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Middelkoop K, Micklesfield LK, Walker N, Stewart J, Delport C, Jolliffe DA, Mendham AE, Coussens AK, van Graan A, Nuttall J, Tang JCY, Fraser WD, Cooper C, Harvey NC, Hooper RL, Wilkinson RJ, Bekker LG, Martineau AR. Influence of vitamin D supplementation on bone mineral content, bone turnover markers, and fracture risk in South African schoolchildren: multicenter double-blind randomized placebo-controlled trial (ViDiKids). J Bone Miner Res 2024; 39:211-221. [PMID: 38477739 DOI: 10.1093/jbmr/zjae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/27/2023] [Accepted: 01/05/2024] [Indexed: 03/14/2024]
Abstract
Randomized controlled trials (RCTs) to determine the influence of vitamin D on BMC and fracture risk in children of Black African ancestry are lacking. We conducted a sub-study (n = 450) nested within a phase 3 RCT of weekly oral supplementation with 10 000 IU vitamin D3 vs placebo for 3 yr in HIV-uninfected Cape Town schoolchildren aged 6-11 yr. Outcomes were BMC at the whole body less head (WBLH) and LS and serum 25-hydroxyvitamin D3 (25(OH)D3), PTH, alkaline phosphatase, C-terminal telopeptide, and PINP. Incidence of fractures was a secondary outcome of the main trial (n = 1682). At baseline, mean serum 25(OH)D3 concentration was 70.0 nmol/L (SD 13.5), and 5.8% of participants had serum 25(OH)D3 concentrations <50 nmol/L. Among sub-study participants, end-trial serum 25(OH)D3 concentrations were higher for participants allocated to vitamin D vs placebo (adjusted mean difference [aMD] 39.9 nmol/L, 95% CI, 36.1 to 43.6) and serum PTH concentrations were lower (aMD -0.55 pmol/L, 95% CI, -0.94 to -0.17). However, no interarm differences were seen for WBLH BMC (aMD -8.0 g, 95% CI, -30.7 to 14.7) or LS BMC (aMD -0.3 g, 95% CI, -1.3 to 0.8) or serum concentrations of bone turnover markers. Fractures were rare among participants in the main trial randomized to vitamin D vs placebo (7/755 vs 10/758 attending at least 1 follow-up; adjusted odds ratio 0.70, 95% CI, 0.27 to 1.85). In conclusion, a 3-yr course of weekly oral vitamin D supplementation elevated serum 25(OH)D3 concentrations and suppressed serum PTH concentrations in HIV-uninfected South African schoolchildren of Black African ancestry but did not influence BMC or serum concentrations of bone turnover markers. Fracture incidence was low, limiting power to detect an effect of vitamin D on this outcome.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Lisa K Micklesfield
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Newlands, Cape Town 7700, Western Cape, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, Gauteng, South Africa
| | - Neil Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Carmen Delport
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - David A Jolliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| | - Amy E Mendham
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Newlands, Cape Town 7700, Western Cape, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, Gauteng, South Africa
| | - Anna K Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia
| | - Averalda van Graan
- Biostatistics Unit, SAFOODS Division, South African Medical Research Council, Tygerberg, Cape Town 7505, Western Cape, South Africa
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, Western Cape, South Africa
| | - James Nuttall
- Department of Paediatrics and Child Health, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town 7700, Western Cape, South Africa
| | - Jonathan C Y Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
- Departments of Laboratory Medicine, Clinical Biochemistry and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, United Kingdom
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
- Departments of Laboratory Medicine, Clinical Biochemistry and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Richard L Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- The Francis Crick Institute, London NW1 1AT, United Kingdom
- Imperial College London, London W12 0NN, United Kingdom
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
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Middelkoop K, Micklesfield L, Stewart J, Walker N, Jolliffe DA, Mendham AE, Coussens AK, Nuttall J, Tang J, Fraser WD, Momand W, Cooper C, Harvey NC, Wilkinson RJ, Bekker LG, Martineau AR. Influence of vitamin D supplementation on growth, body composition, pubertal development and spirometry in South African schoolchildren: a randomised controlled trial (ViDiKids). BMJ Paediatr Open 2024; 8:e002495. [PMID: 38599800 PMCID: PMC11015302 DOI: 10.1136/bmjpo-2024-002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/29/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE To determine whether weekly oral vitamin D supplementation influences growth, body composition, pubertal development or spirometric outcomes in South African schoolchildren. DESIGN Phase 3 double-blind randomised placebo-controlled trial. SETTING Socioeconomically disadvantaged peri-urban district of Cape Town, South Africa. PARTICIPANTS 1682 children of black African ancestry attending government primary schools and aged 6-11 years at baseline. INTERVENTIONS Oral vitamin D3 (10 000 IU/week) versus placebo for 3 years. MAIN OUTCOME MEASURES Height-for-age and body mass index-for-age, measured in all participants; Tanner scores for pubertal development, spirometric lung volumes and body composition, measured in a subset of 450 children who additionally took part in a nested substudy. RESULTS Mean serum 25-hydroxyvitamin D3 concentration at 3-year follow-up was higher among children randomised to receive vitamin D versus placebo (104.3 vs 64.7 nmol/L, respectively; mean difference (MD) 39.7 nmol/L, 95% CI 37.6 to 41.9 nmol/L). No statistically significant differences in height-for-age z-score (adjusted MD (aMD) -0.08, 95% CI -0.19 to 0.03) or body mass index-for-age z-score (aMD -0.04, 95% CI -0.16 to 0.07) were seen between vitamin D versus placebo groups at follow-up. Among substudy participants, allocation to vitamin D versus placebo did not influence pubertal development scores, % predicted forced expiratory volume in 1 s (FEV1), % predicted forced vital capacity (FVC), % predicted FEV1/FVC, fat mass or fat-free mass. CONCLUSIONS Weekly oral administration of 10 000 IU vitamin D3 boosted vitamin D status but did not influence growth, body composition, pubertal development or spirometric outcomes in South African schoolchildren. TRIAL REGISTRATION NUMBERS ClinicalTrials.gov NCT02880982, South African National Clinical Trials Register DOH-27-0916-5527.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lisa Micklesfield
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Neil Walker
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David A Jolliffe
- Blizard Institiute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Amy E Mendham
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Anna K Coussens
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - James Nuttall
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Jonathan Tang
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Laboratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Laboratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Waheedullah Momand
- Blizard Institiute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert J Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, London, UK
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adrian R Martineau
- Blizard Institiute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Storoschuk KL, Lesiuk D, Nuttall J, LeBouedec M, Khansari A, Islam H, Gurd BJ. Impact of fasting on the AMPK and PGC-1α axis in rodent and human skeletal muscle: A systematic review. Metabolism 2024; 152:155768. [PMID: 38154612 DOI: 10.1016/j.metabol.2023.155768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 12/30/2023]
Abstract
Based primarily on evidence from rodent models fasting is currently believed to improve metabolic health via activation of the AMPK-PGC-1α axis in skeletal muscle. However, it is unclear whether the skeletal muscle AMPK-PGC-1α axis is activated by fasting in humans. The current systematic review examined the fasting response in skeletal muscle from 34 selected studies (7 human, 21 mouse, and 6 rat). From these studies, we gathered 38 unique data points related to AMPK and 47 related to PGC-1α. In human studies, fasting mediated activation of the AMPK-PGC-1α axis is largely absent. Although evidence does support fasting-induced activation of the AMPK-PGC-1α axis in rodent skeletal muscle, the evidence is less robust than anticipated. Our findings question the ability of fasting to activate the AMPK-PGC-1α axis in human skeletal muscle and suggest that the metabolic benefits of fasting in humans are associated with caloric restriction rather than the induction of mitochondrial biogenesis. Registration: https://doi.org/10.17605/OSF.IO/KWNQY.
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Affiliation(s)
- K L Storoschuk
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - D Lesiuk
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - J Nuttall
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - M LeBouedec
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - A Khansari
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - H Islam
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - B J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada.
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Middelkoop K, Stewart J, Walker N, Delport C, Jolliffe DA, Coussens AK, Nuttall J, Tang JCY, Fraser WD, Griffiths CJ, Kumar GT, Filteau S, Hooper RL, Wilkinson RJ, Bekker LG, Martineau AR. Vitamin D supplementation to prevent tuberculosis infection in South African schoolchildren: multicenter phase 3 double-blind randomized placebo-controlled trial (ViDiKids). Int J Infect Dis 2023; 134:63-70. [PMID: 37211272 DOI: 10.1016/j.ijid.2023.05.010] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVES To determine whether weekly oral supplementation with 10,000 IU vitamin D3 for 3 years reduces the risk of sensitization to M. tuberculosis in South African schoolchildren aged 6-11 years with negative QuantiFERON-tuberculosis (TB) Gold Plus (QFT-Plus) assay results at baseline. METHODS We conducted a phase 3 randomized placebo-controlled trial in 1682 children attending 23 primary schools in Cape Town. The primary outcome was a positive end-trial QFT-Plus result, analyzed using a mixed effects logistic regression model with the school of attendance included as a random effect. RESULTS 829 vs. 853 QFT-Plus-negative children were randomized to receive vitamin D3 vs. placebo, respectively. Mean end-study 25(OH)D concentrations in participants randomized to vitamin D vs. placebo were 104.3 vs 64.7 nmol/l, respectively (95% confidence interval for difference, 37.6 to 41.9 nmol/l). A total of 76/667 (11.4%) participants allocated to vitamin D vs. 89/687 (13.0%) participants allocated to placebo tested QFT-Plus positive at 3-year follow-up (adjusted odds ratio 0.86, 95% confidence interval 0.62-1.19, P = 0.35). CONCLUSION Weekly oral supplementation with 10,000 IU vitamin D3 for 3 years elevated serum 25(OH)D concentrations among QFT-Plus-negative Cape Town schoolchildren but did not reduce their risk of QFT-Plus conversion.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Neil Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carmen Delport
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - David A Jolliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna K Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Infectious Diseases and Immune Defense Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Jonathan C Y Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK; Departments of Laboratory Medicine, Clinical Biochemistry, and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK; Departments of Laboratory Medicine, Clinical Biochemistry, and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Christopher J Griffiths
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Geeta Trilok Kumar
- Delhi School of Public Health, Institute of Eminence, University of Delhi, Delhi, India; Trivedi School of Biosciences, Ashoka University, Sonipat, India
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard L Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; The Francis Crick Institute, London, UK; Imperial College London, London, UK
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Anderson K, Iyun V, Eley BS, Rabie H, Ferreira T, Nuttall J, Frigati L, Van Dongen N, Davies MA. Hospitalization among infants who initiate antiretroviral therapy before 3 months of age. AIDS 2023; 37:435-445. [PMID: 36695356 PMCID: PMC9881839 DOI: 10.1097/qad.0000000000003422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Studies examining hospitalization among infants with HIV in resource-limited settings, in the context of early infant diagnosis and early antiretroviral therapy (ART) initiation, are limited. METHODS We used routinely collected data on infants who initiated ART aged <3 months (Western Cape province, South Africa; 2013-2017) to describe hospitalization from birth until 12 months post-ART initiation. Record reviews were additionally performed at three tertiary-level facilities. We used mixed-effects Poisson regression to examine factors associated with hospitalization. RESULTS Among 840 infants, 579 (69%) were hospitalized; 36% had >1 hospitalization. Median age at ART initiation decreased from 57 days (interquartile range [IQR] 22-74; 2013-2015) to 19 days (IQR 5-54; 2016-2017). Early neonatal hospitalization (age <7 days) occurred in 271 infants (32%) and represented 24% of hospitalizations (272/1131). Overall, 443 infants (53%) were hospitalized at age ≥7 days, including 13% with hospitalizations pre-ART initiation, 15% pre and post-ART initiation and 25% post-ART initiation. Excluding early neonatal hospitalizations, initiating ART at older age vs. age <1 week was associated with higher hospitalization rates: adjusted incidence rate ratios (95% confidence interval) were 1.86 (1.31-2.64); 2.31 (1.62-3.29) and 2.47 (1.76-3.46) if ART initiation age was 1-4 weeks; 5-8 weeks and 9-12 weeks respectively. Among infants whose hospital records were reviewed, reasons for early neonatal hospitalizations mostly related to prematurity or low birthweight (n = 46/60; 77%) whereas hospitalizations at age ≥7 days were mostly due to infections (n = 206/243; 85%). CONCLUSIONS Earlier ART initiation is associated with lower hospitalization rates. High hospitalization rates, despite initiation age <3 months, is concerning.
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Affiliation(s)
- Kim Anderson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences
| | - Victoria Iyun
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences
| | - Brian S Eley
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town
| | - Helena Rabie
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Stellenbosch
| | - Thalia Ferreira
- Empilweni Services and Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Stellenbosch
| | - Nicola Van Dongen
- Empilweni Services and Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences
- Directorate of Health Impact Assessment, Western Cape Department of Health, Cape Town, South Africa
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Middelkoop K, Walker N, Stewart J, Delport C, Jolliffe DA, Nuttall J, Coussens AK, Naude CE, Tang JCY, Fraser WD, Wilkinson RJ, Bekker LG, Martineau AR. Prevalence and Determinants of Vitamin D Deficiency in 1825 Cape Town Primary Schoolchildren: A Cross-Sectional Study. Nutrients 2022; 14:nu14061263. [PMID: 35334921 PMCID: PMC8952729 DOI: 10.3390/nu14061263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
Vitamin D deficiency (25-hydroxyvitamin D[25(OH)D] <50 nmol/L) is common among adults in Cape Town, South Africa, but studies investigating vitamin D status of children in this setting are lacking. We conducted a cross-sectional study to determine the prevalence and determinants of vitamin D deficiency in 1825 Cape Town schoolchildren aged 6−11 years. Prevalence of vitamin D deficiency was 7.6% (95% Confidence Interval [CI] 6.5% to 8.9%). Determinants of vitamin D deficiency included month of sampling (adjusted odds ratio [aOR] for July−September vs. January−March 10.69, 95% CI 5.02 to 22.77; aOR for October−December vs. January−March 6.73, 95% CI 2.82 to 16.08), older age (aOR 1.25 per increasing year, 95% CI: 1.01−1.53) and higher body mass index (BMI; aOR 1.24 per unit increase in BMI-for-age Z-score, 95% CI: 1.03−1.49). In a subset of 370 participants in whom parathyroid hormone (PTH) concentrations were measured; these were inversely related to serum 25(OH)D concentrations (p < 0.001). However, no association between participants with hyperparathyroidism (PTH >6.9 pmol/L) and vitamin D deficiency was seen (p = 0.42). In conclusion, we report that season is the major determinant of vitamin D status among Cape Town primary schoolchildren, with prevalence of vitamin D deficiency ranging from 1.4% in January−March to 22.8% in July−September.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
- Correspondence: (K.M.); (A.R.M.)
| | - Neil Walker
- Wolfson Institute of Population Health, Queen Mary University of London, London E1 2AB, UK; (N.W.); (D.A.J.)
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Carmen Delport
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - David A. Jolliffe
- Wolfson Institute of Population Health, Queen Mary University of London, London E1 2AB, UK; (N.W.); (D.A.J.)
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town 7700, South Africa;
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7700, South Africa
| | - Anna K. Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (A.K.C.); (R.J.W.)
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute, Parkville, VIC 3052, Australia
| | - Celeste E. Naude
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Jonathan C. Y. Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (J.C.Y.T.); (W.D.F.)
| | - William D. Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (J.C.Y.T.); (W.D.F.)
- Departments of Clinical Biochemistry and Endocrinology, Norfolk and Norwich University Hospitals Trust, Norwich NR4 7UY, UK
| | - Robert J. Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (A.K.C.); (R.J.W.)
- The Francis Crick Institute, Midland Road, London NW1 1AT, UK
- Department of Infectious Diseases, Imperial College London, London W12 0NN, UK
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Adrian R. Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- Correspondence: (K.M.); (A.R.M.)
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7
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Craig J, Frost I, Sriram A, Nuttall J, Kapoor G, Alimi Y, Varma JK. Development of the first edition of African treatment guidelines for common bacterial infections and syndromes. J Public Health Afr 2021; 12:2009. [PMID: 35126891 PMCID: PMC8791021 DOI: 10.4081/jphia.2021.2009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022] Open
Abstract
Standard treatment guidelines (STGs) are an important tool for ensuring high quality clinical care and prudent antimicrobial use (AMU) and stewardship (AMS). In 2018, African Union (AU) member state representatives recognized the lack of STGs as a barrier to AMS at national and facility levels. Previous research reported that only 17 of 55 (31%) member states had STGs that provided disease- or pathogen-specific antimicrobial treatment recommendations, excluding those that covered only treatment of HIV, malaria, and tuberculosis). The Africa Centres for Disease Control and Prevention convened expert panels to develop first edition antibiotic treatment guidelines for priority infectious diseases and clinical syndromes for pediatric and adult patient populations in Africa. The purpose of the guidelines is to provide healthcare workers with treatment guidance by harmonising existing national STGs, filling gaps where existing STGs are not available, and serving as a model for future guidelines. Two expert panels of 28 total clinicians, pharmacists, and other relevant stakeholders from 14 AU member states representing each continental region convened to develop consensus treatment recommendations for select priority bacterial infections and clinical syndromes. In developing recommendations, the panels considered treatment recommendations from existing STGs, drug availability, clinical experience, and available antimicrobial resistance data. The guidelines underwent an external review process where clinical stakeholders who did not serve on either panel were invited to submit feedback prior to their publication. The guidelines provide empiric antibiotic therapy guidelines - including drug selection, route of administration, formulation, dosage, and therapy duration - and principles of stewardship for 28 bacterial infections or clinical syndromes. The first edition guidelines for the treatment of common infectious diseases and clinical syndromes in Africa aims to improve clinical treatment and antimicrobial stewardship and will serve as a template for future regional guidelines.
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Affiliation(s)
- Jessica Craig
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA
| | | | - Aditi Sriram
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - James Nuttall
- Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
| | | | - Yewande Alimi
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Jay K. Varma
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
- Weill Cornell Medicine, Department of Population Health Sciences, New York, USA
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8
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Levin LJ, Horak JL, Nuttall J. Looking back at paediatric HIV treatment in South Africa. My, how we have grown! South Afr J HIV Med 2021; 22:1283. [PMID: 34691770 PMCID: PMC8517800 DOI: 10.4102/sajhivmed.v22i1.1283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/01/2021] [Indexed: 11/06/2022] Open
Abstract
Antiretroviral treatment has undergone major changes in the last 20 years, from monotherapy, to dual therapy and finally to triple therapy. Lately, more focus has been placed on better, more well-tolerated combinations and formulations. As in most other disciplines in medicine, the development of paediatric HIV dosages and formulations always tends to lag behind adult research. Twenty years ago, it could take several years before data were available to enable the use of life-saving antiretrovirals in children. Paediatricians, being ever resourceful, were not prepared to let their paediatric patients suffer despite the lack of data or formulations and so made a plan. This article describes some of the trials and tribulations that we went through trying to make sure that our paediatric HIV patients not only survived but thrived. Clinicians treating paediatric patients today have it so much easier because of what our colleagues and their patients went through in those early days.
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Affiliation(s)
- Leon J Levin
- Department of Paediatrics, Right to Care, Johannesburg, South Africa
| | - Juliet L Horak
- Department of Paediatrics, Dora Nginza Hospital, Gqeberha, South Africa
| | - James Nuttall
- Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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9
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Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J, Eminton Z, Ball D, Barrett C, Johnson L, Nuttall J, Fox K, Connolly D, O'Kane P, Hobson A, Chauhan A, Uren N, Mccann GP, Berry C, Carter J, Roobottom C, Mamas M, Rajani R, Ford I, Douglas P, Hlatky MA. Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J 2021; 42:3844-3852. [PMID: 34269376 PMCID: PMC8648068 DOI: 10.1093/eurheartj/ehab444] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/10/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Fractional flow reserve (FFRCT) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFRCT would improve economic and clinical outcomes compared with standard care. Methods and results Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFRCT (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFRCT. Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from −£112 (−8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). Conclusion A strategy of CTCA with selective FFRCT in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.
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Affiliation(s)
- N Curzen
- Faculty of Medicine, University of Southampton.,Coronary Research Group, University Hospital Southampton
| | - Z Nicholas
- Coronary Research Group, University Hospital Southampton
| | - B Stuart
- Clinical Trials Unit, University of Southampton
| | - S Wilding
- Clinical Trials Unit, University of Southampton
| | - K Hill
- Clinical Trials Unit, University of Southampton
| | - J Shambrook
- Cardiothoracic Radiology, University Hospital Southampton
| | - Z Eminton
- Clinical Trials Unit, University of Southampton
| | - D Ball
- Clinical Trials Unit, University of Southampton
| | - C Barrett
- Clinical Trials Unit, University of Southampton
| | - L Johnson
- Clinical Trials Unit, University of Southampton
| | - J Nuttall
- Clinical Trials Unit, University of Southampton
| | - K Fox
- Imperial College, London, UK
| | | | - P O'Kane
- Dorset Heart Centre, University Hospitals Dorset, Bournemouth
| | - A Hobson
- Queen Alexandra Hospital, Portsmouth
| | | | - N Uren
- Royal Infirmary, Edinburgh
| | - G P Mccann
- Department of Cardiovascular Sciences, University of Leicester & NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow
| | - J Carter
- University Hospital of North Tees, Stockton on Tees
| | | | - M Mamas
- Royal Stoke University Hospital, Stoke-on-Trent
| | - R Rajani
- Guy's & St Thomas' Hospital, London
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow
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10
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Ogunbosi BO, Moodley C, Naicker P, Nuttall J, Bamford C, Eley B. Colonisation with extended spectrum beta-lactamase-producing and carbapenem-resistant Enterobacterales in children admitted to a paediatric referral hospital in South Africa. PLoS One 2020; 15:e0241776. [PMID: 33156820 PMCID: PMC7647087 DOI: 10.1371/journal.pone.0241776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION There are few studies describing colonisation with extended spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE) among children in sub-Saharan Africa. Colonisation often precedes infection and multi-drug-resistant Enterobacterales are important causes of invasive infection. METHODS In this prospective cross-sectional study, conducted between April and June 2017, 200 children in a tertiary academic hospital were screened by rectal swab for EBSL-PE and CRE. The resistance-conferring genes were identified using polymerase chain reaction technology. Risk factors for colonisation were also evaluated. RESULTS Overall, 48% (96/200) of the children were colonised with at least one ESBL-PE, 8.3% (8/96) of these with 2 ESBL-PE, and one other child was colonised with a CRE (0.5% (1/200)). Common colonising ESBL-PE were Klebsiella pneumoniae (62.5%, 65/104) and Escherichia coli (34.6%, 36/104). The most frequent ESBL-conferring gene was blaCTX-M in 95% (76/80) of the isolates. No resistance- conferring gene was identified in the CRE isolate (Enterobacter cloacae). Most of the Klebsiella pneumoniae isolates were susceptible to piperacillin/tazobactam (86.2%) and amikacin (63.9%). Similarly, 94.4% and 97.2% of the Escherichia coli isolates were susceptible to piperacillin/tazobactam and amikacin, respectively. Hospitalisation for more than 7 days before study enrolment was associated with ESBL-PE colonisation. CONCLUSION Approximately half of the hospitalised children in this study were colonised with ESBL-PE. This highlights the need for improved infection prevention and control practices to limit the dissemination of these microorganisms.
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Affiliation(s)
- Babatunde O. Ogunbosi
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Clinton Moodley
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Preneshni Naicker
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Colleen Bamford
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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11
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Dame JA, Beylis N, Nuttall J, Eley B. Pseudomonas aeruginosa bloodstream infection at a tertiary referral hospital for children. BMC Infect Dis 2020; 20:729. [PMID: 33028225 PMCID: PMC7541237 DOI: 10.1186/s12879-020-05437-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/20/2020] [Indexed: 05/30/2023] Open
Abstract
Background This study describes the disease burden, clinical characteristics, antibiotic management, impact of multidrug resistance and outcome of Pseudomonas aeruginosa bloodstream infection (PABSI) among children admitted to a tertiary referral hospital for children in Cape Town, South Africa. Methods A retrospective descriptive study was conducted at a paediatric referral hospital in Cape Town, South Africa. Demographic and clinical details, antibiotic management and patient outcome information were extracted from medical and laboratory records. Antibiotic susceptibility results of identified organisms were obtained from the National Health Laboratory Service database. Results The incidence risk of PABSI was 5.4 (95% CI: 4.34–6.54) PABSI episodes / 10,000 hospital admissions and the most common presenting feature was respiratory distress, 34/91 (37.4%). Overall, 69/91 (75.8%) of the PA isolates were susceptible to all antipseudomonal antibiotic classes evaluated. Fifty (54.9%) of the PABSI episodes were treated with appropriate empiric antibiotic therapy. The mortality rate was 24.2% and in multivariable analysis, empiric antibiotic therapy to which PA isolates were not susceptible, infections present on admission, and not being in the intensive care unit at the time that PABSI was diagnosed were significantly associated with 14-day mortality. Conclusions PABSI caused appreciable mortality, however, appropriate empiric antibiotic therapy was associated with reduced 14-day mortality.
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Affiliation(s)
- Joycelyn Assimeng Dame
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - Natalie Beylis
- National Health Laboratory Service, Groote Schuur Hospital and Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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12
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Enimil AK, Eley B, Nuttall J. The initial intravenous treatment of a human immunodeficiency virus-infected child with complicated abdominal tuberculosis. South Afr J HIV Med 2020; 21:1121. [PMID: 32934837 PMCID: PMC7479423 DOI: 10.4102/sajhivmed.v21i1.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/11/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction There is very limited published experience with intravenous (IV) antituberculosis (anti-TB) and antiretroviral therapy (ART) especially in children. We have described a human immunodeficiency virus (HIV)-infected child with complicated abdominal tuberculosis who was initially treated with IV anti-TB and a partially IV ART regimen before transitioning to oral therapy. Patient presentation A 3-year-old boy presented with hypovolaemic shock with a 3-day history of inability to pass stools, abdominal distension and bile-stained vomiting. Abdominal ultrasound and X-ray showed small-bowel obstruction. Human immunodeficiency virus antibody testing was positive, and Cluster of Differentiation (CD)4+ lymphocyte count was 56 cells/mL (15%). Xpert Mycobacterium tuberculosis (MTB)/Rifampicin (RIF) Ultra and TB culture on induced sputum detected MTB complex sensitive to rifampicin and isoniazid. Management and outcome Following laparotomy and closure of bowel perforations, the child was commenced on IV rifampicin, moxifloxacin and amikacin. Amikacin was stopped after 3 days because of nephrotoxicity, and meropenem and IV linezolid were added. After 20 days, ART comprising IV zidovudine, oral lamivudine solution, oral lopinavir/ritonavir solution and additional oral ritonavir solution for super boosting was commenced. By day 40, the patient was well established on oral feeds and was switched to standard oral anti-TB medications. Sputum examined 1 month after starting the treatment was found culture-negative for MTB. After 4 months of treatment, the HIV viral load was < 100 copies/mL. He completed a total of 12 months of anti-TB treatment. Conclusion Despite limited experience and few available IV formulations of standard anti-TB and ARV medications, initial IV therapy may be beneficial for patients in whom oral medication is not an option.
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Affiliation(s)
- Anthony K Enimil
- Department of Paediatrics and Child Health, College of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Paediatrics and Child Health, College of Health Sciences, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Brian Eley
- Department of Paediatrics and Child Health, College of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Paediatrics and Child Health, College of Health Sciences, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - James Nuttall
- Department of Paediatrics and Child Health, College of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Paediatrics and Child Health, College of Health Sciences, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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13
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Motaze NV, Manamela J, Smit S, Rabie H, Harper K, duPlessis N, Reubenson G, Coetzee M, Ballot D, Moore D, Nuttall J, Linley L, Tooke L, Kriel J, Hallbauer U, Sutton C, Moodley P, Hardie D, Mazanderani AH, Goosen F, Kyaw T, Leroux D, Hussain A, Singh R, Kelly C, Ducasse G, Muller M, Blaauw M, Hamese M, Leeuw T, Mekgoe O, Rakgole P, Dungwa N, Maphosa T, Sanyane K, Preiser W, Cohen C, Suchard M. Congenital Rubella Syndrome Surveillance in South Africa Using a Sentinel Site Approach: A Cross-sectional Study. Clin Infect Dis 2020; 68:1658-1664. [PMID: 30203002 PMCID: PMC6495013 DOI: 10.1093/cid/ciy758] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/31/2018] [Indexed: 11/12/2022] Open
Abstract
Background Congenital rubella syndrome (CRS) includes disorders associated with intrauterine rubella infection. Incidence of CRS is higher in countries with no rubella-containing vaccines (RCV) in their immunization schedules. In the World Health Organization African region, RCVs are being introduced as part of the 2012–2020 global measles and rubella strategic plan. This study aimed to describe the epidemiology of confirmed CRS in South Africa prior to introduction of RCVs in the immunization schedule. Methods This was a descriptive study with 28 sentinel sites reporting laboratory-confirmed CRS cases in all 9 provinces of South Africa. In the retrospective phase (2010 to 2014), CRS cases were retrieved from medical records, and in the prospective phase (2015 to 2017) clinicians at study sites reported CRS cases monthly. Results There were 42 confirmed CRS cases in the retrospective phase and 53 confirmed CRS cases in the prospective phase. Most frequently reported birth defects were congenital heart disease and cataracts. The median age of mothers of CRS cases was 21 years in the retrospective phase (range: 11 to 38 years) and 22 years in the prospective phase (range: 15 to 38 years). Conclusion Baseline data on laboratory-confirmed CRS will enable planning and monitoring of RCV implementation in the South African Expanded Programme on Immunization program. Ninety-eight percent of mothers of infants with CRS were young women 14–30 years old, indicating a potential immunity gap in this age group for consideration during introduction of RCV.
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Affiliation(s)
- Nkengafac Villyen Motaze
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Jack Manamela
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sheilagh Smit
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Helena Rabie
- Department of Pediatrics, Tygerberg Hospital, Stellenbosch University, South Africa
| | - Kim Harper
- Department of Pediatrics, Frere Hospital, East London, South Africa
| | - Nicolette duPlessis
- Department of Pediatrics, Kalafong Hospital, University of Pretoria, South Africa
| | - Gary Reubenson
- Department of Pediatrics and Child Health, Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Melantha Coetzee
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital, University of Pretoria, South Africa
| | - Daynia Ballot
- Department of Pediatrics and Child Health, Charlotte Maxeke Academic Hospital, Johannesburg
| | - David Moore
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - James Nuttall
- Department of Pediatrics, Red Cross War Memorial Children's Hospital, South Africa
| | - Lucy Linley
- Department of Pediatrics, Mowbray Maternity Hospital, South Africa
| | - Lloyd Tooke
- Department of Pediatrics, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Jeannette Kriel
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Ute Hallbauer
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Christopher Sutton
- Department of Pediatrics and Child Health, Polokwane Hospital, University of Limpopo, South Africa
| | - Pravi Moodley
- Department of Virology, Inkosi Albert Luthuli Central Hospital, University of Kwazulu-Natal, South Africa
| | - Diana Hardie
- Division of Medical Virology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Ahmad Haeri Mazanderani
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Felicity Goosen
- Department of Pediatrics, Cecilia Makiwane Hospital, East London, South Africa
| | - Thanda Kyaw
- Department of Virological Pathology, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Dave Leroux
- Department of Pediatrics, New Somerset Hospital, University of Cape Town, South Africa
| | - Akhtar Hussain
- Department of Pediatrics, Prince Mshiyeni Memorial Hospital, Durban
| | - Radhika Singh
- Department of Pediatrics, King Edward VIII Hospital, Durban
| | | | - Graham Ducasse
- Department of Pediatrics, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Magdaleen Blaauw
- Department of Pediatrics and Neonatology, Dr Harry Surtie Hospital, Upington, South Africa
| | - Mohlabi Hamese
- Department of Pediatrics and Child Health, Mankweng Hospital, University of Limpopo, South Africa
| | - Tumelo Leeuw
- Department of Pediatrics, Mafikeng Provincial Hospital, South Africa
| | - Omphile Mekgoe
- Department of Pediatrics, Klerksdorp Hospital, South Africa
| | - Philemon Rakgole
- Department of Pediatrics, Job Shimankana Tabane Hospital, Rustenburg, South Africa
| | - Norman Dungwa
- Department of Pediatrics, Witbank Hospital, South Africa
| | - Thulisile Maphosa
- Department of Pediatrics, Rob Fereirra Hospital, Nelspruit, South Africa
| | - Kgomotso Sanyane
- Department of Pediatrics, Dr George Mukhari Hospital, Sefako Makgatho University, Pretoria, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service Tygerberg, South Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa
| | - Melinda Suchard
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Wessels J, Sherman G, Bamford L, Makua M, Ntloana M, Nuttall J, Pillay Y, Goga A, Feucht U. The updated South African National Guideline for the Prevention of Mother to Child Transmission of Communicable Infections (2019). South Afr J HIV Med 2020; 21:1079. [PMID: 32832113 PMCID: PMC7433286 DOI: 10.4102/sajhivmed.v21i1.1079] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/03/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jeannette Wessels
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Gayle Sherman
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for HIV & STI, National Institute for Communicable Diseases, Division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Lesley Bamford
- Child, Youth, and School Health Chief Directorate, National Department of Health, Pretoria, South Africa.,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Manala Makua
- Communicable and Non-Communicable Diseases Branch, National Department of Health, Pretoria
| | - Mathilda Ntloana
- Communicable and Non-Communicable Diseases Branch, National Department of Health, Pretoria
| | - James Nuttall
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Yogan Pillay
- Communicable and Non-Communicable Diseases Branch, National Department of Health, Pretoria
| | - Ameena Goga
- Health Systems Research Unit, South African Research Council, Cape Town, South Africa.,Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa.,HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ute Feucht
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa.,Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa.,Tshwane District Health Services, Gauteng Department of Health, Tshwane, South Africa.,Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
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15
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Meintjes G, Brust JCM, Nuttall J, Maartens G. Management of active tuberculosis in adults with HIV. Lancet HIV 2020; 6:e463-e474. [PMID: 31272663 DOI: 10.1016/s2352-3018(19)30154-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/25/2019] [Accepted: 05/08/2019] [Indexed: 12/11/2022]
Abstract
Every year, about 1 million people living with HIV worldwide develop tuberculosis. Although the drug regimens used to treat tuberculosis in these patients are the same as those used in HIV-negative patients, cotreatment of tuberculosis with antiretroviral therapy involves challenges including the optimal timing of antiretroviral initiation, drug-drug interactions, drug tolerability, and the prevention and treatment of tuberculosis-associated immune reconstitution syndrome. Furthermore, mortality is high in people with HIV who are diagnosed with tuberculosis during a hospital admission, and in those with tuberculous meningitis. Studies in this field have better characterised these challenges and informed optimal management and guideline revisions. In patients with tuberculosis, antiretroviral therapy improves survival, is well tolerated, and can be adjusted to manage drug-drug interactions with rifampicin. Prednisone is effective in both preventing and treating the paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome.
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Affiliation(s)
- Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, South Africa; Division of Infectious Diseases and HIV Medicine, Department of Medicine, South Africa.
| | - James C M Brust
- University of Cape Town, Observatory, South Africa; Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, New York, NY, USA
| | - James Nuttall
- Department of Paediatrics and Child Health, South Africa
| | - Gary Maartens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, South Africa; Division of Clinical Pharmacology, Department of Medicine, South Africa
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Parvin S, Uddin S, Bourgault M, Delahunty A, Nuttall J, Brand J, O'Leary G, Fitzgerald GJ, Armstrong R, Tausz M. Effect of heat wave on N 2 fixation and N remobilisation of lentil (Lens culinaris MEDIK) grown under free air CO 2 enrichment in a mediterranean-type environment. Plant Biol (Stuttg) 2020; 22 Suppl 1:123-132. [PMID: 31532043 DOI: 10.1111/plb.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/06/2019] [Indexed: 05/14/2023]
Abstract
The stimulatory effect of elevated [CO2 ] (e[CO2 ]) on crop production in future climates is likely to be cancelled out by predicted increases in average temperatures. This effect may become stronger through more frequent and severe heat waves, which are predicted to increase in most climate change scenarios. Whilst the growth and yield response of some legumes grown under the interactive effect of e[CO2 ] and heat waves has been studied, little is known about how N2 fixation and overall N metabolism is affected by this combination. To address these knowledge gaps, two lentil genotypes were grown under ambient [CO2 ] (a[CO2 ], ~400 µmol·mol-1 ) and e[CO2 ] (~550 µmol·mol-1 ) in the Australian Grains Free Air CO2 Enrichment facility and exposed to a simulated heat wave (3-day periods of high temperatures ~40 °C) at flat pod stage. Nodulation and concentrations of water-soluble carbohydrates (WSC), total free amino acids, N and N2 fixation were assessed following the imposition of the heat wave until crop maturity. Elevated [CO2 ] stimulated N2 fixation so that total N2 fixation in e[CO2 ]-grown plants was always higher than in a[CO2 ], non-stressed control plants. Heat wave triggered a significant decrease in active nodules and WSC concentrations, but e[CO2 ] had the opposite effect. Leaf N remobilization and grain N improved under interaction of e[CO2 ] and heat wave. These results suggested that larger WSC pools and nodulation under e[CO2 ] can support post-heat wave recovery of N2 fixation. Elevated [CO2 ]-induced accelerated leaf N remobilisation might contribute to restore grain N concentration following a heat wave.
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Affiliation(s)
- S Parvin
- Southern Cross Plant Science, Southern Cross University, Lismore, NSW, Australia
- School of Ecosystem and Forest Sciences, The University of Melbourne, Creswick, Vic., Australia
- Department of Agronomy, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - S Uddin
- Department of Agronomy, Bangladesh Agricultural University, Mymensingh, Bangladesh
- NSW Department of Primary Industries, Wagga Wagga Agricultural Institute, Wagga Wagga, NSW, Australia
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Creswick, Vic., Australia
| | - M Bourgault
- Northern Agricultural Research Centre, Montana State University, Havre, MT, USA
| | - A Delahunty
- Agriculture Victoria Research, Horsham, Vic., Australia
| | - J Nuttall
- Agriculture Victoria Research, Horsham, Vic., Australia
| | - J Brand
- Agriculture Victoria Research, Horsham, Vic., Australia
| | - G O'Leary
- Agriculture Victoria Research, Horsham, Vic., Australia
| | - G J Fitzgerald
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Creswick, Vic., Australia
- Agriculture Victoria Research, Horsham, Vic., Australia
| | - R Armstrong
- Agriculture Victoria Research, Horsham, Vic., Australia
- Department of Animal, Plant and Soil Sciences, La Trobe University, Bundoora, Vic., Australia
| | - M Tausz
- Department of Agriculture, Science and the Environment, School of Health, Medical and Applied Science, CQUniversity Australia, Rockhampton, Qld, Australia
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Nuttall J, Brazil N, Cain J, Fukofuka H, Harris O, Lawrence A, Lomax-Sawyers I, Perkov T, Sames T, Tinielu J, Vehikite L, Athens J, Hancox R, Wilson B, Edmond J, Coffey S. A063 CT Coronary Angiography at Dunedin Public Hospital – A Retrospective Clinical Audit. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Adamson H, Nicholl A, Tiede C, Tang AA, Davidson A, Curd H, Wignall A, Ford R, Nuttall J, McPherson MJ, Johnson M, Tomlinson DC. Affimers as anti-idiotypic affinity reagents for pharmacokinetic analysis of biotherapeutics. Biotechniques 2019; 67:261-269. [DOI: 10.2144/btn-2019-0089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Therapeutic antibodies are the fastest growing class of drugs in the treatment of cancer, and autoimmune and inflammatory diseases that require the concomitant development of assays to monitor therapeutic antibody levels. Here, we demonstrate that the use of Affimer nonantibody binding proteins provides an advantage over current antibody-based detection systems. For four therapeutic antibodies, we used phage display to isolate highly specific anti-idiotypic Affimer reagents, which selectively bind to the therapeutic antibody idiotype. For each antibody target the calibration curves met US Food and Drug Administration criteria and the dynamic range compared favorably with commercially available reagents. Affimer proteins therefore represent promising anti-idiotypic reagents that are simple to select and manufacture, and that offer the sensitivity, specificity and consistency required for pharmacokinetic assays.
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Affiliation(s)
- Hope Adamson
- School of Molecular & Cellular Biology, Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda Nicholl
- Avacta Life Sciences, Ash Way, Thorp Arch Estate, Wetherby, LS23 7FA, UK
| | - Christian Tiede
- School of Molecular & Cellular Biology, Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, LS2 9JT, UK
| | - Anna A Tang
- School of Molecular & Cellular Biology, Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, LS2 9JT, UK
| | - Alex Davidson
- Avacta Life Sciences, Ash Way, Thorp Arch Estate, Wetherby, LS23 7FA, UK
| | - Helen Curd
- Avacta Life Sciences, Ash Way, Thorp Arch Estate, Wetherby, LS23 7FA, UK
| | - Alex Wignall
- Avacta Life Sciences, Ash Way, Thorp Arch Estate, Wetherby, LS23 7FA, UK
| | - Robert Ford
- Avacta Life Sciences, Ash Way, Thorp Arch Estate, Wetherby, LS23 7FA, UK
| | - James Nuttall
- Avacta Life Sciences, Ash Way, Thorp Arch Estate, Wetherby, LS23 7FA, UK
| | - Michael J McPherson
- School of Molecular & Cellular Biology, Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, LS2 9JT, UK
| | - Matt Johnson
- Avacta Life Sciences, Ash Way, Thorp Arch Estate, Wetherby, LS23 7FA, UK
| | - Darren C Tomlinson
- School of Molecular & Cellular Biology, Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, LS2 9JT, UK
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Malande OO, Nuttall J, Pillay V, Bamford C, Eley B. A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa. PLoS One 2019; 14:e0222675. [PMID: 31550295 PMCID: PMC6759190 DOI: 10.1371/journal.pone.0222675] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/03/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction There are few studies describing Escherichia coli (E. coli) bloodstream infection (BSI) among children in Africa, yet E.coli is increasing in importance as a cause of antibiotic resistant infection in paediatric settings. Methods In this retrospective, descriptive study aspects of E. coli BSI epidemiology are described over a 10-year period including incidence risk, risk factors for extended-spectrum β-lactamase (ESBL)-producing E. coli BSI, antibiotic susceptibility of the bacterial isolates and outcome including risk factors for severe disease. Results There were 583 new E. coli BSI episodes among 217,483 admissions, an overall incidence risk of 2.7 events/1,000 hospital admissions. Of 455 of these E. coli BSI episodes that were analysed, 136 (29.9%) were caused by ESBL-producing isolates. Risk factors for ESBL-producing E. coli BSI included hospitalization in the 28-day period preceding E. coli BSI episodes, having an underlying chronic illness other than HIV infection at the time of the E. coli BSI and having a temperature of 38° Celsius or higher at the time of the E. coli BSI. None of the E. coli isolates were resistant to carbapenems or colistin. The mortality rate was 5.9% and admission to the intensive care unit was required in 12.3% of BSI episodes. Predictors of severe disease included age less than 1 month, hospitalization in the 28-day period preceding E. coli BSI and BSI without a definable focus. Conclusions These findings extend our understanding of E. coli BSI in a sub-Saharan African setting, provide useful information that can guide empiric treatment choices for community- and hospital-acquired BSI and help inform prevention strategies.
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Affiliation(s)
- Oliver Ombeva Malande
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Vashini Pillay
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Colleen Bamford
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Microbiology, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Hunter MS, Nuttall J, Fenlon D. A comparison of three outcome measures of the impact of vasomotor symptoms on women's lives. Climacteric 2019; 22:419-423. [PMID: 30905177 DOI: 10.1080/13697137.2019.1580258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Abstract
Objective: Measures of the impact of vasomotor symptoms (VMS) have been used as outcomes in clinical trials but have not been compared. This study compares the Hot Flush Rating Scale (HFRS), the Hot Flash Related Daily Interference Scale (HFRDIS), and the shorter Hot Flash Interference (HFI) scale. Methods: Baseline data were taken from two studies including healthy women (menopause transition or postmenopause) and breast cancer patients experiencing VMS. Participants completed questionnaires on sociodemographics, the HFRS, the HFRDIS, the HFI, the Work and Social Adjustment Scale (WSAS), on depression (Generalized Anxiety Disorder 7), on anxiety (Patient Health Questionnaire 9), and on use of medical services. Results: A total of 169 women (129 with history of breast cancer and 40 without) aged 54.47 (standard deviation [SD] = 9.11) years took part. They had an average of 66 (SD = 40.94) VMS per week, with a mean HFRS problem-rating of 6.53 (SD = 1.99), HFRDIS score of 5.36 (SD = 2.22), and HFI score of 6.13 (SD = 2.30). The HFRS problem-rating, HFRDIS, and HFI were significantly associated (r = 0.61-0.85), had good internal reliability (α = 0.76-0.91), and had significant concurrent validity with mood, the WSAS, and use of medical services. VMS frequency was not associated with mood, the WSAS, or use of medical services. Conclusion: The HFRS problem-rating scale and the HFI are two brief, three-item measures that measure a similar concept of VMS interference/impact, with evidence of reliability and validity.
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Affiliation(s)
- M S Hunter
- a Institute of Psychiatry , Psychology and Neuroscience, King's College London , London , UK
| | - J Nuttall
- b Southampton Clinical Trials Unit , University of Southampton , Southampton , UK
| | - D Fenlon
- c Department of Nursing , Swansea University , Swansea , UK
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Patten G, Schomaker M, Davies MA, Rabie H, van Zyl G, Technau K, Eley B, Boulle A, Van Dyke RB, Patel K, Sipambo N, Wood R, Tanser F, Giddy J, Cotton M, Nuttall J, Essack G, Karalius B, Seage G, Sawry S, Egger M, Fairlie L. What Should We Do When HIV-positive Children Fail First-line Combination Antiretroviral Therapy? A Comparison of 4 ART Management Strategies. Pediatr Infect Dis J 2019; 38:400-405. [PMID: 30882732 PMCID: PMC6355383 DOI: 10.1097/inf.0000000000002156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Managing virologic failure (VF) in HIV-infected children is especially difficult in resource-limited settings, given limited availability of alternative drugs, concerns around adherence, and the development of HIV resistance mutations. We aimed to evaluate 4 management strategies for children following their first episode of VF by comparing their immunologic and virologic outcomes. METHODS We included children (< 16 years of age) with VF from 8 International Epidemiologic Database to Evaluate AIDS Southern Africa cohorts, initiating combination antiretroviral therapy (cART) between 2004 and 2010, who followed one of the 4 management strategies: continuing on their failing regimen; switching to a second-line regimen; switching to a holding regimen (either lamivudine monotherapy or other non-cART regimen); discontinuing all ART. We compared the effect of management strategy on the 52-week change in CD4% and log10VL from VF, using inverse probability weighting of marginal structural linear models. RESULTS Nine hundred eighty-two patients were followed over 54,168 weeks. Relative to remaining on a failing regimen, switching to second-line showed improved immunologic and virologic responses 52 weeks after VF with gains in CD4% of 1.5% (95% confidence interval [CI], 0.2-2.8) and declines in log10VL of -1.4 copies/mL (95% CI, -2.0, -0.8), while switching to holding regimens or discontinuing treatment had worse immunologic (-5.4% (95% CI, -12.1, 1.3) and -5.6% (95% CI, -15.4, 4.1) and virologic outcomes (0.2 (95% CI, -3.6, 4.1) and 0.8 (95% CI, -0.6, 2.1), respectively. CONCLUSIONS The results provide useful guidance for managing children with VF. Consideration should be given to switching children failing first-line cART to second-line, given the improved virologic and immune responses when compared with other strategies.
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Affiliation(s)
- Gabriela Patten
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa
| | - Helena Rabie
- Tygerberg Academic Hospital, University of Stellenbosch, [Tygerberg, Cape Town, South Africa]
| | - Gert van Zyl
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Service, Tygerberg, Cape Town, South Africa
| | - Karl Technau
- University of the Witwatersrand, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa
| | - Brian Eley
- Red Cross War Memorial Children’s Hospital, and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa
| | - Russell B. Van Dyke
- Department of Pediatric, Tulane University, School of Medicine, New Orleans, United States
| | - Kunjal Patel
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Centre for Biostatistics in AIDS Research (CBAR), Boston, United States
| | - Nosisa Sipambo
- University of the Witwatersrand, Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Robin Wood
- The Desmond Tutu HIV Centre, Institute for Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Frank Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
| | | | - Mark Cotton
- Stellenbosch University and Tygerberg Children’s Hospital, Department of Paediatrics and Child Health Division of Paediatric Infectious Diseases, Cape Town, South Africa
| | - James Nuttall
- Red Cross War Memorial Children’s Hospital, and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Gadija Essack
- Tygerberg Academic Hospital, University of Stellenbosch, [Tygerberg, Cape Town, South Africa]
| | - Brad Karalius
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Centre for Biostatistics in AIDS Research (CBAR), Boston, United States
| | - George Seage
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Centre for Biostatistics in AIDS Research (CBAR), Boston, United States
| | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthias Egger
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
PURPOSE OF REVIEW To provide an update on the patterns of HIV drug resistance in children, including pretreatment drug resistance (PDR) and acquired drug resistance (ADR), focusing on children in low- and middle-income countries (LMICs) for whom empiric first-line (FL) and second-line (SL) antiretroviral regimens are usually recommended. RECENT FINDINGS High levels of PDR, particularly to non-nucleoside reverse transcriptase inhibitors (NNRTIs), and poor treatment outcomes on NNRTI-based FL antiretroviral therapy (ART) have been widely reported among infants and young children. There is a paucity of recent data on the use of protease inhibitor (PI)-based FL and SL regimens in children, but studies have reported poor tolerability, adherence problems and the development of PI resistance. Limited access to virological monitoring and HIV drug resistance testing contributes to delays in identifying treatment failure due to ADR and delays in switching to SL regimens in children. Implementation of FL ART regimens that have a higher barrier to developing resistance and are safe and well tolerated is required in order to attain global treatment targets. Although PI-based regimens may be effective as FL or SL treatment in children, lack of appropriate formulations leading to poor tolerability, drug-drug interactions, and cost considerations have negatively impacted their use among children in LMICs. There is hope that dolutegravir-based regimens recommended for children by the World Health Organization will be widely implemented once child-friendly formulations are available, and dosing and safety studies currently underway are completed, and that this will significantly improve treatment outcomes.
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Affiliation(s)
- J Nuttall
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa.
| | - V Pillay
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
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Dlamini SK, Madhi SA, Muloiwa R, Von Gottberg A, Moosa MYS, Meiring ST, Wiysonge CS, Hefer E, Mulaudzi MB, Nuttall J, Moorhouse M, Kagina BM. Guidelines for the vaccination of HIV-infected adolescents and adults in South Africa. South Afr J HIV Med 2018. [DOI: 10.4102/sajhivmed.v19i1.839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
No abstract available.
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Brittain K, Asafu-Agyei NA, Hoare J, Bekker LG, Rabie H, Nuttall J, Roux P, Stein DJ, Zar HJ, Myer L. Association of Adolescent- and Caregiver-Reported Antiretroviral Therapy Adherence with HIV Viral Load Among Perinatally-infected South African Adolescents. AIDS Behav 2018; 22:909-917. [PMID: 29224045 DOI: 10.1007/s10461-017-2004-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accurate measurement of antiretroviral therapy (ART) adherence remains challenging and there are few data assessing the validity of self-reported adherence among perinatally HIV-infected adolescents. We examined adolescent and caregiver reports of adolescent adherence among perinatally-infected adolescents aged 9-14 years in Cape Town, South Africa, and explored factors that may modify associations between reported adherence and elevated viral load (VL). Among 474 adolescents (median age 12.0 years; median duration of ART use 7.5 years), elevated VL and caregiver- and adolescent-report of missed ART doses were common. Elevated VL was particularly prevalent among older, male adolescents. Low-moderate concordance was observed between caregiver and adolescent report. Among adolescents aged ≥ 12 years, caregiver- and adolescent-reported adherence was associated with elevated VL across most items assessed, but few significant associations were observed among adolescents < 12 years of age. Refined adherence measures and tools to identify adolescents who require adherence interventions are needed in this context.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Nana Akua Asafu-Agyei
- Department of Paediatrics & Child Health, University of Cape Town, Cape Town, South Africa
- Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Helena Rabie
- Department of Paediatrics & Child Health, Tygerberg Academic Hospital & Stellenbosch University, Cape Town, South Africa
| | - James Nuttall
- Department of Paediatrics & Child Health, University of Cape Town, Cape Town, South Africa
| | - Paul Roux
- Department of Paediatrics & Child Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics & Child Health, University of Cape Town, Cape Town, South Africa
- Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Lochan H, Pillay V, Bamford C, Nuttall J, Eley B. Bloodstream infections at a tertiary level paediatric hospital in South Africa. BMC Infect Dis 2017; 17:750. [PMID: 29207958 PMCID: PMC5718141 DOI: 10.1186/s12879-017-2862-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 11/27/2017] [Indexed: 11/17/2022] Open
Abstract
Background Bloodstream infection (BSI) in children causes significant morbidity and mortality. There are few studies describing the epidemiology of BSI in South African children. Methods A retrospective descriptive cohort study was conducted at a paediatric referral hospital in Cape Town, South Africa. The National Health Laboratory Service (NHLS) microbiology database was accessed to identify positive blood culture specimens during the period 2011–2012. Demographic and clinical details, antimicrobial management and patient outcome information were extracted from medical and laboratory records. Antibiotic susceptibility results of identified organisms were obtained from the NHLS database. Results Of the 693 unique bacterial and fungal BSI episodes identified during the study period, 248 (35.8%) were community-acquired (CA), 371 (53.5%) hospital-acquired (HA) and 74 (10.7%) healthcare-associated (HCA). The overall risk was 6.7 BSI episodes per 1000 admissions. Escherichia coli, Staphylococcus aureus and Streptococcus pneumoniae were the most frequent causes of CA-BSI and Klebsiella pneumoniae, Acinetobacter baumanii and S.aureus were most commonly isolated in HA-BSI. On multivariable analysis, severe underweight, severe anaemia at the time of BSI, admission in the ICU at the time of BSI, and requiring ICU admission after BSI was diagnosed were significantly associated with 14-day mortality. Conclusion This study adds to the limited literature describing BSI in children in Africa. Further studies are required to understand the impact that BSI has on the paediatric population in sub-Saharan Africa.
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Affiliation(s)
- Harsha Lochan
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Vashini Pillay
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Colleen Bamford
- Division of Medical Microbiology, University of Cape Town and the National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Chestnutt IG, Playle R, Hutchings S, Morgan-Trimmer S, Fitzsimmons D, Aawar N, Angel L, Derrick S, Drew C, Hoddell C, Hood K, Humphreys I, Kirby N, Lau TMM, Lisles C, Morgan MZ, Murphy S, Nuttall J, Onishchenko K, Phillips C, Pickles T, Scoble C, Townson J, Withers B, Chadwick BL. Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness. J Dent Res 2017; 96:754-761. [PMID: 28394709 DOI: 10.1177/0022034517702094] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).
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Affiliation(s)
- I G Chestnutt
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - R Playle
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK.,2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Hutchings
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Morgan-Trimmer
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - D Fitzsimmons
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Aawar
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - L Angel
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Derrick
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - C Drew
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Hoddell
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - K Hood
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - I Humphreys
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Kirby
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - T M M Lau
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Lisles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - M Z Morgan
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - S Murphy
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - J Nuttall
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - K Onishchenko
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - C Phillips
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - T Pickles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Scoble
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - J Townson
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - B Withers
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - B L Chadwick
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
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Culshaw C, Newton H, Sutcliffe R, Nuttall J, Sharman A, Al-Aloul M. CT Derived Estimates of Total Lung Volume in Transplant Candidates: Can We Do without Plethysmography? J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nuttall J, Evaniew N, Thornley P, Griffin A, Deheshi B, O'Shea T, Wunder J, Ferguson P, Randall RL, Turcotte R, Schneider P, McKay P, Bhandari M, Ghert M. The inter-rater reliability of the diagnosis of surgical site infection in the context of a clinical trial. Bone Joint Res 2016; 5:347-52. [PMID: 27528711 PMCID: PMC5013894 DOI: 10.1302/2046-3758.58.bjr-2016-0036.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/07/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The diagnosis of surgical site infection following endoprosthetic reconstruction for bone tumours is frequently a subjective diagnosis. Large clinical trials use blinded Central Adjudication Committees (CACs) to minimise the variability and bias associated with assessing a clinical outcome. The aim of this study was to determine the level of inter-rater and intra-rater agreement in the diagnosis of surgical site infection in the context of a clinical trial. MATERIALS AND METHODS The Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial CAC adjudicated 29 non-PARITY cases of lower extremity endoprosthetic reconstruction. The CAC members classified each case according to the Centers for Disease Control (CDC) criteria for surgical site infection (superficial, deep, or organ space). Combinatorial analysis was used to calculate the smallest CAC panel size required to maximise agreement. A final meeting was held to establish a consensus. RESULTS Full or near consensus was reached in 20 of the 29 cases. The Fleiss kappa value was calculated as 0.44 (95% confidence interval (CI) 0.35 to 0.53), or moderate agreement. The greatest statistical agreement was observed in the outcome of no infection, 0.61 (95% CI 0.49 to 0.72, substantial agreement). Panelists reached a full consensus in 12 of 29 cases and near consensus in five of 29 cases when CDC criteria were used (superficial, deep or organ space). A stable maximum Fleiss kappa of 0.46 (95% CI 0.50 to 0.35) at CAC sizes greater than three members was obtained. CONCLUSIONS There is substantial agreement among the members of the PARITY CAC regarding the presence or absence of surgical site infection. Agreement on the level of infection, however, is more challenging. Additional clinical information routinely collected by the prospective PARITY trial may improve the discriminatory capacity of the CAC in the parent study for the diagnosis of infection.Cite this article: J. Nuttall, N. Evaniew, P. Thornley, A. Griffin, B. Deheshi, T. O'Shea, J. Wunder, P. Ferguson, R. L. Randall, R. Turcotte, P. Schneider, P. McKay, M. Bhandari, M. Ghert. The inter-rater reliability of the diagnosis of surgical site infection in the context of a clinical trial. Bone Joint Res 2016;5:347-352. DOI: 10.1302/2046-3758.58.BJR-2016-0036.R1.
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Affiliation(s)
- J Nuttall
- Orthopaedic Resident, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - N Evaniew
- Orthopaedic Resident, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - P Thornley
- Orthopaedic Resident, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - A Griffin
- University Musculoskeletal Oncology Unit
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - B Deheshi
- Department of Surgery, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - T O'Shea
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - J Wunder
- University of Toronto, Toronto, Ontario, Canada
| | - P Ferguson
- Division of Orthopaedic Surgery, University of Toronto, 600 University Avenue, Suite 476(G)
- Toronto, M5G 1X5, Canada
| | - R L Randall
- Department of Orthopaedics, University of Utah, 2000 Circle of Hope, Suite 4260
- Salt Lake City, 84112-5550, USA
| | - R Turcotte
- Division of Orthopaedic Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room B5.159.6, Montreal, QC, H3G 1A4, Canada
| | - P Schneider
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - P McKay
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - M Bhandari
- Department of Clinical Epidemiology and Biostatistics and Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110
- Hamilton, ON, L8L 8E7, Canada
| | - M Ghert
- Department of Surgery, McMaster University, 711 Concession Street, Surgical Offices B3 169A, Hamilton, ON, L8V 1C3, Canada
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Oladokun R, Muloiwa R, Hsiao NY, Valley-Omar Z, Nuttall J, Eley B. Clinical characterisation and phylogeny of respiratory syncytial virus infection in hospitalised children at Red Cross War Memorial Children's Hospital, Cape Town. BMC Infect Dis 2016; 16:236. [PMID: 27246848 PMCID: PMC4888648 DOI: 10.1186/s12879-016-1572-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in young children in both the community and hospital setting. METHODS The clinical presentation, patient and phylogenetic characteristicsof laboratory-confirmed cases of RSV, as well as risk factors for nosocomial infectionat Red Cross War Memorial Children's Hospital in Cape Town were analysed. A multiplex PCR assay that detects 7 respiratory viruses was used to identify RSV nucleic acid on respiratory specimens. RESULTS A total of 226 children were studied, ages ranging between 1 week and 92.5 months (median: 2.8 months, IQR: 1.3-6.3 months) and 51.8 % were males. The median duration of symptoms prior to diagnosis was 2 days (IQR: 1-4 days). Nosocomial infections wereidentified in 22 (9.7 %) children. There were pre-existing medical conditions in 113 (50.0 %) excluding HIV, most commonly prematurity (n = 58, 50.0 %) and congenital heart disease (n = 34, 29.3 %). The commonest presenting symptoms were cough (196, 86.7 %), difficulty in breathing (115, 50.9 %) and fever (91, 41.6 %).A case fatality rate of 0.9 % was recorded. RSV group A predominated (n = 181, 80.1 %) while group B accounted for only 45 (19.9 %) of the infections. The prevalent genotypes were NA1 (n = 127,70.1 %), ON1 (n = 45,24.9 %) and NA2 (n = 9,5.0 %) for group A while the only circulating RSV B genotype was BA4. There was no significant difference in the genotype distribution between the nosocomial and community-acquired RSV infections. Age ≥ 6 months was independently associated with nosocomial infection. CONCLUSIONS A large percentage of children with RSV infection had pre-existing conditions. Approximately one tenth of the infections were nosocomial with age 6 months or older being a risk factor. Though both RSV groups co-circulated during the season, group A was predominant and included the novel ON1 genotype. Continued surveillance is necessary to identify prevalent and newly emerging genotypes ahead of vaccine development and efficacy studies.
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Affiliation(s)
- Regina Oladokun
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Nei-Yuan Hsiao
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Grootes Schuur Hospital, Cape Town, South Africa
| | - Ziyaad Valley-Omar
- Centre for Respiratory Diseases and Meningitis, Virology, National Institute for Communicable Diseases, Sandringham, Johannesburg, South Africa.,Faculty of Health Sciences, Department of Clinical Laboratory Sciences Medical Virology, University of Cape Town, Cape Town, South Africa
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Nuttall J, Newton H, Culshaw C, Pate L, Leonard C, Al-Aloul M. Changes in Smoking Habits in Potential Lung Transplant (LTx) Candidates. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.141] [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: 10/21/2022] Open
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31
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Porter M, Davies MA, Mapani MK, Rabie H, Phiri S, Nuttall J, Fairlie L, Technau KG, Stinson K, Wood R, Wellington M, Haas AD, Giddy J, Tanser F, Eley B. Outcomes of Infants Starting Antiretroviral Therapy in Southern Africa, 2004-2012. J Acquir Immune Defic Syndr 2015; 69:593-601. [PMID: 26167620 PMCID: PMC4509628 DOI: 10.1097/qai.0000000000000683] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are limited published data on the outcomes of infants starting antiretroviral therapy (ART) in routine care in Southern Africa. This study aimed to examine the baseline characteristics and outcomes of infants initiating ART. METHODS We analyzed prospectively collected cohort data from routine ART initiation in infants from 11 cohorts contributing to the International Epidemiologic Database to Evaluate AIDS in Southern Africa. We included ART-naive HIV-infected infants aged <12 months initiating ≥3 antiretroviral drugs between 2004 and 2012. Kaplan-Meier estimates were calculated for mortality, loss to follow-up (LTFU), transfer out, and virological suppression. We used Cox proportional hazard models stratified by cohort to determine baseline characteristics associated with outcomes mortality and virological suppression. RESULTS The median (interquartile range) age at ART initiation of 4945 infants was 5.9 months (3.7-8.7) with follow-up of 11.2 months (2.8-20.0). At ART initiation, 77% had WHO clinical stage 3 or 4 disease and 87% were severely immunosuppressed. Three-year mortality probability was 16% and LTFU 29%. Severe immunosuppression, WHO stage 3 or 4, anemia, being severely underweight, and initiation of treatment before 2010 were associated with higher mortality. At 12 months after ART initiation, 17% of infants were severely immunosuppressed and the probability of attaining virological suppression was 56%. CONCLUSIONS Most infants initiating ART in Southern Africa had severe disease with high probability of LTFU and mortality on ART. Although the majority of infants remaining in care showed immune recovery and virological suppression, these responses were suboptimal.
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Affiliation(s)
- Mireille Porter
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | | | - Helena Rabie
- Tygerberg Academic Hospital and Stellenbosch University, Tygerberg, W Cape
| | - Sam Phiri
- Lighthouse Trust Clinic, Lilongwe, Malawi
| | - James Nuttall
- Red Cross War Memorial Children's Hospital, Cape Town, and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Karl-Günter Technau
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn Stinson
- Médecins Sans Frontierès, Khayelitsha and School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Robin Wood
- Gugulethu Community Health Centre and Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
| | | | - Andreas D. Haas
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | | | - Frank Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
| | - Brian Eley
- Red Cross War Memorial Children's Hospital, Cape Town, and School of Child and Adolescent Health, University of Cape Town, South Africa
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Boyles T, Bamford C, Bateman K, Blumberg L, Dramowski A, Karstaedt A, Korsman S, le Roux D, Maartens G, Madhi S, Naidoo R, Nuttall J, Reubenson G, Taljaard J, Thomas J, van Zyl G, von Gottberg A, Whitelaw A, Mendelson M. Guidelines for the management of acute meningitis in children and adults in South Africa. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/10158782.2013.11441513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T.H. Boyles
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - C. Bamford
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - K. Bateman
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - L. Blumberg
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - A. Dramowski
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - A. Karstaedt
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - S. Korsman
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - D.M. le Roux
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - G. Maartens
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - S. Madhi
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - R. Naidoo
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - J. Nuttall
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - G. Reubenson
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - J. Taljaard
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - J. Thomas
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - G. van Zyl
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - A. von Gottberg
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - A. Whitelaw
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - M. Mendelson
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
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Moore DP, Schaaf HS, Nuttall J, Marais BJ. Childhood tuberculosis guidelines of the Southern African Society for Paediatric Infectious Diseases. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/10158782.2009.11441353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D P Moore
- Department of Paediatrics and Child Health, University of the Witwatersrand and Chris Hani Baragwanath Hospital
| | - H S Schaaf
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Stellenbosch and Tygerberg Children's Hospital
| | - J Nuttall
- Paediatric Infectious Diseases Unit, School of Child and Adolescent Health, University of Cape Town and Red Cross Children's Hospital
| | - B J Marais
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Stellenbosch and Tygerberg Children's Hospital
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O'Leary GJ, Christy B, Nuttall J, Huth N, Cammarano D, Stöckle C, Basso B, Shcherbak I, Fitzgerald G, Luo Q, Farre‐Codina I, Palta J, Asseng S. Response of wheat growth, grain yield and water use to elevated CO 2 under a Free-Air CO 2 Enrichment (FACE) experiment and modelling in a semi-arid environment. Glob Chang Biol 2015; 21:2670-2686. [PMID: 25482824 PMCID: PMC5016785 DOI: 10.1111/gcb.12830] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/28/2014] [Indexed: 05/18/2023]
Abstract
The response of wheat crops to elevated CO2 (eCO2 ) was measured and modelled with the Australian Grains Free-Air CO2 Enrichment experiment, located at Horsham, Australia. Treatments included CO2 by water, N and temperature. The location represents a semi-arid environment with a seasonal VPD of around 0.5 kPa. Over 3 years, the observed mean biomass at anthesis and grain yield ranged from 4200 to 10 200 kg ha-1 and 1600 to 3900 kg ha-1 , respectively, over various sowing times and irrigation regimes. The mean observed response to daytime eCO2 (from 365 to 550 μmol mol-1 CO2 ) was relatively consistent for biomass at stem elongation and at anthesis and LAI at anthesis and grain yield with 21%, 23%, 21% and 26%, respectively. Seasonal water use was decreased from 320 to 301 mm (P = 0.10) by eCO2 , increasing water use efficiency for biomass and yield, 36% and 31%, respectively. The performance of six models (APSIM-Wheat, APSIM-Nwheat, CAT-Wheat, CROPSYST, OLEARY-CONNOR and SALUS) in simulating crop responses to eCO2 was similar and within or close to the experimental error for accumulated biomass, yield and water use response, despite some variations in early growth and LAI. The primary mechanism of biomass accumulation via radiation use efficiency (RUE) or transpiration efficiency (TE) was not critical to define the overall response to eCO2 . However, under irrigation, the effect of late sowing on response to eCO2 to biomass accumulation at DC65 was substantial in the observed data (~40%), but the simulated response was smaller, ranging from 17% to 28%. Simulated response from all six models under no water or nitrogen stress showed similar response to eCO2 under irrigation, but the differences compared to the dryland treatment were small. Further experimental work on the interactive effects of eCO2 , water and temperature is required to resolve these model discrepancies.
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Affiliation(s)
- Garry J. O'Leary
- Department of Environment and Primary IndustriesHorshamVic.3401Australia
| | - Brendan Christy
- Department of Environment and Primary IndustriesRutherglenVic.3658Australia
| | - James Nuttall
- Department of Environment and Primary IndustriesHorshamVic.3401Australia
| | - Neil Huth
- CSIRO AgricultureToowoombaQld4350Australia
| | - Davide Cammarano
- University of FloridaGainesvilleFL32611‐0570USA
- Present address: The James Hutton InstituteInvergowrie DundeeUK
| | | | - Bruno Basso
- Michigan State UniversityEast LansingMI48824USA
| | | | - Glenn Fitzgerald
- Department of Environment and Primary IndustriesHorshamVic.3401Australia
| | - Qunying Luo
- Plant Functional Biology & Climate ChangeUniversity of Technology SydneySydneyNSWAustralia
| | | | - Jairo Palta
- CSIRO AgricultureFloreatWA6014Australia
- School of Plant BiologyThe University of Western Australia35 Stirling HwyCrawleyWA6009Australia
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Felce D, Cohen D, Willner P, Rose J, Kroese B, Rose N, Shead J, Jahoda A, MacMahon P, Lammie C, Stimpson A, Woodgate C, Gillespie D, Townson J, Nuttall J, Hood K. Cognitive behavioural anger management intervention for people with intellectual disabilities: costs of intervention and impact on health and social care resource use. J Intellect Disabil Res 2015; 59:68-81. [PMID: 24404992 DOI: 10.1111/jir.12112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Anger and aggression among adults with intellectual disability (ID) are associated with a range of adverse consequences for their well-being and that of their family or staff carers. The aims were to evaluate the effectiveness of an anger management intervention for adults with mild to moderate ID and to evaluate the costs of the intervention and its impact on health and social care resource use. This paper is concerned with the latter aim. METHODS A cluster-randomised controlled trial was conducted involving day services for adults with ID in Scotland, England and Wales. Incremental costs of delivering the intervention and its impact on subsequent total health and social care package costs were calculated. Full data comparing costs between baseline and follow-up 10 months later were collected for 67 participants in the intervention arm and 62 participants in the control arm. Cost differences between the groups at follow-up, adjusted for baseline levels, were calculated using non-parametric bootstrapping controlling for clustering. RESULTS The mean hourly excess cost of intervention over treatment as usual was £12.34. A mean adjusted cost difference of £22.46 per person per week in favour of the intervention group was found but this was not statistically significant. CONCLUSIONS The baseline-adjusted cost difference at follow-up would result in a fairly immediate compensation for the excess costs of intervention, provided the difference is not a statistical artefact. Further research is needed to clarify the extent to which it might represent a real saving in service support costs.
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Affiliation(s)
- D Felce
- Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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Bamford C, Moodley C, Davidson A, Hendricks M, Eley B, Nuttall J, Rinquist C, Smith M. Emergence of vancomycin resistant Enterococci in a paediatric hospital in Cape Town. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1276] [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: 10/25/2022] Open
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Eley BS, Nuttall J. Developments in pediatric infectious diseases: a review of WSPID 2013. Expert Rev Anti Infect Ther 2014; 12:419-22. [DOI: 10.1586/14787210.2014.894460] [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: 11/08/2022]
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Nabukeera-Barungi N, Wilmshurst J, Rudzani M, Nuttall J. Presentation and outcome of tuberculous meningitis among children: experiences from a tertiary children's hospital. Afr Health Sci 2014; 14:143-9. [PMID: 26060471 PMCID: PMC4449047 DOI: 10.4314/ahs.v14i1.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Diagnosis of tuberculous meningitis (TBM) is complicated and outcome is poor especially in resource limited settings. Early diagnosis and prompt treatment are vital in effective treatment. We set out to describe experiences in the management and immediate outcome of TBM a tertiary-level children's hospital in a high HIV and tuberculosis co-infection setting. METHODS This retrospective study included children who were diagnosed with TBM in the year 2009. A pre-coded questionnaire was used to extract data on presentation, diagnostics, treatment and outcome at the time of hospital discharge. Data was analyzed using STATA statistical package (StataCorp, Version 11). RESULTS Of the 40 children diagnosed with TBM, 6 (15%) had definitive TBM, 17 (42.5%) had probable TBM and 17 (42.5%) had possible TBM. The cerebrospinal fluid (CSF) chemistry and cells were abnormal in 39/40 (98%). Mantoux test was reactive in 16/29 (55%) and 17/30 (57%) had Chest X-rays suggestive of tuberculosis. Only 3/21 (14%) had positive sputum tuberculosis culture and 89% (32/36) had neuro-imaging abnormalities. Outcome at discharge was; 8% died, 49% improved with neurological sequelae and 43% improved without sequelae. Having TBM stage 3 at admission was associated with mortality (p=0.001). CONCLUSIONS Most children had early diagnosis of TBM and mortality was lower than in previous studies. We recommend a larger prospective study to further understand the outcome of TBM.
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Affiliation(s)
| | - Jo Wilmshurst
- Red Cross War Memorial Children's Hospital and the School of Child and Adolescent Health, University of Cape Town
| | - Muloiwa Rudzani
- Red Cross War Memorial Children's Hospital and the School of Child and Adolescent Health, University of Cape Town
| | - James Nuttall
- Red Cross War Memorial Children's Hospital and the School of Child and Adolescent Health, University of Cape Town
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Willner P, Rose J, Jahoda A, Stenfert Kroese B, Felce D, MacMahon P, Stimpson A, Rose N, Gillespie D, Shead J, Lammie C, Woodgate C, Townson JK, Nuttall J, Cohen D, Hood K. A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities. Health Technol Assess 2014; 17:1-173, v-vi. [PMID: 23701738 DOI: 10.3310/hta17210] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Anger is a frequent problem for many people with intellectual disabilities, and is often expressed as verbal and/or physical aggression. Cognitive-behaviour therapy (CBT) is the treatment of choice for common mental health problems, but CBT has only recently been adapted for people with intellectual disabilities. Anger is the main psychological presentation in which controlled trials have been used to evaluate CBT interventions for people with intellectual disabilities but these do not include rigorous randomised studies. OBJECTIVES To evaluate (1) the impact of a staff-delivered manualised CBT anger management intervention on (a) reported anger among people with mild to moderate intellectual disabilities, and (b) anger coping skills, aggression, mental health, quality of life and costs of health and social care; (2) factors that influence outcome; and (3) the experience of service users, lay therapists and service managers. DESIGN A cluster randomised controlled trial based on 30 day centres (15 intervention and 15 control). Intention-to-treat comparisons of outcomes used a two-level linear regression model to allow for clustering within centres with baseline outcome levels as a covariate. Comparison of cost data used non-parametric bootstrapping. Qualitative analysis used interpretative phenomenological analysis and thematic analysis. SETTING Recruited day centres had four-plus service users with problem anger who were prepared to participate, two-plus staff willing to be lay therapists, a supportive manager and facilities for group work, and no current anger interventions. PARTICIPANTS A total of 212 service users with problem anger were recruited. Thirty-three were deemed ineligible (30 could not complete assessments and three withdrew before randomisation). Retention at follow-up was 81%, with 17 withdrawals in each arm. Two to four staff per centre were recruited as lay therapists. Eleven service users, nine lay therapists and eight managers were interviewed. INTERVENTIONS The manualised intervention comprised 12 weekly 2-hour group sessions supplemented by 'homework'. Lay therapists received training and ongoing supervision from a clinical psychologist. Treatment fidelity, group attendance and resources used in intervention delivery were monitored. MAIN OUTCOME MEASURES The primary outcome was the service user-rated Provocation Index (PI), a measure of response to hypothetical situations that may provoke anger. Secondary trial outcomes were the key worker-rated PI; the service user- and key worker-rated Profile of Anger Coping Skills (PACS); the service user-rated PACS imaginal provocation test (PACS-IPT), a measure of response to actual situations known to provoke anger; aggression; mental health; self-esteem; quality of life; and health and social care resource use. Assessments were administered before randomisation and at 16 weeks and 10 months after randomisation. RESULTS Fourteen treatment groups were delivered, each with 12 sessions lasting an average of 114 minutes, with a mean of 4.9 service users and 2.0 lay therapists. The mean hourly cost per service user was £ 25.26. The mean hourly excess cost over treatment as usual was £ 12.34. There was no effect of intervention on the primary outcome - self-rated PI. There was a significant impact on the following secondary outcomes at the 10-month follow-up: key worker-rated PI, self-rated PACS-IPT and self- and key worker-rated PACS. Key workers and home carers reported significantly lower aggression at 16 weeks, but not at 10 months. There was no impact on mental health, self-esteem, quality of life or total cost of health and social care. Service users, key workers and service managers were uniformly positive. CONCLUSIONS The intervention was effective at changing anger coping skills and staff-rated anger. Impact on self-rated anger was equivocal. With hindsight there are reasons, from an analysis of factors influencing outcomes, to think that self-rated PI was not a well-chosen primary outcome. Widespread implementation of manualised lay therapist-led but psychologist-supervised anger management CBT for people with mild to moderate intellectual disabilities is recommended.
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Affiliation(s)
- P Willner
- Department of Psychology, Swansea University, Swansea, UK
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Evaniew N, Nuttall J, Farrokhyar F, Bhandari M, Ghert M. What are the levels of evidence on which we base decisions for surgical management of lower extremity bone tumors? Clin Orthop Relat Res 2014; 472:8-15. [PMID: 24081669 PMCID: PMC3889455 DOI: 10.1007/s11999-013-3311-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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] [Received: 06/22/2013] [Accepted: 09/19/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Benign and malignant lower extremity primary bone tumors are among the least common conditions treated by orthopaedic surgeons. The literature supporting their surgical management has historically been in the form of observational studies rather than prospective controlled studies. Observational studies are prone to confounding bias, sampling bias, and recall bias. QUESTIONS/PURPOSES (1) What are the overall levels of evidence of articles published on the surgical management of lower extremity bone tumors? (2) What is the overall quality of reporting of studies in this field based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist? (3) What are the most common pitfalls in reporting that authors might improve on? METHODS All studies describing the surgical management of lower extremity primary bone tumors from 2002 to 2012 were systematically reviewed. Two authors independently appraised levels of evidence. Quality of reporting was assessed with the STROBE checklist. Pitfalls in reporting were quantified by determining the 10 most underreported elements of research study design in the group of studies analyzed, again using the STROBE checklist as the reference standard. Of 1387 studies identified, 607 met eligibility criteria. RESULTS There were no Level I studies, two Level II studies, 47 Level III studies, 308 Level IV studies, and 250 Level V studies. The mean percentage of STROBE points reported satisfactorily in each article as graded by the two reviewers was 53% (95% confidence interval, 42%-63%). The most common pitfalls in reporting were failures to justify sample size (2.2% reported), examine sensitivity (2.2%), account for missing data (9.8%), and discuss sources of bias (14%). Followup (66%), precision of outcomes (64%), eligibility criteria (55%), and methodological limitations (53%) were variably reported. CONCLUSIONS Observational studies are the dominant evidence for the surgical management of primary lower extremity bone tumors. Numerous deficiencies in reporting limit their clinical use. Authors may use these results to inform future work and improve reporting in observational studies, and treating surgeons should be aware of these limitations when choosing among the various options with their patients.
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Affiliation(s)
- Nathan Evaniew
- />Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - James Nuttall
- />Division of Orthopaedics, Department of Surgery, McMaster University, 711 Concession Street, Hamilton, ON L8V 1C3 Canada
| | - Forough Farrokhyar
- />Department of Clinical Epidemiology and Biostatistics, McMaster University, 39 Charlton Ave.East, Hamilton, ON L8N 1Y3 Canada
| | - Mohit Bhandari
- />Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7 Canada , />Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - Michelle Ghert
- />Division of Orthopaedics, Department of Surgery, McMaster University, 711 Concession Street, Hamilton, ON L8V 1C3 Canada
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Naidoo R, Nuttall J, Whitelaw A, Eley B. Epidemiology of Staphylococcus aureus bacteraemia at a tertiary children's hospital in Cape Town, South Africa. PLoS One 2013; 8:e78396. [PMID: 24167621 PMCID: PMC3805599 DOI: 10.1371/journal.pone.0078396] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/11/2013] [Indexed: 11/18/2022] Open
Abstract
Background Staphylococcus aureus is an important pathogen in paediatric patients with bloodstream infections. The epidemiology of S. aureus bacteraemia, however, has not been well documented in children in South Africa. Methods A retrospective study was conducted at a children’s hospital in Cape Town, South Africa, to investigate the epidemiology of S. aureus bacteraemia from 2007-2011. The incidence, clinical presentation, risk factors, management and outcomes of methicillin sensitive S. aureus (MSSA) and methicillin resistant S. aureus (MRSA) bacteraemia were compared. Results Over the five year study period, 365 episodes of S. aureus bacteraemia were identified. The annual incidence was 3.28 cases per 1000 hospital admissions. MRSA was responsible for 26% of S. aureus bacteraemia and 72% of nosocomial infections. Only six possible cases of community-acquired MRSA infections were described. MSSA bacteraemia was more likely to present as pulmonary and bone or joint infections, while bacteraemia without a source was the most common presentation with MRSA. Infants, children with malnutrition, and residents of long-term care facilities were at highest risk for MRSA bacteraemia. The overall case fatality rate for S. aureus bacteraemia was 8.8% over five years, with MRSA being the only significant risk factor for mortality. Conclusion The incidence of S. aureus bacteraemia and MRSA bacteraemia in children has remained stable over the past five years. MRSA is a predominantly nosocomial pathogen in children with S. aureus bacteraemia in Cape Town, South Africa.
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Affiliation(s)
- Reené Naidoo
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Whitelaw
- National Health Laboratory Services, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Eley B, Meyers T, Nuttall J. Clinical utility of raltegravir for the treatment of HIV infection in children and adolescents. Pediatric Health Med Ther 2013. [DOI: 10.2147/phmt.s34925] [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: 11/23/2022] Open
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Abstract
Currently, <10% of all HIV-infected children who need anti-retroviral therapy in sub-Saharan Africa are actually receiving therapy. Many constraints prevent these children from gaining access to appropriate care, including the magnitude of the paediatric epidemic, competing interests of adult care, health system inadequacies, technical challenges and patient-related factors. These issues form the basis of this paper which discusses the practical challenges of extending optimal care to all deserving children. Besides the need for major human, infrastructural, technical and logistic investments to overcome existing constraints, more clinical research is required before treatment guidelines can be refined in resource-constrained settings. In this regard, the paper lists some important research questions that should be addressed.
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Affiliation(s)
- Brian Eley
- Red Cross Children's Hospital and School of Child & Adolescent Health, University of Cape Town, South Africa.
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45
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Nuttall J, Schowalter L. Update: ARV Dosing Chart for Children and Adolescents, 2012. South Afr J HIV Med 2012. [DOI: 10.4102/sajhivmed.v13i3.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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46
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Naidoo R, Jordaan N, Chan KW, Le Roux DM, Pienaar S, Nuttall J, Lau YL, Eley BS. A novel CYBB mutation with the first genetically confirmed case of chronic granulomatous disease in South Africa. S Afr Med J 2011; 101:768-769. [PMID: 22272860] [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] [Received: 03/07/2011] [Accepted: 08/03/2011] [Indexed: 05/31/2023] Open
Abstract
A case of a child with chronic granulomatous disease (CGD) presenting with recurrent mycobacterial infections and invasive Aspergillus fumigatus disease is described. Genetic analysis confirmed X-linked CGD with a novel mutation in exon 10 of the CYBB gene - the first South African report of genetically confirmed CGD.
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Affiliation(s)
- R Naidoo
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Childrens's Hospital, Cape Town, South Africa.
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McIlleron H, Ren Y, Nuttall J, Fairlie L, Rabie H, Cotton M, Eley B, Meyers T, Smith PJ, Merry C, Maartens G. Lopinavir exposure is insufficient in children given double doses of lopinavir/ritonavir during rifampicin-based treatment for tuberculosis. Antivir Ther 2011; 16:417-21. [PMID: 21555825 DOI: 10.3851/imp1757] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Coadministration of rifampicin dramatically reduces the concentrations of protease inhibitors. A pharmacokinetic study in healthy adults showed that doubling the dose of coformulated lopinavir/ritonavir was able to overcome the inducing effect of rifampicin. We evaluated this strategy in children treated with rifampicin-based antituberculosis therapy attending antiretroviral clinics in South Africa. METHODS Plasma concentrations of lopinavir were measured in children (aged 0.64-2.43 years) established on antituberculosis treatment who commenced antiretroviral therapy comprising double the usual recommended dose of lopinavir/ritonavir oral solution (460/115 mg/m(2) twice daily) plus two nucleoside reverse transcriptase inhibitors. Control children (0.57-4.23 years old) without tuberculosis received standard doses of lopinavir/ritonavir (230/57.5 mg/m(2) twice daily). RESULTS Pre-dose lopinavir concentrations were reduced by >80% in children with tuberculosis (median 0.7 mg/l, IQR 0.1-2.0) compared with controls (4.2 mg/l, IQR 3.4-8.1; P<0.001) and were below the minimum recommended concentration of 1 mg/l in 12 of 20 (60%) children with tuberculosis versus 2 of 24 (8%) controls (P<0.001). CONCLUSIONS Double doses of coformulated lopinavir/ritonavir results in inadequate lopinavir concentrations in young children treated concurrently with rifampicin. Suitable regimens are urgently needed for treating young children with HIV-associated tuberculosis.
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Affiliation(s)
- Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa.
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Kovac JR, Nuttall J, Demaria J, Braga LH. Ureteric catheter encrustation 6 weeks following paediatric laparoscopic pyeloplasty: a case report and review of the literature. Eur J Pediatr Surg 2011; 21:204-6. [PMID: 21337300 DOI: 10.1055/s-0031-1271671] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J R Kovac
- Division of Pediatric Urology, McMaster University, Hamilton, Canada.
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Butler CC, Kelly MJ, Hood K, Schaberg T, Melbye H, Serra-Prat M, Blasi F, Little P, Verheij T, Molstad S, Godycki-Cwirko M, Edwards P, Almirall J, Torres A, Rautakorpi UM, Nuttall J, Goossens H, Coenen S. Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection. Eur Respir J 2011; 38:119-25. [DOI: 10.1183/09031936.00133910] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wood J, Butler CC, Hood K, Kelly MJ, Verheij T, Little P, Torres A, Blasi F, Schaberg T, Goossens H, Nuttall J, Coenen S. Antibiotic prescribing for adults with acute cough/lower respiratory tract infection: congruence with guidelines. Eur Respir J 2011; 38:112-8. [PMID: 21233267 DOI: 10.1183/09031936.00145810] [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] [Indexed: 11/05/2022]
Abstract
European guidelines for treating acute cough/lower respiratory tract infection (LRTI) aim to reduce nonevidence-based variation in prescribing, and better target and increase the use of first-line antibiotics. However, their application in primary care is unknown. We explored congruence of both antibiotic prescribing and antibiotic choice with European Respiratory Society (ERS)/European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for managing LRTI. The present study was an analysis of prospective observational data from patients presenting to primary care with acute cough/LRTI. Clinicians recorded symptoms on presentation, and their examination and management. Patients were followed up with self-complete diaries. 1,776 (52.7%) patients were prescribed antibiotics. Given patients' clinical presentation, clinicians could have justified an antibiotic prescription for 1,915 (71.2%) patients according to the ERS/ESCMID guidelines. 761 (42.8%) of those who were prescribed antibiotics received a first-choice antibiotic (i.e. tetracycline or amoxicillin). Ciprofloxacin was prescribed for 37 (2.1%) and cephalosporins for 117 (6.6%). A lack of specificity in definitions in the ERS/ESCMID guidelines could have enabled clinicians to justify a higher rate of antibiotic prescription. More studies are needed to produce specific clinical definitions and indications for treatment. First-choice antibiotics were prescribed to the minority of patients who received an antibiotic prescription.
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Affiliation(s)
- J Wood
- South East Wales Trials Unit, Cardiff University, Cardiff, UK
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