
|
5
|
Sohani ZN, Butler-Laporte G, Aw A, Belga S, Benedetti A, Carignan A, Cheng MP, Coburn B, Costiniuk CT, Ezer N, Gregson D, Johnson A, Khwaja K, Lawandi A, Leung V, Lother S, MacFadden D, McGuinty M, Parkes L, Qureshi S, Roy V, Rush B, Schwartz I, So M, Somayaji R, Tan D, Trinh E, Lee TC, McDonald EG. Low-dose trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia (LOW-TMP): protocol for a phase III randomised, placebo-controlled, dose-comparison trial. BMJ Open 2022; 12:e053039. [PMID: 35863836 PMCID: PMC9310160 DOI: 10.1136/bmjopen-2021-053039] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection of immunocompromised hosts with significant morbidity and mortality. The current standard of care, trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 15-20 mg/kg/day, is associated with serious adverse drug events (ADE) in 20%-60% of patients. ADEs include hypersensitivity reactions, drug-induced liver injury, cytopenias and renal failure, all of which can be treatment limiting. In a recent meta-analysis of observational studies, reduced dose TMP-SMX for the treatment of PJP was associated with fewer ADEs, without increased mortality. METHODS AND ANALYSIS A phase III randomised, placebo-controlled, trial to directly compare the efficacy and safety of low-dose TMP-SMX (10 mg/kg/day of TMP) with the standard of care (15 mg/kg/day of TMP) among patients with PJP, for a composite primary outcome of change of treatment, new mechanical ventilation, or death. The trial will be undertaken at 16 Canadian hospitals. Data will be analysed as intention to treat. Primary and secondary outcomes will be compared using logistic regression adjusting for stratification and presented with 95% CI. ETHICS AND DISSEMINATION This study has been conditionally approved by the McGill University Health Centre; Ethics approval will be obtained from all participating centres. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04851015.
Collapse
Affiliation(s)
- Zahra N Sohani
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Guillaume Butler-Laporte
- Department of Epidemiology, Occupational Health, and Biostatistics, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew Aw
- Division of Hematology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sara Belga
- Division of Infectious Diseases, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Benedetti
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Occupational Health, and Biostatistics, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Alex Carignan
- Division of Microbiology and Infectious Diseases, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Matthew P Cheng
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bryan Coburn
- Division of Infectious Diseases, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Cecilia T Costiniuk
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Nicole Ezer
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Respirology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan Gregson
- Departments of Pathology and Laboratory Medicine and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Johnson
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kosar Khwaja
- Department of Epidemiology, Occupational Health, and Biostatistics, McGill University, Montreal, Quebec, Canada
- Department of Critical Care Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alexander Lawandi
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Victor Leung
- Department of Laboratory Medicine & Pathology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sylvain Lother
- Department of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Derek MacFadden
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michaeline McGuinty
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Leighanne Parkes
- Division of Medical Microbiology and Infectious Diseases, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Salman Qureshi
- Department of Epidemiology, Occupational Health, and Biostatistics, McGill University, Montreal, Quebec, Canada
- Division of Respirology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Critical Care Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Valerie Roy
- Division of Microbiology and Infectious Diseases, Centre Hospitalier Universitaire de Sherbrooke Hôtel-Dieu, Sherbrooke, Quebec, Canada
| | - Barret Rush
- Department of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ilan Schwartz
- Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Miranda So
- Sinai Health System-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto, Ontario, Canada
| | - Ranjani Somayaji
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Darrell Tan
- Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada
| | - Emilie Trinh
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Clinical Practice Assessment Unit, Montreal, Quebec, Canada
| | - Emily G McDonald
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Clinical Practice Assessment Unit, Montreal, Quebec, Canada
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
6
|
Stone N, Gupta N, Schwartz I. Mucormycosis: time to address this deadly fungal infection. The Lancet Microbe 2021; 2:e343-e344. [DOI: 10.1016/s2666-5247(21)00148-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 12/25/2022] Open
|
7
|
Schwartz I, Boesen ME, Cerchiaro G, Doram C, Edwards BD, Ganesh A, Greenfield J, Jamieson S, Karnik V, Kenney C, Lim R, Menon BK, Mponponsuo K, Rathwell S, Ryckborst KJ, Stewart B, Yaskina M, Metz L, Richer L, Hill MD. Assessing the efficacy and safety of hydroxychloroquine as outpatient treatment of COVID-19: a randomized controlled trial. CMAJ Open 2021; 9:E693-E702. [PMID: 34145052 PMCID: PMC8248582 DOI: 10.9778/cmajo.20210069] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Identification of therapies to prevent severe COVID-19 remains a priority. We sought to determine whether hydroxychloroquine treatment for outpatients with SARS-CoV-2 infection could prevent hospitalization, mechanical ventilation or death. METHODS This randomized controlled trial was conducted in Alberta during the first wave of the COVID-19 pandemic without direct contact with participants. Community-dwelling individuals with confirmed SARS-CoV-2 infection (by reverse transcription polymerase chain reaction [RT-PCR] viral ribonucleic acid test) within the previous 4 days, and symptom onset within the previous 12 days, were randomly assigned to oral hydroxychloroquine or matching placebo for 5 days. Enrolment began Apr. 15, 2020. The primary outcome was the composite of hospitalization, invasive mechanical ventilation or death within 30 days. Secondary outcomes included symptom duration and disposition at 30 days. Safety outcomes, such as serious adverse events and mortality, were also ascertained. Outcomes were determined by telephone follow-up and administrative data. RESULTS Among 4919 individuals with a positive RT-PCR test, 148 (10.2% of a planned 1446 patients) were randomly assigned, 111 to hydroxychloroquine and 37 to placebo. Of the 148 participants, 24 (16.2%) did not start the study drug. Four participants in the hydroxychloroquine group met the primary outcome (4 hospitalizations, 0 mechanical ventilation, 4 survived to 30 days) and none in the placebo group. Hydroxychloroquine did not reduce symptom duration (hazard ratio 0.77, 95% confidence interval 0.49-1.21). Recruitment was paused on May 22, 2020, when a since-retracted publication raised concerns about the safety of hydroxychloroquine for hospitalized patients with COVID-19. Although we had not identified concerns in a safety review, enrolment was slower than expected among those eligible for the study, and cases within the community were decreasing. Recruitment goals were deemed to be unattainable and the trial was not resumed, resulting in a study underpowered to assess the effect of treatment with hydroxychloroquine and safety. INTERPRETATION There was no evidence that hydroxychloroquine reduced symptom duration or prevented severe outcomes among outpatients with proven COVID-19, but the early termination of our study meant that it was underpowered. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT04329611.
Collapse
Affiliation(s)
- Ilan Schwartz
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Mari E Boesen
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Graziela Cerchiaro
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Craig Doram
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Brett D Edwards
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Aravind Ganesh
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Jamie Greenfield
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Scott Jamieson
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Vikram Karnik
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Carol Kenney
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Rachel Lim
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Bijoy K Menon
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Kwadwo Mponponsuo
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Sarah Rathwell
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Karla J Ryckborst
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Breanne Stewart
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Maryna Yaskina
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Luanne Metz
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Lawrence Richer
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Michael D Hill
- Division of Infectious Diseases (Schwartz, Mponponsuo), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Alberta Strategy for Patient Oriented Research SUPPORT Unit (Boesen); Cumming School of Medicine (Boesen, Cerchiaro, Greenfield, Kenney, Ryckborst), University of Calgary; Section of Infectious Diseases (Edwards), Department of Medicine, and Department of Clinical Neurosciences (Doram, Ganesh, Karnik), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Quality Management in Clinical Research Office (Jamieson, Stewart), University of Alberta, Edmonton, Alta.; Division of Respirology (Lim), Department of Medicine, Cumming School of Medicine, and Departments of Clinical Neurosciences and Community Health Sciences (Menon, Metz), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Women and Children's Research Institute (Rathwell, Yaskina), and Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences, Community Health Sciences, and Medicine (Hill), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta.
| |
Collapse
|
8
|
Affiliation(s)
- Adilia Warris
- MRC Centre for Medical Mycology, University of Exeter, United Kingdom
| | - Ilan Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
| |
Collapse
|
9
|
Lother SA, Abassi M, Agostinis A, Bangdiwala AS, Cheng MP, Drobot G, Engen N, Hullsiek KH, Kelly LE, Lee TC, Lofgren SM, MacKenzie LJ, Marten N, McDonald EG, Okafor EC, Pastick KA, Pullen MF, Rajasingham R, Schwartz I, Skipper CP, Turgeon AF, Zarychanski R, Boulware DR. Post-exposure prophylaxis or pre-emptive therapy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): study protocol for a pragmatic randomized-controlled trial. Can J Anaesth 2020; 67:1201-1211. [PMID: 32383125 PMCID: PMC7205369 DOI: 10.1007/s12630-020-01684-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 causing the coronavirus disease (COVID-19) pandemic. Currently, there is a lack of evidence-based therapies to prevent COVID-19 following exposure to the virus, or to prevent worsening of symptoms following confirmed infection. We describe the design of a clinical trial of hydroxychloroquine for post-exposure prophylaxis (PEP) and pre-emptive therapy (PET) for COVID-19. METHODS We will conduct two nested multicentre international double-blind randomized placebo-controlled clinical trials of hydroxychloroquine for: 1) PEP of asymptomatic household contacts or healthcare workers exposed to COVID-19 within the past four days, and 2) PET for symptomatic outpatients with COVID-19 showing symptoms for less than four days. We will recruit 1,500 patients each for the PEP and PET trials. Participants will be randomized 1:1 to receive five days of hydroxychloroquine or placebo. The primary PEP trial outcome will be the incidence of symptomatic COVID-19. The primary PET trial outcome will be an ordinal scale of disease severity (not hospitalized, hospitalized without intensive care, hospitalization with intensive care, or death). Participant screening, informed consent, and follow-up will be exclusively internet-based with appropriate regulatory and research ethics board approvals in Canada and the United States. DISCUSSION These complementary randomized-controlled trials are innovatively designed and adequately powered to rapidly answer urgent questions regarding the effectiveness of hydroxychloroquine to reduce virus transmission and disease severity of COVID-19 during a pandemic. In-person participant follow-up will not be conducted to facilitate social distancing strategies and reduce risks of exposure to study personnel. Innovative trial approaches are needed to urgently assess therapeutic options to mitigate the global impact of this pandemic. TRIALS REGISTRATION clinicaltrials.gov (NCT04308668); registered 16 March, 2020.
Collapse
Affiliation(s)
- Sylvain A Lother
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.
- Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Mahsa Abassi
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Alyssa Agostinis
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ananta S Bangdiwala
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Matthew P Cheng
- Divisions of Infectious Diseases & Medical Microbiology, McGill University Health Centre, Montreal, QC, Canada
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, QC, Canada
| | - Glen Drobot
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Engen
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kathy H Hullsiek
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lauren E Kelly
- Department of Pediatrics and Child Health, Department of Pharmacology, University of Manitoba, Winnipeg, MB, Canada
| | - Todd C Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sarah M Lofgren
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Lauren J MacKenzie
- Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Marten
- Critical Care Research, St-Boniface Hospital, Winnipeg, MB, Canada
| | - Emily G McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Katelyn A Pastick
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Matthew F Pullen
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Radha Rajasingham
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ilan Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Caleb P Skipper
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit Trauma - Emergency - Critical Care Medicine, Université Laval, Quebec, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Section of Hematology and Oncology, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - David R Boulware
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
10
|
Schwartz I, Denning D. The estimated burden of fungal diseases in South Africa. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
11
|
Oliveira MR, Schwartz I, Costa LS, Maia H, Ribeiro M, Guerreiro LB, Acosta A, Rocha NS. Quality of life in mucopolysaccharidoses: construction of a specific measure using the focus group technique. BMC Res Notes 2018; 11:28. [PMID: 29334993 PMCID: PMC5769464 DOI: 10.1186/s13104-018-3157-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/11/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the perceptions of patients, their caregivers, and their healthcare providers to the development of a new specific instrument for assessment of the quality of life (QoL) in patients with mucopolysaccharidoses (MPS) using a qualitative focus group (FG) design. FGs were held in two Brazilian states (Rio Grande do Sul and Rio de Janeiro). RESULTS Three versions of the new instrument were developed, each for a different age group: children (age 8-12 years), adolescents (age 13-17), and adults (age ≥ 18). The FGs mostly confirmed the relevance of items. All FGs unanimously agreed on the facets: School, Happiness, Life Prospects, Religiosity, Pain, Continuity of Treatment, Trust in Treatment, Relationship with Family, Relationship with Healthcare Providers, Acceptance, and Meaning of Life. The overall concept of QoL (as proposed by the WHO-World Health Organization) and its facets apply to this patient population. However, other specific facets-particularly concerning clinical manifestations and the reality of the disease-were suggested, confirming the need for the development of a specific QoL instrument for MPS.
Collapse
Affiliation(s)
- M R Oliveira
- Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil
| | - I Schwartz
- Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil
| | - L S Costa
- Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil
| | - H Maia
- Universidade Federal Fluminense, Rua Miguel de Frias, 9 Icaraí, Niterói, RJ, 24220-008, Brazil
| | - M Ribeiro
- Universidade Federal do Rio de Janeiro, Av. Pedro Calmon, 550, Cidade Universitária, Rio de Janeiro, RJ, 21941-901, Brazil
| | - L B Guerreiro
- Universidade Federal Fluminense, Rua Miguel de Frias, 9 Icaraí, Niterói, RJ, 24220-008, Brazil
| | - A Acosta
- Universidade Federal da Bahia, R. Auristides, 2, Federacao, Salvador, BA, 40210-340, Brazil
| | - N S Rocha
- Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil. .,, Ramiro Barcelos, 2400 2º andar, Porto Alegre, RS, 90 003-035, Brazil.
| |
Collapse
|
12
|
Southard V, Roumba S, Schwartz I, Sparacino N, Weddingfeld K, Donoghue J. DOES WHOLE-BODY PERIODIC ACCELERATION REDUCE NON-MOTOR SYMPTOMS IN PERSONS WITH PARKINSON’S DISEASE? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V. Southard
- Physical Therapy, NYIT, Old Westbury, New York,
| | - S. Roumba
- Physical Therapy, NYIT, Old Westbury, New York,
| | - I. Schwartz
- Physical Therapy, NYIT, Old Westbury, New York,
| | | | | | | |
Collapse
|
13
|
Margos G, Marosevic D, Cutler S, Derdakova M, Diuk-Wasser M, Emler S, Fish D, Gray J, Hunfeld KP, Jaulhac B, Kahl O, Kovalev S, Kraiczy P, Lane RS, Lienhard R, Lindgren PE, Ogden NH, Ornstein K, Rupprecht T, Schwartz I, Sing A, Straubinger RK, Strle F, Voordouw M, Rizzoli A, Stevenson B, Fingerle V. Corrigendum: There is inadequate evidence to support the division of the genus Borrelia. Int J Syst Evol Microbiol 2017; 67:2073. [PMID: 28665266 DOI: 10.1099/ijsem.0.002100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- G Margos
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - D Marosevic
- European Programme for Public Health Microbiology Training, European Centre of Disease Prevention and Control (ECDC), Stockholm, Sweden.,National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - S Cutler
- School of Health Sport and Bioscience, University of East London, Water Lane, London, UK
| | - M Derdakova
- Department of Zoology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - M Diuk-Wasser
- Department of Ecology, Evolution and Environmental Biology, Columbia University, 1200 Amsterdam Avenue, New York, NY 10027, USA
| | - S Emler
- SmartGene Services SARL, Innovation Park, Building C, EPFL-Ecublens, CH-1015 Lausanne, Switzerland
| | - D Fish
- Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College Street, New Haven, CT 06510, USA
| | - J Gray
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR).,Emeritus Professor of Animal Parasitology, University College Dublin, Dublin, Ireland
| | - K-P Hunfeld
- Zentralinstitut für Labormedizin, Mikrobiologie and Krankenhaushygiene, Krankenhaus Nordwest, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität, Steinbacher Hohl 2-26, D-60488 Frankfurt am Main, Frankfurt, Germany.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - B Jaulhac
- Laboratoire de Bactériologie, CNR des Borrelia, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg et Faculté de Médecine de Strasbourg, 1 rue Koeberlé, Strasbourg 67000, France.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - O Kahl
- tick-radar GmbH, Haderslebener Str. 9, Berlin 12163, Germany.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - S Kovalev
- Molecular Genetics Lab (www.dnk-ural.ru) Biology Department, Ural Federal University named after the first President of Russia B.N.Yeltsin, Lenin Avenue, Yekaterinburg 620000, Russia
| | - P Kraiczy
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str, Frankfurt/Main 40, 60596, Germany
| | - R S Lane
- Environmental Science, Policy and Management, University of California Berkeley, 130 Mulford Hall, Berkeley CA 94720, California, USA
| | - R Lienhard
- Borrelia Laboratory for the National Reference Centre of Tick Diseases (CNRT/ NRZK), ADMed Microbiology, La Chaux-de-Fonds 2303, Switzerland
| | - P E Lindgren
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - N H Ogden
- Director, Public Health Risk Sciences Division, National Microbiology Laboratory, @ Saint-Hyacinthe and Guelph, Public Health Agency of Canada, Saint-Hyacinthe, Canada
| | - K Ornstein
- Clinical and Experimental Infectious Medicine Section, Department of Clinical Sciences, Lund University, Sweden.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - T Rupprecht
- Klinikum Dachau, Abt. Neurology u. Schlafmedizinisches Zentrum, Krankenhausstr. 15, 8521 Dachau, Germany.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - I Schwartz
- Department of Microbiology and Immunology, School of Medicine, New York Medical College, Basic Sciences Building, Valhalla, NY 10595, USA
| | - A Sing
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - R K Straubinger
- Chair Bacteriology and Mykology, Department of Veterinary Science, Veterinary Faculty, LMU Munich, Veterinärstraße, München 13, 80539, Gemany
| | - F Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - M Voordouw
- Université de Neuchâtel, Institut de Biologie, Laboratoire d'Ecologie et Evolution des Parasites, Rue Emile-Argand 11, CH-2000, Neuchâtel, Switzerland
| | - A Rizzoli
- Fondazione Edmund Mach, Research and Innovation Centre, Via Mach, 1, San Michele all'Adige, Trento, Italy
| | - B Stevenson
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, MS421 Chandler Medical Center, Lexington, Kentucky, 40536-0298, USA
| | - V Fingerle
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR).,National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| |
Collapse
|
14
|
Margos G, Marosevic D, Cutler S, Derdakova M, Diuk-Wasser M, Emler S, Fish D, Gray J, Hunfeldt KP, Jaulhac B, Kahl O, Kovalev S, Kraiczy P, Lane RS, Lienhard R, Lindgren PE, Ogden N, Ornstein K, Rupprecht T, Schwartz I, Sing A, Straubinger RK, Strle F, Voordouw M, Rizzoli A, Stevenson B, Fingerle V. There is inadequate evidence to support the division of the genus Borrelia. Int J Syst Evol Microbiol 2017; 67:1081-1084. [PMID: 27930271 DOI: 10.1099/ijsem.0.001717] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- G Margos
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - D Marosevic
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
- European Programme for Public Health Microbiology Training, European Centre of Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - S Cutler
- School of Health Sport and Bioscience, University of East London, Water Lane, London, UK
| | - M Derdakova
- Department of Zoology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - M Diuk-Wasser
- Department of Ecology, Evolution and Environmental Biology, Columbia University, 1200 Amsterdam Avenue, New York, NY 10027, USA
| | - S Emler
- SmartGene Services SARL, Innovation Park, Building C, EPFL-Ecublens, CH-1015 Lausanne, Switzerland
| | - D Fish
- Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College Street, New Haven, CT 06510, USA
| | - J Gray
- Emeritus Professor of Animal Parasitology, University College Dublin, Dublin, Ireland
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - K-P Hunfeldt
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Zentralinstitut für Labormedizin, Mikrobiologie and Krankenhaushygiene, Krankenhaus Nordwest, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität, Steinbacher Hohl 2-26, D-60488 Frankfurt am Main, Frankfurt, Germany
| | - B Jaulhac
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Laboratoire de Bactériologie, CNR des Borrelia, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg et Faculté de Médecine de Strasbourg, 1 rue Koeberlé, Strasbourg 67000, France
| | - O Kahl
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- tick-radar GmbH, Haderslebener Str. 9, Berlin 12163, Germany
| | - S Kovalev
- Molecular Genetics Lab (www.dnk-ural.ru) Biology Department, Ural Federal University named after the first President of Russia B.N.Yeltsin, Lenin Avenue, Yekaterinburg 620000, Russia
| | - P Kraiczy
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str, Frankfurt/Main 40, 60596, Germany
| | - R S Lane
- Environmental Science, Policy and Management, University of California Berkeley, 130 Mulford Hall, Berkeley CA 94720, California, USA
| | - R Lienhard
- Borrelia Laboratory for the National Reference Centre of Tick Diseases (CNRT/ NRZK), ADMed Microbiology, La Chaux-de-Fonds 2303, Switzerland
| | - P E Lindgren
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - N Ogden
- Director, Public Health Risk Sciences Division, National Microbiology Laboratory, @ Saint-Hyacinthe and Guelph, Public Health Agency of Canada, Saint-Hyacinthe, Canada
| | - K Ornstein
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Clinical and Experimental Infectious Medicine Section, Department of Clinical Sciences, Lund University, Sweden
| | - T Rupprecht
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Klinikum Dachau, Abt. Neurology u. Schlafmedizinisches Zentrum, Krankenhausstr. 15, 8521 Dachau, Germany
| | - I Schwartz
- Department of Microbiology and Immunology, School of Medicine, New York Medical College, Basic Sciences Building, Valhalla, NY 10595, USA
| | - A Sing
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - R K Straubinger
- Chair Bacteriology and Mykology, Department of Veterinary Science, Veterinary Faculty, LMU Munich, Veterinärstraße, München 13, 80539, Gemany
| | - F Strle
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Voordouw
- Université de Neuchâtel, Institut de Biologie, Laboratoire d'Ecologie et Evolution des Parasites, Rue Emile-Argand 11, CH-2000, Neuchâtel, Switzerland
| | - A Rizzoli
- Fondazione Edmund Mach, Research and Innovation Centre, Via Mach, 1, San Michele all'Adige, Trento, Italy
| | - B Stevenson
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, MS421 Chandler Medical Center, Lexington, Kentucky, 40536-0298, USA
| | - V Fingerle
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| |
Collapse
|
15
|
Elhanan E, Boaz M, Schwartz I, Schwartz D, Chernin G, Soetendorp H, Gal Oz A, Agbaria A, Weinstein T. A randomized, controlled clinical trial to evaluate the immunogenicity of a PreS/S hepatitis B vaccine Sci-B-Vac™, as compared to Engerix B ®, among vaccine naïve and vaccine non-responder dialysis patients. Clin Exp Nephrol 2017; 22:151-158. [PMID: 28456864 DOI: 10.1007/s10157-017-1416-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 05/02/2016] [Accepted: 04/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dialysis patients have a suboptimal response to hepatitis B (HBV) vaccination. This study aimed to compare the immunogenicity of two vaccines: the third-generation Sci-B-Vac™ vs. the second-generation Engerix B®. The cohort included two groups of dialysis patients: naïve and previously vaccinated non-responders. Primary endpoints were antibody titers ≥10 IU/L at 3 and 7 month post-vaccination. Secondary objectives were seroprotection rates in vaccine-naïve patients and in previously vaccinated non-responders. METHODS Eighty-six patients were assigned to vaccine (Sci-B-Vac™ or Engerix B®) using computer-generated randomization, stratified by age, gender, diabetes, and previous HBV vaccination. Sci-B-Vac™ was administered in three doses, 10 μg, at 0, 1, and 6 months in naïve patients; or 20 μg in previously vaccinated non-responders. Engerix B® included four doses, 40 μg at 0, 1, 2, and 6 months. RESULTS Each group had 43 patients. Seroconversion was 69.8% with Engerix B® vs. 73.2% with Sci-B-Vac™. Antibody titers at 7 months were higher with Sci-B-Vac™ (266.4 ± 383.9, median 53.4) than with Engerix® (193.2 ± 328.9, median 19). However, these differences were not significant, perhaps due to a suboptimal sample size. CONCLUSIONS This study suggests comparable immunogenicity for both vaccines. Thus, we cannot reject the null hypothesis that there is no difference in seroconversion by vaccine type. It is noteworthy that naïve patients were vaccinated with a standard dose of Sci-B-Vac™, while Engerix B® was administered at a double dose. Similarly, although mean antibody titer levels in the Sci-B-Vac™ group were higher than in the Engerix® group, this difference did not reach significance. Consequently, a future clinical trial should recruit a larger cohort of patients, using a standard double-dose protocol in both groups.
Collapse
Affiliation(s)
- E Elhanan
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - M Boaz
- Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel
- Ariel University, Ariel, Israel
| | - I Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - D Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - G Chernin
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - H Soetendorp
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Gal Oz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Agbaria
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - T Weinstein
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel.
| |
Collapse
|
16
|
Schwartz I, Cogan D, Schmidgall ER, Don Y, Gantz L, Kenneth O, Lindner NH, Gershoni D. Deterministic generation of a cluster state of entangled photons. Science 2016; 354:434-437. [DOI: 10.1126/science.aah4758] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/30/2016] [Indexed: 11/02/2022]
|
17
|
Bodor N, Schwartz I, Trinajstić N. SCFMO Study of the Tautomerism of Anilino-Thiazole and Related Compounds. Zeitschrift für Naturforschung B 2014. [DOI: 10.1515/znb-1971-0505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
SCFMO study of the tautomerism of anilino-thiazole, anilino-oxazole, and anilino-oxadiazole shows that amino form predominates.
Collapse
Affiliation(s)
- N. Bodor
- Chemical-Pharmaceutical Research Institute, Cluj, Romania,
| | - I. Schwartz
- Medico-Pharmaceutical Institut, Catedra Chimie Fisica, Cluj, Romania,
| | - N. Trinajstić
- Institute “Rudjer Bošković”, Zagreb, Croatia, Yugoslavia
| |
Collapse
|
18
|
Portnoy S, Schwartz I. Gait characteristics of post-poliomyelitis patients: Standardization of quantitative data reporting. Ann Phys Rehabil Med 2013; 56:527-41. [PMID: 23891005 DOI: 10.1016/j.rehab.2013.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 06/24/2013] [Accepted: 06/29/2013] [Indexed: 01/03/2023]
Affiliation(s)
- S Portnoy
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Mount Scopus, Jerusalem 91240, Israel; Department of Occupational Therapy, Tel Aviv University, Tel Aviv, Israel.
| | | |
Collapse
|
19
|
Schwartz I, Kandel L, Sajina A, Litinezki D, Herman A, Mattan Y. Balance is an important predictive factor for quality of life and function after primary total knee replacement. ACTA ACUST UNITED AC 2012; 94:782-6. [PMID: 22628592 DOI: 10.1302/0301-620x.94b6.27874] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated the extent to which improved balance relative to pain relief correlates with the success of total knee replacement (TKR). A total of 81 patients were recruited to the study: 16 men (19.8%) and 65 women (80.2%). Of these, 62 patients (10 men, 52 women) with a mean age of 73 (57 to 83) underwent static and dynamic assessment of balance pre-operatively and one year post-operatively. The parameters of balance were quantified using commercially available and validated equipment. Motor function and self-reported outcome were also assessed. There was a significant improvement in dynamic balance (p < 0.001) one year after TKR, and better balance correlated with improved mobility, functional balance and increased health-related quality of life. As it seems that balance, and not only pain relief, influences the success of TKR, balance skills should be better addressed during the post-operative rehabilitation of patients who undergo TKR.
Collapse
Affiliation(s)
- I Schwartz
- Hadassah-Hebrew University Medical Center, Department of Physical Medicine and Rehabilitation, P.O. Box 24035, Jerusalem 91240, Israel
| | | | | | | | | | | |
Collapse
|
20
|
Yi Chun DX, Alexandre H, Edith B, Nacera O, Julie P, Chantal J, Eric R, Zhang X, Jin Y, Miravete M, Dissard R, Klein J, Gonzalez J, Caubet C, Pecher C, Pipy B, Bascands JL, Mercier-Bonin M, Schanstra J, Buffin-Meyer B, Claire R, Rigothier C, Richard D, Sebastien L, Moin S, Chantal B, Christian C, Jean R, Migliori M, Migliori M, Cantaluppi V, Mannari C, Medica D, Giovannini L, Panichi V, Goldwich A, Alexander S, Andre G, Amann K, Migliorini A, Sagrinati C, Angelotti ML, Mulay SR, Ronconi E, Peired A, Romagnani P, Anders HJ, Chiang WC, Lai CF, Peng WH, Wu CF, Chang FC, Chen YT, Lin SL, Chen YM, Wu KD, Lu KS, Tsai TJ, Virgine O, Qing Feng F, Zhang SY, Dominique D, Vincent A, Marina C, Philippe L, Georges G, Pawlak A, Sahali D, Matsumoto S, Kiyomoto H, Ichimura A, Dan T, Nakamichi T, Tsujita T, Akahori K, Ito S, Miyata T, Xie S, Zhang B, Shi W, Yang Y, Nagasu H, Satoh M, Kidokoro K, Nishi Y, Ihoriya C, Kadoya H, Sasaki T, Kashihara N, Wu CF, Chang FC, Chen YT, Chou YH, Duffield J, Lin SL, Rocca C, Rocca C, Gregorini M, Corradetti V, Valsania T, Bedino G, Bosio F, Pattonieri EF, Esposito P, Sepe V, Libetta C, Rampino T, Dal Canton A, Bedino G, Gregorini M, Corradetti V, Rocca C, Pattonieri EF, Valsania T, Bosio F, Esposito P, Sepe V, Libetta C, Rampino T, Dal Canton A, Omori H, Kawada N, Inoue K, Ueda Y, Yamamoto R, Matsui I, Kaimori J, Takabatake Y, Moriyama T, Isaka Y, Rakugi H, Wasilewska A, Taranta-Janusz K, Deebek W, Kuroczycka-Saniutycz E, Lee AS, Lee AS, Lee JE, Jung YJ, Kang KP, Lee S, Kim W, Arfian N, Emoto N, Yagi K, Nakayama K, Hartopo AB, Nugrahaningsih DA, Yanagisawa M, Hirata KI, Munoz-Felix JM, Lopez-Novoa JM, Martinez-Salgado C, Oujo B, Munoz-Felix JM, Arevalo M, Bernabeu C, Perez-Barriocanal F, Lopez-Novoa JM, Jesper K, Nathalie V, Pierre G, Yi Chun DX, Alexandre H, Eric R, Iyoda M, Shibata T, Matsumoto K, Shindo-Hirai Y, Kuno Y, Wada Y, Akizawa T, Schwartz I, Schwartz D, Prot Bertoye C, Prot Bertoye C, Terryn S, Claver J, Beghdadi WB, Monteiro R, Blank U, Devuyst O, Daugas E, Van Beneden K, Geers C, Pauwels M, Mannaerts I, Van den Branden C, Van Grunsven LA, Seckin I, Pekpak M, Uzunalan M, Uruluer B, Kokturk S, Ozturk Z, Sonmez H, Yaprak E, Furuno Y, Tsutsui M, Morishita T, Shimokawa H, Otsuji Y, Yanagihara N, Kabashima N, Ryota S, Kanegae K, Miyamoto T, Nakamata J, Ishimatsu N, Tamura M, Nakagawa T, Nakagawa T, Ichikawa K, Miyamoto M, Takabayashi D, Yamazaki H, Kakeshita K, Koike T, Kagitani S, Tomoda F, Hamashima T, Ishii Y, Inoue H, Sasahara M, El Machhour F, Kerroch M, Mesnard L, Chatziantoniou C, Dussaule JC, Inui K, Sasai F, Maruta Y, Nishiwaki H, Kawashima E, Inoue Y, Yoshimura A, Matsumoto K, Matsumoto K, Iyoda M, Shibata T, Wada Y, Shindo-Hirai Y, Kuno Y, Akizawa T, Musacchio E, Priante G, Valvason C, Sartori L, Baggio B, Kim JH, Gross O, Diana R, Gry DH, Asimal B, Johanna T, Imke SE, Lydia W, Gerhard-Anton M, Hassan D, Cano JL, Griera M, Olmos G, Martin P, Cortes MA, Lopez-Ongil S, Rodriguez-Puyol D, DE Frutos S, Gonzalez M, DE Frutos S, Cano JL, Luengo A, Martin P, Rodriguez-Puyol M, Calleros L, Lupica R, Lacquaniti A, Donato V, Maggio R, Mastroeni C, Lucisano S, Cernaro V, Fazio MR, Quartarone A, Buemi M, Kacik M, Goedicke S, Eggert H, Hoyer JD, Wurm S, Wurm S, Steege A, Banas M, Kurtz A, Banas B, Lasagni L, Lazzeri E, Peired A, Angelotti ML, Ronconi E, Romoli S, Romagnani P, Schaefer I, Teng B, Worthmann K, Haller H, Schiffer M, Prattichizzo C, Netti GS, Rocchetti MT, Cormio L, Carrieri G, Stallone G, Grandaliano G, Ranieri E, Gesualdo L, Kucher A, Smirnov A, Parastayeva M, Beresneva O, Kayukov I, Zubina I, Ivanova G, Abed A, Schlekenbach L, Foglia B, Chatziantoniou C, Kwak B, Chadjichristos C, Queisser N, Schupp N, Brand S, Himer L, Himer L, Szebeni B, Sziksz E, Saijo S, Kis E, Prokai A, Banki NF, Fekete A, Tulassay T, Vannay A, Hegner B, Schaub T, Lange C, Dragun D, Klinkhammer BM, Rafael K, Monika M, Anna M, Van Roeyen C, Boor P, Eva Bettina B, Simon O, Esther S, Floege J, Kunter U, Hegner B, Janke D, Schaub T, Lange C, Jankowski J, Dragun D, Hayashi M, Takamatsu I, Horimai C, Yoshida T, Seno DI Marco G, Koenig M, Stock C, Reiermann S, Amler S, Koehler G, Fobker M, Buck F, Pavenstaedt H, Lang D, Brand M, Plotnikov E, Morosanova M, Pevzner I, Zorova L, Pulkova N, Zorov D, Wornle M, Ribeiro A, Belling F, Merkle M, Nakazawa D, Nishio S, Shibasaki S, Tomaru U, Akihiro I, Kobayashi I, Imanishi Y, Kurajoh M, Nagata Y, Yamagata M, Emoto M, Michigami T, Ishimura E, Inaba M, Nishi Y, Satoh M, Sasaki T, Kashihara N, Wu CC, Lu KC, Chen JS, Chu P, Lin YF, Eller K, Schroll A, Banas M, Kirsch A, Huber J, Weiss G, Theurl I, Rosenkranz AR, Zawada A, Rogacev K, Achenbach M, Fliser D, Held G, Heine GH, Miyamoto Y, Iwao Y, Watanabe H, Kadowaki D, Ishima Y, Chuang VTG, Sato K, Otagiri M, Maruyama T, Ueda Y, Iwatani H, Isaka Y, Watanabe H, Honda D, Miyamoto Y, Noguchi T, Kadowaki D, Ishima Y, Tanaka M, Tanaka H, Fukagawa M, Otagiri M, Maruyama T, Wornle M, Ribeiro A, Pircher J, Koppel S, Mannell H, Krotz F, Merkle M, Virzi GM, Bolin C, Cruz D, Scalzotto E, De Cal M, Vescovo G, Ronco C, Virzi GM, Bolin C, Cruz D, Scalzotto E, De Cal M, Vescovo G, Ronco C, Grobmayr R, Lech M, Ryu M, Anders HJ, Aoshima Y, Mizobuchi M, Ogata H, Kumata C, Nakazawa A, Kondo F, Ono N, Koiwa F, Kinugasa E, Akizawa T, Freisinger W, Lale N, Lampert A, Ditting T, Heinlein S, Schmieder RE, Veelken R, Nave H, Perthel R, Suntharalingam M, Bode-Boger S, Beutel G, Kielstein J, Rodrigues-Diez R, Rodrigues-Diez R, Rayego-Mateos S, Lavoz C, Stark Aroeira LG, Orejudo M, Alique M, Ortiz A, Egido J, Ruiz-Ortega M, Oskar W, Rusan C, Schaub T, Hegner B, Dragun D, Padberg JS, Wiesinger A, Brand M, Seno DI Marco G, Reuter S, Grabner A, Kentrup D, Lukasz A, Oberleithner H, Pavenstadt H, Kumpers P, Eberhardt HU, Skerka C, Chen Q, Hallstroem T, Hartmann A, Kemper MJ, Zipfel PF, N'gome-Sendeyo K, Fan QF, Zhang SY, Pawlak A, Sahali D, Wornle M, Ribeiro A, Merkle M, Toblli J, Toblli J, Cao G, Giani JF, Dominici FP, Kim JS, Yang JW, Kim MK, Han BG, Choi SO. Experimental pathology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
21
|
Meiner Z, Cohen JE, Gomori JM, Sajin A, Schwartz I, Tsenter J, Yovchev I, Eichel R, Ben-Hur T, Leker RR. Rehabilitation outcomes of stroke patients treated with multi-modal endovascular reperfusion therapy. Eur J Phys Rehabil Med 2012; 48:31-37. [PMID: 21602761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of this study was to investigate the influence of multi-modal endovascular reperfusion therapy (MMRT) on functional outcomes following rehabilitation. METHODS Data from 14 MMRT-treated patients were analyzed and compared to MMRT-ineligible, age and stroke severity-matched patients treated at the same Neurological and Rehabilitation departments. Neurological evaluation was assessed with the NIH stroke scale (NIHSS). Activity of daily living was measured using the FIMTM instrument. Functional outcome was measured using the modified Rankin scale (mRS). RESULTS The baseline characteristics of both groups were similar. NIHSS scores were lower in the MMRT group and they had slightly better functional and rehabilitation scores on admission to rehabilitation. At the end of rehabilitation, more MMRT-treated patients reached functional independence (mRS≤2; 50% vs. 7% respectively P=0.03). FIM scores were also higher in the MMRT group (mean score 93.3 vs. 87.7, respectively) but the difference did not reach significance. The delta in FIM and NIHSS scores obtained during rehabilitation did not significantly differ between the groups. MMRT remained a significant modifier of good outcome after regression analysis (OR 21.5 95% CI 1.1-410). CONCLUSION MMRT-treated patients have better chances of attaining independence after rehabilitation therapy. However, the additional improvements gained while in active rehabilitation were independent of reperfusion status.
Collapse
Affiliation(s)
- Z Meiner
- Departments of Physical Medicine and Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Hamilton K, Salman MS, Schwartz I, McCusker PJ, Wrogemann J, Rafay MF. Arterial ischemic stroke in an adolescent with presumed perinatal ischemic stroke. J Child Neurol 2012; 27:94-8. [PMID: 21868371 DOI: 10.1177/0883073811414421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The risk of recurrent ischemic stroke after presumed perinatal stroke and the risk factors for such recurrence are rarely reported. Here, we present an adolescent with a history of presumed perinatal stroke who presented with arterial ischemic stroke recurrence at the age of 15 years. Hereditary thrombophilia screening performed at the time of his stroke recurrence demonstrated protein S deficiency. No evidence-based consensus guidelines on thrombophilia screening in children with presumed perinatal stroke exist, nor has the role of secondary prophylaxis been addressed. There is a risk of stroke recurrence after presumed perinatal stroke, and routine thrombophilia screening may identify those children who are at higher risk for recurrence and who might therefore benefit from secondary prophylaxis. Clear guidelines should be developed to standardize investigations and management of children with presumed perinatal ischemic stroke.
Collapse
Affiliation(s)
- Kristin Hamilton
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | | | | | | | | | | |
Collapse
|
23
|
Liveris D, Schwartz I, McKenna D, Nowakowski J, Nadelman RB, DeMarco J, Iyer R, Cox ME, Holmgren D, Wormser GP. Quantitation of cell-associated borrelial DNA in the blood of Lyme disease patients with erythema migrans. Eur J Clin Microbiol Infect Dis 2011; 31:791-5. [PMID: 21842448 DOI: 10.1007/s10096-011-1376-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
Bloodstream invasion is an important event in the pathogenesis of the more serious manifestations of Lyme disease. The number of spirochetes in the blood of infected patients, however, has not been determined, and, therefore, it is unknown whether the number of spirochetes can be correlated with particular clinical or laboratory features. This study was designed to measure the level of Borrelia burgdorferi in the plasma of Lyme disease patients and correlate these levels with selected clinical and laboratory findings. Nested and quantitative polymerase chain reaction (qPCR) was employed to detect cell-associated flaB gene DNA in the plasma of untreated early Lyme disease patients with erythema migrans (EM). Twenty-nine (45.3%) of 64 patients had evidence of B. burgdorferi in their plasma by at least one of the PCR methods. For the 22 qPCR-positive patients, the mean number of flaB gene copies per mL of plasma was 4,660, with a range of 414 to 56,000. The number of flaB gene copies did not significantly correlate with any of the clinical, demographic, or laboratory variables assessed. For reasons discussed, we suggest caution in extrapolating an estimate of the number of viable Borrelia in plasma from the observed number of flaB copies.
Collapse
Affiliation(s)
- D Liveris
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY 10595, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
John A, Fagondes S, Schwartz I, Azevedo A, Barrios P, Dalcin P, Barreto S, Giugliani R. 259 SLEEP EVALUATION IN PATIENTS WITH MUCOPOLYSACCHARIDOSIS TYPE VI. Sleep Med 2009. [DOI: 10.1016/s1389-9457(09)70261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Pat-Horenczyk R, Machyevsky D, Brom D, Schwartz I, Inbar M, Rice A, Wexler I, Corn B. Dyadic coping among breast cancer patients treated with radiotherapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20589 Background: Cancer poses a major stressor for patients and their partners. Understanding dyad coping is useful for determining if one partner's involvement is beneficial or harmful to the other. We sought to evaluate whether dyadic coping enhances resilience in the context of other risk and protective factors for coping with serious illness. Methods: An IRB-approved questionnaire was offered to breast cancer patients and their spouses. Consent was obtained from 21 dyads who were queried prior to initiation of breast irradiation and within 2 weeks of completing treatment. The nature of dyadic coping (positive or negative), level of posttraumatic stress, functional impairment, depression, and markers of resiliency were assessed for each partner at the beginning and conclusion of therapy. Results: Depression was significantly higher in patients than in their spouses (df = 1, 13; F = 6.13; p = 0.028). Over the course of the radiotherapy, partner's depression improved while the patient's depression worsened (df=1,13; F=5.46; p=0.030). The patient's negative dyadic coping assessment before radiation therapy was positively associated with depression (β = 0.78; df = 31.3; t = 2.15; p = 0.04), as well as the partner's depression (β = 0.92; df = 31.3; t = 2.52; p = 0.017) and posttraumatic stress (β = 0.74; df = 31.7; t = 2.10; p = 0.04). Patient's pre-radiation negative dyadic coping was negatively associated with the partner's flexibility (β = -.21; df = 19; t = -2.28; p = 0.03) and self efficacy (β = 0.46; df = 21.8; t = 2.96; p = 0.007) at completion of therapy. Positive dyadic coping assessment was not associated with negative coping behaviors on the part of either the patient or partner. Conclusions: The results of this pilot study support interventions incorporating dyadic support to enhance the resilience of patients and partners. Intervention should promote flexibility and self-efficacy while providing tools for altering negative dyadic coping patterns. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- R. Pat-Horenczyk
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - D. Machyevsky
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - D. Brom
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - I. Schwartz
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - M. Inbar
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - A. Rice
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - I. Wexler
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - B. Corn
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| |
Collapse
|
26
|
Moreh E, Meiner Z, Neeb M, Hiller N, Schwartz I. Spinal decompression sickness presenting as partial brown-sequard syndrome and treated with robotic-assisted body-weight support treadmill training. J Rehabil Med 2009; 41:88-9. [DOI: 10.2340/16501977-0279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
27
|
Pevni D, Frolkis I, Schwartz D, Schwartz I, Chernichovski T, Kramer A, Ben-Gal Y, Uretzky G, Shapira I, Weinbroum A. New evidence for the role of TNF-alpha in liver ischaemic/reperfusion injury. Eur J Clin Invest 2008; 38:649-55. [PMID: 18837741 DOI: 10.1111/j.1365-2362.2008.01996.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tumour necrosis factor-alpha (TNF-alpha) plays a key role in causing ischaemia/reperfusion (I/R) injury. I/R also causes activation of xanthine oxidase and dehydrogenase (XDH + XO) system that, via generated free radicals, causes organ damage. We investigated the effect of ischaemia, reperfusion and non-ischaemic prolonged perfusion (NIP) on TNF-alpha and XDH + XO production in an isolated perfused rat liver model. MATERIALS AND METHODS Rat livers underwent 150 min NIP (control group) or two hours of ischaemia followed by reperfusion (I/R group). TNF-alpha (TNF-alpha mRNA and protein level), XDH + XO production and bile secretion were determined in tissue and effluent at baseline, at 120 min of ischaemia, after 30 min of reperfusion (I/R group) and after 120 and 150 min of prolonged perfusion (control). RESULTS Unexpectedly, neither ischaemia nor reperfusion had any effect on TNF-alpha production. TNF-alpha in effluent was 11 +/- 4.8 pg mL(-1) at baseline, 7 +/- 3.2 pg mL(-1) at the end of ischaemia, and 13 +/- 5.3 pg mL(-1) after 30 min of reperfusion. NIP, however, caused a significant increase of TNF-alpha synthesis and release. TNF-alpha effluent level after 120 and 150 min of perfusion was 392 +/- 78.7 pg mL(-1) and 408 +/- 64.3 pg mL(-1), respectively. TNF-alpha mRNA in tissue was also significantly elevated compared to baseline levels (1.31 +/- 0.2 P < 0.001 and 1.38 P < 0.002, respectively). Decrease of liver function (expressed by bile secretion) during I/R and NIP was accompanied by significant XDH + XO elevation. CONCLUSION This is the first evidence that NIP, and not I/R, is the decisive trigger for TNF-alpha production. This study leads to a better understanding of pathogenesis of liver I/R and perfusion damage.
Collapse
Affiliation(s)
- D Pevni
- Department of Cardiac Surgery, Tel-Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Chu J, Schwartz I. eToims twitch relief method in chronic refractory myofascial pain (CRMP). Electromyogr Clin Neurophysiol 2008; 48:311-320. [PMID: 18837197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION CRMP management involves electrical stimulation of motor points. OBJECTIVE To demonstrate that Electrical Twitch-Obtaining Intramuscular Stimulation (eToims) using ET127 system for noninvasive motor point stimulation is safe and efficacious in CRMP management. METHOD Longitudinal observation of consecutive self-pay outpatients treated from 10/06 through 4/08, divided into Preferred Group ("PG", N = 49, 3 Hz, 4 stimuli/site) and Basic Group ("BG", N = 43, 1 Hz stimulation, 1 stimulus/site). PG and BG had comparable ages, symptom durations, treatment session durations and treatment intervals. Each session involved treatment to large muscles of C4-C7 and L3-S1 myotomes. Outcome measures include prior week's verbal pain levels, pre and immediate post-session pain levels, blood pressure (BP), pulse rate (PR), symptomatic (S) and asymptomatic (A) side range-of-motion (ROM) for neck rotation (NR), shoulder external rotation (ER), shoulder internal rotation (IR), straight leg raising (SLR) and FABERE testing. RESULTS PG and BG showed significant improvements (p < 0.01) in immediate post-session pain levels and measured ROM. Significantly higher ERS (pre and post session percentage changes) noted for BG over PG (p < 0.05). Post-session PR decreased in both groups, more so in PG Systolic BP was mildly elevated in PG but was mildly reduced in BG Both groups showed no diastolic BP changes. Significant negative correlation noted between increasing number of treatments and pain level only in PG (r = -0.3, p = 0.00). Increasing number of treatments in PG correlated significantly with improvement in NRS, NRA, IRS, SLRS, LRA, FABERES and FABEREA whereas BG significantly correlated only for improvement in LRS. PG had lower average pain levels than BG (3.4 +/- 1.9 vs. 4.3 +/- 2.5, p < 0.02). CONCLUSION eToims using ET127 electrical stimulator appears safe and efficacious in CRMP management.
Collapse
Affiliation(s)
- J Chu
- Department of Physial Medicine and Rehabilitation, University of Pennsylvania School of Medicine, USA.
| | | |
Collapse
|
29
|
Portlock CS, Hamlin P, Noy A, Chey W, Gaydos CA, Palomba L, Schwartz I, Corcoran S, Rosenzweig L, Walker D, Papanicolaou G, Markowitz A. Infectious disease associations in advanced stage, indolent lymphoma (follicular and nonfollicular): developing a lymphoma prevention strategy. Ann Oncol 2007; 19:254-8. [PMID: 17965114 DOI: 10.1093/annonc/mdm484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Eradication of Helicobacter pylori in gastric mucosa-associated lymphoid tumor can result in lymphoma remission. We prospectively identified/treated infections in nonbulky, advanced stage indolent lymphoma (follicular; nonfollicular lymphoma) eligible for observation. MATERIALS AND METHODS Stool H. pylori, hepatitis C and Borrelia serologies, Borrelia and Chlamydia fixed tissue PCR, Chlamydia peripheral blood mononuclear cell PCR and hydrogen breath test for small bowel bacterial overgrowth (SBBO) were obtained. RESULTS Fifty-six patients were enrolled. Positive infections: H. pylori (13); hepatitis C (3); SBBO (11). Negative: Borrelia (13); Chlamydophila psittaci (12, except one PCR). Lymphoma responses to antimicrobial therapy: H. pylori [one complete response (CR), 24+ months; one transient near CR]; hepatitis C [two CRs, 18+ and 30+ months; one partial response (PR) but hepatitis C virus persistent]; SBBO (one PR, 30+ months). Patients with associated infections, but without lymphoma CR, have required lymphoma treatment sooner than those without initial infections (treatment-free survival at 23.4 months median follow-up, 40.5% versus 74.7%, P = 0.01), indicating a different biology. CONCLUSION Infections are common in advanced stage indolent lymphoma (37.5% in our series). Anecdotal lymphoma responses have been seen and three have been durable CRs (18 to 30+ months) with infection eradication alone. The identification and treatment of associated infections may be a first step towards developing a lymphoma prevention strategy.
Collapse
Affiliation(s)
- C S Portlock
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY 10021, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Steiner I, Wirguin I, Blumen SC, Dano M, Raphaeli G, Schwartz I, Korn-Lubetzki I. 'Hyperacute' Guillain-Barré syndrome. Eur Neurol 2007; 59:88-90. [PMID: 17934279 DOI: 10.1159/000109575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 03/31/2007] [Indexed: 11/19/2022]
|
31
|
Feder HM, Johnson BJB, O'Connell S, Shapiro ED, Steere AC, Wormser GP, Agger WA, Artsob H, Auwaerter P, Dumler JS, Bakken JS, Bockenstedt LK, Green J, Dattwyler RJ, Munoz J, Nadelman RB, Schwartz I, Draper T, McSweegan E, Halperin JJ, Klempner MS, Krause PJ, Mead P, Morshed M, Porwancher R, Radolf JD, Smith RP, Sood S, Weinstein A, Wong SJ, Zemel L. A critical appraisal of "chronic Lyme disease". N Engl J Med 2007; 357:1422-30. [PMID: 17914043 DOI: 10.1056/nejmra072023] [Citation(s) in RCA: 397] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Henry M Feder
- Department of Family Medicine and Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Chavatte-Palmer P, Heyman Y, Schwartz I. 26 EFFECTS OF SOMATIC CLONING ON THE IMMUNE RESPONSE IN YOUNG AND ADULT CATTLE. Reprod Fertil Dev 2006. [DOI: 10.1071/rdv18n2ab26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Somatic cloning in cattle is associated with important gestational abnormalities, including implantation delay during the first 2 months of pregnancy and abnormal fetal and placental growth (known as large offspring syndrome, or LOS) in the third trimester. In our laboratory, between 3 and 25% of the cloned blastocysts transferred to recipient cows reach term, depending on genotype. About 20% of the newborns die rapidly due to various causes that appear to be direct consequences of the LOS. We previously reported on a thymic atrophy resulting from nuclear transfer (Renard et al. 1999 Lancet 353, 1459-1491) and have further diagnosed distinct pathological events occurring in the infancy and adult age of clones, including death due to apparently benign infections (despite treatment) and also thymic atrophy in approximately 20% of the postmortem cases. These observations in clones have led us to investigate the immune function of apparently normal bovine clones. Holstein cows housed in the same farm were used. Circulating lymphocyte populations during the resting state were marked, counted in 17 clones and 17 contemporary controls ranging from 15 days to 5 years of age, and allotted to one of three groups: 1 (0.5-2 months, n = 4 clones, n = 6 controls), 2 (3-9 months, n = 7 clones, n = 5 controls) and 3 (1.5-5 years, n = 6 clones, n = 6 controls). Clones originated from adult fibroblast cells from four different genotypes distributed in the three groups. Peripheral mononuclear blood cells (PMBCs) were collected, marked, and counted by flow cytometry. The specific markers were CD2, CD3, CD4, CD8, CD14, CD11b, CD25, CD45RO, P46 (NK cells), ��, PanB, MHC1, and MHC2. In a second experiment, six clones from three different genotypes and six controls aged 8-9 months were vaccinated with 10 mg ovalbumin in alum to evaluate the na�ve immune response. The cell subset proportions were not different between clones and controls. There was no difference between groups for antibody response to vaccination. However, T cell restimulation with specific antigens after immunization with evalbumin was significantly lower in clones compared to controls (P < 0.05). Furthermore, nonspecific stimulation with phytohemagglutinin (PHA) was also lower in clones (P < 0.05). These results show that lymphocyte populations are normally represented in apparently healthy clones. Bovine clones presented, however, a reduced capacity to build up a cellular immune response against a newly encountered antigen, such as ovalbumin. It remains to be determined whether these functional alterations are a result of defective reprogramming of immune functions during the cloning process or the consequence of an abnormal placental development leading to altered feto-placental interactions during pregnancy and fetal programming. Previous work by others has shown that there may be an abnormal expression of MHC1 in the placenta of bovine clones (Hill et al. 2002 Biol. Reprod. 67, 55-63), and this may well be part of the same phenomenon affecting overall immune regulation in clones.
Collapse
|
33
|
Weissberg D, Kaufmann M, Schwartz I. Iatrogenic bile duct stricture. Br J Surg 2005. [DOI: 10.1002/bjs.1800731238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- D Weissberg
- Department of Surgery, E. Wolfson Hospital, Holon, Israel
| | - M Kaufmann
- Department of Surgery, E. Wolfson Hospital, Holon, Israel
| | - I Schwartz
- Department of Surgery, E. Wolfson Hospital, Holon, Israel
| |
Collapse
|
34
|
Chu J, Eun SS, Schwartz I. Quantitative motor unit action potentials (QMUAP) in whiplash patients with neck and upper-limb pain. Electromyogr Clin Neurophysiol 2005; 45:323-8. [PMID: 16315969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Needle EMG studies in patients with whiplash symptoms to document presence of neural injury, such as cervical radiculopathy, are not available. OBJECTIVE To document presence of motor unit action potential (MUAP) parameter changes compatible with neurogenic involvement in symptomatic-limb muscles in whiplash induced acute and chronic pain states. DESIGN Retrospective review. SETTING Out patient quantitative electromyography (QEMG) laboratory. PARTICIPANTS 72 consecutive patients (mean age 43.6 years) who underwent QEMG between 1/2001 - 12/2004 for electrodiagnosis of neck and upper-limb pain related to auto-accidents (mean symptom duration 15.3 months). INTERVENTIONS QEMG with MUAP parameter analysis. MAIN OUTCOME MEASURES Amplitude, duration, size-index (SI), percentage of polyphasic units and firing rate analysis in chosen bilateral muscles representing C3-C8 myotomes. RESULTS No spontaneous activity noted in muscles examined. Without subsetting symptom duration, symptomatic-side: asymptomatic-side MUAP parameter comparison showed significant increase in MUAP frequency on the symptomatic-side C6-muscle (10.4 +/- 1.3 vs. 9.7 +/- 1.4, p = < 0.05), and C7 muscle (10.0 +/- 1.2 vs. 9.1 +/- 1.1, p < or = 0.01). The symptomatic-side C6-muscle also showed increased percentage of polyphasic-MUAPs (23.7 +/- 13.1 vs. 15.9 +/- 12.7, p < 0.001). Patients with acute symptom duration (< 6 months, mean duration 3.4 +/- 1.4 months, N=26), showed increased percentage of polyphasic MUAPs in the symptomatic-side C6-muscle (27.0 +/- 12.3% vs. asymptomatic 22.2 +/- 17.6%, p < or = 0.05). In patients with chronic symptom duration (> or =6 months, mean duration 22.0 +/- 17.9 months, N=46), symptomatic-side C6-muscle showed increased polyphasic MUAPs (22.2 +/- 13.2%) vs. asymptomatic (15.5 +/- 11.6%), p < or = 0.02, and higher firing rates (10.3 +/- 1.7 vs. 9.6 +/- 1.3 respectively, p < or = 0.003). CONCLUSIONS QEMG changes suggest neural injury in symptomatic side C6 and C7 innervated muscles, even in the absence of spontaneous activity. In acute and chronic pain patients a higher percentage of polyphasic MUAPs is noted in the symptomatic side C6 muscle. In chronic pain patients higher MUAP frequencies are noted in the symptomatic side C6 muscle.
Collapse
Affiliation(s)
- J Chu
- Department of Physical Medicine and Rehabilitation, Hospital of the University of PA, Philadelphia 19104, USA.
| | | | | |
Collapse
|
35
|
Takehara I, Chu J, Schwartz I, Aye HH. Motor unit action potential (MUAP) parameters affected by editing duration cursors. Electromyogr Clin Neurophysiol 2004; 44:265-9. [PMID: 15378864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Quantitative electromyography (QEMG) allows fast analysis of motor unit action potential (MUAP) parameters such as amplitude, duration, size index (SI), phases, turns and firing rate. When automated duration cursor placement is incorrect, the electrodiagnostician will manually edit this function potentially introducing bias to the final results. OBJECTIVE To identify that (1) size index is the MUAP parameter least affected by manually editing duration cursors and (2) MUAP amplitude will influence the manual cursor correction rate. MATERIALS AND METHODS Included were twenty-one consecutive patients who had QEMG with monopolar needle electrode for diagnostic evaluation of their myofascial pain symptoms. Evaluated for neck pain included 6 bilateral upper limb and cervical paraspinal muscles and for lower back pain were 5 bilateral lower limb and lower back muscles. Twenty MUAPs were recorded from each muscle and hardcopies of data obtained before and after manual edit. RESULTS Of a total of 5360 MUAPs analyzed 1764 (33%) required manual editing of duration cursors. Cursor correction rate 120 MUAP s/individual muscle analyzed was also similar at 33+/-17%. Percentage change in duration more so than turns, before and after correction, was significantly larger than that of other parameters. No significant differences in percentage changes noted between SI and phases. CONCLUSIONS SI and phases are least influenced by the manual correction of duration cursors since there is insubstantial amplitude and area at the tail-end of the MUAP.
Collapse
Affiliation(s)
- I Takehara
- Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | | | | | | |
Collapse
|
36
|
Bayard-Mc Neeley M, Bansal A, Chowdhury I, Girao G, Small CB, Seiter K, Nelson J, Liveris D, Schwartz I, Mc Neeley DF, Wormser GP, Aguero-Rosenfeld ME. In vivo and in vitro studies on Anaplasma phagocytophilum infection of the myeloid cells of a patient with chronic myelogenous leukaemia and human granulocytic ehrlichiosis. J Clin Pathol 2004; 57:499-503. [PMID: 15113857 PMCID: PMC1770287 DOI: 10.1136/jcp.2003.011775] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The occurrence of human granulocytic ehrlichiosis (HGE) in a patient with chronic myelogenous leukaemia (CML) provided an opportunity to study whether Anaplasma phagocytophilum, the aetiological agent of HGE, infects mature or immature cells, both in vivo and in vitro. METHODS Diagnosis of HGE was confirmed by culture, polymerase chain reaction (PCR), detection of intragranulocytic inclusions, and serology. The infection rates of different myelogenous stages of granulocytic differentiation were determined by microscopy. Anaplasma phagocytophilum infection of the bone marrow was analysed by PCR, culture, and microscopy. In addition, the in vitro growth of A phagocytophilum in the patient's granulocytes and in HL-60 cells (a promyelocytic leukaemia cell line) was compared. RESULTS Pretreatment blood smears showed that mature granulocytic cells had a higher infection rate with A phagocytophilum than did immature cells. In the original inoculation of the patient's cells into HL-60 cells to isolate A phagocytophilum, the bacterium grew faster in the patient's leukaemic cells than in HL-60 cells. Anaplasma phagocytophilum inclusions were rarely seen in bone marrow granulocytes and PCR was negative. In vitro, two A phagocytophilum isolates grew faster in the patient's granulocytes than in HL-60 cells. CONCLUSIONS The superior growth in CML cells compared with HL-60 cells suggests that A phagocytophilum preferentially infects mature granulocytes. The higher infection rate of the patient's mature versus immature granulocytes before treatment and the minimal level of infection of the patient's bone marrow support this. It is possible that the primary site of infection in HGE is the peripheral mature granulocytic population.
Collapse
Affiliation(s)
- M Bayard-Mc Neeley
- Department of Pathology, New York Medical College, Westchester Medical Center, Valhalla, New York 10595, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Sade K, Schwartz I, Schwartz D, Wolman Y, Chernichovski T, Fireman E, Iaina A, Kivity S. Effect of montelukast pretreatment on inducible nitric oxide synthase mRNA expression in the lungs of antigen-challenged allergic mice. Clin Exp Allergy 2004; 33:1741-6. [PMID: 14656364 DOI: 10.1111/j.1365-2222.2003.01798.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Growing evidence suggests that inducible nitric oxide synthase (iNOS) is the main source of the high output of exhaled nitric oxide (NO) in asthma. Treatment of asthmatic patients with glucocorticoids reduces high levels of exhaled NO mainly by inhibiting the transcription of iNOS. A similar reduction in exhaled NO was recently observed in patients treated with the leukotriene receptor antagonists, but the exact interaction between these drugs and iNOS remains obscure. OBJECTIVE The purpose of this study was to evaluate the effect of a leukotriene receptor antagonist, montelukast, on the expression and activity of iNOS in a murine model of allergic asthma. METHODS Twenty-four BALB/c mice were sensitized to OVA and were equally divided into 3 groups (Groups 1-3). Eight additional mice were sham sensitized and served as a negative control group (Group 4). Group 1 received montelukast 1 mg/kg/day in their drinking water, Group 2 received dexamethasone 1 mg/kg/day in their drinking water and Groups 3 and 4 received plain tap water. After 1 week, the animals were challenged by inhalation of OVA and, 3 h later, they were killed and their lung cells were isolated by enzymatic tissue digestion. NO generation was measured by a Griess assay, and iNOS mRNA was studied by RT-PCR. RESULTS A significant increase in iNOS mRNA expression and in NO generation was evident after allergen challenge compared with the controls. Pretreatment with montelukast mildly decreased NO production without producing a concomitant significant decrease in iNOS mRNA expression. CONCLUSION Unlike pretreatment with glucocorticoids, we failed to find compelling evidence for a major role for montelukast treatment in the modulation of iNOS mRNA in a murine model of acute asthma.
Collapse
Affiliation(s)
- K Sade
- Department of Pulmonary and Allergic Diseases, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Chu J, Takehara I, Li TC, Schwartz I. Skill and selection bias has least influence on motor unit action potential firing rate/frequency. Electromyogr Clin Neurophysiol 2003; 43:387-92. [PMID: 14626717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
INTRODUCTION Motor unit action potential (MUAP) rise time in quantitative electromyography (QEMG) using multi-MUAP analysis may influence neuromuscular disease diagnosis. OBJECTIVE To demonstrate in QEMG that MUAP firing rate/frequency (FR) is the parameter least dependent on electrodiagnostician skill (EDXc) skill and selection bias. METHODS AND MATERIALS During minimal contraction (< 6 MUAPs/4.8 s analysis period) of tibialis anterior, 20 MUAPs were selected for QEMG at each of the 3 insertion sites. There were three EDXcs (professor & two fellows), each an independent MUAP selector + EMG machine itself (EMGM), for a total of four independent MUAP selectors. EDXc and selector order variation at each site involved the following. At insertion site1, during EMG by EDXc 1, the MUAP selector order was EDXc 1, EMGM, EDXc 2 and EDXc 3. At the following two sites, the previous 1st selector was sequentially rotated to become the last selector during EMG by the subsequent EDXc. The protocol was repeated in two subjects. MUAP inclusion criteria by EDXcs was MUAP rise time < 1 ms by visual inspection and, by the EMGM, any and all MUAPs during the 4.8 s analysis period. RESULTS The reproducibility of measurements between MUAP selectors for mean frequency was satisfactory (correlation coefficient for inter-EDXc was 0.57, and 0.66 between the most experienced EDXc and EMGM. Inter- EDXc correlation coefficient was poor for amplitude (0.10), duration (0.34), size index (0.35), phases (-0.13) and turns (-0.22). Of the MUAPs collected by EMGM, the mean amplitude was smaller and mean duration was longer than those collected by the other 3 selectors with no significant differences for the other parameters. CONCLUSIONS FR was the only satisfactorily reproduced parameter from QEMG of MUAPs between selectors, and least dependent on skill and/or selection bias. From this, FR appears a relatively objective parameter, while other parameters appear unduly influenced by EDXc skill and/or MUAP selection bias.
Collapse
Affiliation(s)
- J Chu
- Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Ground White, Philadelphia, PA 19104-4283, USA.
| | | | | | | |
Collapse
|
39
|
Schwartz I, Silva LR, Leistner S, Todeschini LA, Burin MG, Pina-Neto JM, Islam RM, Shah GN, Sly WS, Giugliani R. Mucopolysaccharidosis VII: clinical, biochemical and molecular investigation of a Brazilian family. Clin Genet 2003; 64:172-5. [PMID: 12859417 DOI: 10.1034/j.1399-0004.2003.00119.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
40
|
Merimsky O, Issakov J, Schwartz I, Kollender Y, Inbar M, Meller I, Bickels J. Lack of c-kit overexpression in soft tissue sarcomas. Isr Med Assoc J 2003; 5:151-2. [PMID: 12674675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
|
41
|
Chu J, Neuhauser DV, Schwartz I, Aye HH. The efficacy of automated/electrical twitch obtaining intramuscular stimulation (atoims/etoims) for chronic pain control: evaluation with statistical process control methods. Electromyogr Clin Neurophysiol 2002; 42:393-401. [PMID: 12395614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Automated and/or electrical twitch-obtaining intramuscular stimulation (ATOIMS & ETOIMS) evoke twitches at/or near motor end plate zones to relieve muscle pain. OBJECTIVES To demonstrate that pain levels recorded daily by patients enable statistical process control (SPC) analysis of ATOIMS & ETOIMS effects over time. METHODS Four chronic fibromyalgic patients received ATOIMS & ETOIMS treatments to bilateral C3-C8 and L3-S1 myotomes and recorded daily pain on a visual analogue scale. Mechanical stimulation with ATOIMS involved a custom device to insert, oscillate and retract a monopolar needle (MN) at 2 Hz x2s. ETOIMS involved manual insertion of the MN and stimulating with 5 Volts, 0.5 ms pulse duration at 2 Hz for 2s to multiple sites. Positive outcome measures include two pain scales reduction. RESULTS Patient 1-4 had 89, 38, 40, 36 treatments during a follow-up time of 625, 1018, 378, 466 days with 5.4 +/- 3.7, 8.0 +/- 4.9, 4.2 +/- 2.4 and 4.6 +/- 2.7 days between treatments (DBT) during the first 6 months and 4.7 +/- 3.0, 21.8 +/- 15.6, 6.2 +/- 4.4 and 4.3 +/- 2.5 DBT respectively in the latter phase of the therapy. The average pain level (APL) in 1st week of treatment for patient 1-4 were 6.4 +/- 1.1, 3.7 +/- 1.1, 6.6 +/- 2.8 and 7.5 +/- 0.4 and in the last week of treatment were 4.5 +/- 0.4, 1.2 +/- 0.1, 4.2 +/- 1.0 and 4.7 +/- 0.7 respectively. APL correlated negatively with time during the first 6 months for patients 2-4 and also after 6 months for patients 4 & 1 who had unchanged and reduced DBT respectively. APL correlated positively with time for patient 2 with no correlation for patient 3 (both had increased DBT) after 6 months. CONCLUSIONS Patients will chronically record their pain scales daily enabling analysis by SPC. ATOIMS & ETOIMS applied periodically can be helpful in relieving fibromyalgic pain.
Collapse
Affiliation(s)
- J Chu
- Department of Rehabilitation Medicine, Ground Floor, White Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | | | | | | |
Collapse
|
42
|
Chu J, Gozon BS, Schwartz I. Twitch-obtaining intramuscular stimulation in reflex sympathetic dystrophy. Electromyogr Clin Neurophysiol 2002; 42:259-66. [PMID: 12168246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Reflex Sympathetic Dystrophy (RSD) remains a painful disease entity of undetermined etiology and variable response to therapy. FINDINGS Presented is a patient with left leg early RSD and chronic musculoskeletal back pain who received automated and electrical twitch-obtaining intramuscular stimulation (ATOIMS & ETOIMS) treatments. Diagnosis combined clinical symptoms of pain and allodynia, signs of motor/trophic changes and electromyographic evidence of especially of left L5 root level irritation, with chronic bilateral, multiple level partial lumbosacral nerve root involvement. Signs and symptoms of early RSD resolved with therapy. CONCLUSIONS ATOIMS-ETOIMS have a promising role in the treatment of early RSD associated with neuropathic pain resulting from spondylotic radiculopathy.
Collapse
Affiliation(s)
- J Chu
- Dept. of Rehabilitation Medicine, University of Pennsylvania Medical Center, Ground Floor, White Building, 3400 Spruce Street, Phila., PA 19104, USA.
| | | | | |
Collapse
|
43
|
Chu J, Schwartz I. The muscle twitch in myofascial pain relief: effects of acupuncture and other needling methods. Electromyogr Clin Neurophysiol 2002; 42:307-11. [PMID: 12168251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Proposed is that needling methods such as acupuncture, primarily effect pain relief in myofascial pain through a local mechanism, elicitation of muscle twitches. Occasionally, diagnostic needling procedures such as electromyography (EMG) can relieve such pain through insertional intramuscular movements of the needle electrode. This results in stimulation of the motor end-plate zones (MEPZs), eliciting muscle twitches. As needle elicitation of muscle twitches is a common diagnostic technique to identify myofascial trigger points (MTrPs), muscle twitches elicited at such points may be therapeutic, not just diagnostic. Occasionally evoked small local muscle twitches are observed in pain relieving methods using needle penetration or manipulation, such as classical or electrical acupuncture and intramuscular stimulation (IMS). Twitch elicitation has been observed to be essential to obtain myofascial pain relief associated with the needling methods of automated and electrical twitch-obtaining intramuscular stimulation (ATOIMS and ETOIMS). These two methods facilitate the elicitation of larger force twitches by mechanical or electrical stimulation respectively at motor end-plate zones.
Collapse
Affiliation(s)
- J Chu
- Department of Rehabilitation Medicine, Ground Floor, White Building, Hospital of the University of PA, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
44
|
Merimsky O, Issakov J, Bickels J, Kollender Y, Flusser G, Soyfer V, Schwartz I, Inbar M, Meller I. ErbB-4 expression in limb soft-tissue sarcoma: correlation with the results of neoadjuvant chemotherapy. Eur J Cancer 2002; 38:1335-42. [PMID: 12091063 DOI: 10.1016/s0959-8049(02)00075-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ErbB-4 is a recently described growth factor receptor. Relatively little is known about its expression in human tumours. In this study, we assessed the possible role of erbB-4 as a tissue marker for soft-tissue sarcomas (STS) and its correlation with the response to chemotherapy. The histological specimen of 29 patients with STS of a limb who had received preoperative doxorubicin (ADR)-based chemotherapy were studied for the degree of necrosis and the expression of erbB-4 (by an avidin-biotin-peroxidase technique). ErbB-4 expression in the preoperative tissue samples was compared with the expression in the postchemotherapy resected tumour. The true objective response rate to preoperative chemotherapy was 34%. Wide resection of the tumour was done in 12 patients, marginal in 14, amputation in 2 and no surgery in 1. The tumour necrosis was above 90% in 9 patients, 60-90% in 12, and less than 60% in 7 patients. An increase in erbB-4 expression was more common in cases with no response to chemotherapy, while no change or a decrease in erbB-4 was more common in responsive tumours (P=0.004). No correlation could be found between the degree of necrosis or the chemotherapeutic regimen and the change in expression of erbB-4. The median disease-free survival (DFS) was longer for patients with a decrease or no change in expression of erbB-4 than for patients with increased expression. It is believed that postchemotherapy new expression or no downregulation of the erbB-4 molecule represents tumour aggressiveness and increased capability of growth and spread.
Collapse
Affiliation(s)
- O Merimsky
- Department of Oncology, The Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Israel.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Nowakowski J, Schwartz I, Liveris D, Wang G, Aguero-Rosenfeld ME, Girao G, McKenna D, Nadelman RB, Cavaliere LF, Wormser GP. Laboratory diagnostic techniques for patients with early Lyme disease associated with erythema migrans: a comparison of different techniques. Clin Infect Dis 2001; 33:2023-7. [PMID: 11700579 DOI: 10.1086/324490] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2001] [Revised: 07/13/2001] [Indexed: 11/03/2022] Open
Abstract
Recently, a number of refinements in diagnostic modalities for detection of Borrelia burgdorferi infection have been developed. These include large-volume blood cultures, quantitative polymerase chain reaction (PCR) techniques, and 2-stage serologic testing. In the present study, we compared 6 diagnostic modalities in 47 adult patients who had a clinical diagnosis of erythema migrans. Quantitative PCR on skin biopsy-derived material was the most sensitive diagnostic method (80.9%), followed by 2-stage serologic testing of convalescent-phase samples (66.0%), conventional nested PCR (63.8%), skin culture (51.1%), blood culture (44.7%), and serologic testing of acute-phase samples (40.4%). Results of all assays were negative for 3 patients (6.4%). We conclude that the clinical diagnosis of erythema migrans is highly accurate in an area where B. burgdorferi is endemic if it is made by experienced health care personnel, but some patients with this diagnosis may not have B. burgdorferi infection. No single diagnostic modality is suitable for detection of B. burgdorferi in every patient with erythema migrans.
Collapse
Affiliation(s)
- J Nowakowski
- Division of Infectious Diseases and Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY, 10595, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Little is known about the natural history of asymptomatic Borrelia burgdorferi infection. Our analysis of the asymptomatic infections diagnosed serologically in a recent OspA vaccine trial conducted in the United States (N Engl J Med 1998;339: 209-215), suggests that the natural history of this event is more benign than that reported for untreated patients with erythema migrans (Ann Intern Med 1987;107: 725-731). We hypothesize that this is due either to incorrect diagnosis since the specificity of the serologic criteria used to diagnose asymptomatic infection in the vaccine study is unknown, or to infection with non-pathogenic strains of B. burgdorferi. Increasing evidence indicates that the invasive potential of strains of B. burgdorferi varies according to the specific subtype. Theoretically, a serologic testing method could be devised which would distinguish infection with invasive versus non-invasive strains of B. burgdorferi, and allow testing of the second hypothesis.
Collapse
Affiliation(s)
- G P Wormser
- Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York, USA
| | | | | | | |
Collapse
|
47
|
Abstract
Borrelia burgdorferi spends a significant proportion of its life cycle within an ixodid tick, which has a cuticle containing chitin, a polymer of N-acetylglucosamine (GlcNAc). The B. burgdorferi celA, celB, and celC genes encode products homologous to transporters for cellobiose and chitobiose (the dimer subunit of chitin) in other bacteria, which could be useful for bacterial nutrient acquisition during growth within ticks. We found that chitobiose efficiently substituted for GlcNAc during bacterial growth in culture medium. We inactivated the celB gene, which encodes the putative membrane-spanning component of the transporter, and compared growth of the mutant in various media to that of its isogenic parent. The mutant was no longer able to utilize chitobiose, while neither the mutant nor the wild type can utilize cellobiose. We propose renaming the three genes chbA, chbB, and chbC, since they probably encode a chitobiose transporter. We also found that the chbC gene was regulated in response to growth temperature and during growth in medium lacking GlcNAc.
Collapse
Affiliation(s)
- K Tilly
- Laboratory of Human Bacterial Pathogenesis, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana 59840, USA.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Iyer R, Liveris D, Adams A, Nowakowski J, McKenna D, Bittker S, Cooper D, Wormser GP, Schwartz I. Characterization of Borrelia burgdorferi isolated from erythema migrans lesions: interrelationship of three molecular typing methods. J Clin Microbiol 2001; 39:2954-7. [PMID: 11474020 PMCID: PMC88267 DOI: 10.1128/jcm.39.8.2954-2957.2001] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 11/20/2022] Open
Abstract
Genetic diversity among Borrelia burgdorferi isolates recovered from the skin of Lyme disease patients was assessed by ribosomal DNA (rDNA) spacer restriction fragment length polymorphism analysis, genomic restriction site polymorphism analysis, and plasmid content analysis. There was a significant association between the three rDNA spacer types, the six pulsed-field gel types, and plasmid content (P < 0.001). The association between distinct chromosomal and plasmid markers implies a clonal origin for each genotype.
Collapse
Affiliation(s)
- R Iyer
- Department of Biochemistry & Molecular Biology, New York Medical College, Valhalla, New York 10595, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Gozon B, Chu J, Schwartz I. Lumbosacral radiculopathic pain presenting as groin and scrotal pain: pain management with twitch-obtaining intramuscular stimulation. A case report and review of literature. Electromyogr Clin Neurophysiol 2001; 41:315-8. [PMID: 11572193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Chronic groin and scrotal pain is a common entity plaguing a significant population of young athletic individuals. Aside from urologic and visceral etiologies, there is a vast array of underlying musculoskeletal and spinal abnormalities that may be found in these individuals. FINDINGS Presented is a patient found to have chronic, spine-related groin and scrotal pain diagnosed with lower lumbar discogenic disease by physical examination findings, imaging studies and multi-level chronic radiculopathy by electrodiagnostic studies who was treated with twitch-obtaining intramuscular stimulation (TOIMS). Symptoms of groin and scrotal pain abated with therapy. CONCLUSION Twitch-obtaining intramuscular stimulation has a promising role in the treatment of groin and scrotal pain of radiculopathic origin.
Collapse
Affiliation(s)
- B Gozon
- Department of Rehabilitation Medicine, Hospital of the University of PA, Philadelphia, USA
| | | | | |
Collapse
|
50
|
Wang G, Ojaimi C, Iyer R, Saksenberg V, McClain SA, Wormser GP, Schwartz I. Impact of genotypic variation of Borrelia burgdorferi sensu stricto on kinetics of dissemination and severity of disease in C3H/HeJ mice. Infect Immun 2001; 69:4303-12. [PMID: 11401967 PMCID: PMC98500 DOI: 10.1128/iai.69.7.4303-4312.2001] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [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: 11/20/2022] Open
Abstract
Various genotypes of Borrelia burgdorferi sensu stricto have been previously identified among a large collection of isolates cultured from patients with Lyme disease in the United States. Furthermore, association of specific genotypes with hematogenous dissemination early in the disease course has been observed. The present study assessed kinetics of spirochete dissemination and disease severity in C3H/HeJ mice infected with two different genotypes of B. burgdorferi. Spirochete load in plasma and ear and other tissue samples of infected mice was measured by quantitative PCR, and these data were compared to those obtained by culture and histopathologic analysis. In mice infected with isolate BL206 (a type 1 strain), the peak number of spirochetes was observed in plasma between day 4 and 7, in heart and ear tissue on day 14, and in joints on day 28 postinoculation. There was a correlation between the peak number of spirochetes in plasma on day 4 or 7 and that in ear biopsy and joint specimens on day 14. By contrast, spirochete burdens in plasma of mice infected with isolate B356 (a type 3 strain) were 16- and 5-fold lower than those of BL206-infected mice on days 7 and 14 of infection, respectively. Similarly, approximately 6- and 13-fold fewer spirochetes were detected in the heart tissues of B356-infected mice compared to BL206-infected mice. Histopathologically, severe arthritis and aortitis were noted only in mice infected with isolate BL206. Spirochete dissemination and disease severity vary significantly in mice infected with distinct genotypes of B. burgdorferi, suggesting that genotypic differences in the infecting spirochetes play a key role in the pathogenesis and development of clinical disease.
Collapse
Affiliation(s)
- G Wang
- Department of Biochemistry and Molecular Biology, Department of Medicine, New York Medical College, Valhalla, New York 10595, USA
| | | | | | | | | | | | | |
Collapse
|