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Rush E, Brandi ML, Khan A, Ali DS, Al-Alwani H, Almonaei K, Alsarraf F, Bacrot S, Dahir KM, Dandurand K, Deal C, Ferrari SL, Giusti F, Guyatt G, Hatcher E, Ing SW, Javaid MK, Khan S, Kocijan R, Lewiecki EM, Linglart A, M'Hiri I, Marini F, Nunes ME, Rockman-Greenberg C, Roux C, Seefried L, Starling SR, Ward L, Yao L, Brignardello-Petersen R, Simmons JH. Proposed diagnostic criteria for the diagnosis of hypophosphatasia in children and adolescents: results from the HPP International Working Group. Osteoporos Int 2024; 35:1-10. [PMID: 37982855 PMCID: PMC10786745 DOI: 10.1007/s00198-023-06843-2] [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: 12/30/2022] [Accepted: 06/23/2023] [Indexed: 11/21/2023]
Abstract
Hypophosphatasia (HPP) is a rare inborn error of metabolism that presents variably in both age of onset and severity. HPP is caused by pathogenic variants in the ALPL gene, resulting in low activity of tissue nonspecific alkaline phosphatase (TNSALP). Patients with HPP tend have a similar pattern of elevation of natural substrates that can be used to aid in diagnosis. No formal diagnostic guidelines currently exist for the diagnosis of this condition in children, adolescents, or adults. The International HPP Working Group is a comprised of a multidisciplinary team of experts from Europe and North America who have expertise in the diagnosis and management of patients with HPP. This group reviewed 93 papers through a Medline, Medline In-Process, and Embase search for the terms "HPP" and "hypophosphatasia" between 2005 and 2020 and that explicitly address either the diagnosis of HPP in children, clinical manifestations of HPP in children, or both. Two reviewers independently evaluated each full-text publication for eligibility and studies were included if they were narrative reviews or case series/reports that concerned diagnosis of pediatric HPP or included clinical aspects of patients diagnosed with HPP. This review focused on 15 initial clinical manifestations that were selected by a group of clinical experts.The highest agreement in included literature was for pathogenic or likely pathogenic ALPL variant, elevation of natural substrates, and early loss of primary teeth. The highest prevalence was similar, including these same three parameters and including decreased bone mineral density. Additional parameters had less agreement and were less prevalent. These were organized into three major and six minor criteria, with diagnosis of HPP being made when two major or one major and two minor criteria are present.
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Affiliation(s)
- Eric Rush
- Division of Clinical Genetics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, USA.
- Department of Pediatrics, University of Missouri - Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, USA.
- Division of Endocrinology, Metabolism, Osteoporosis, and Genetics, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Maria Luisa Brandi
- F.I.R.M.O. Italian Foundation for the Research on Bone Diseases, Florence, Italy
- Donatello Bone Clinic, Villa Donatello Hospital, Florence, Italy
| | - Aliya Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Canada
| | - Dalal S Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Canada
| | - Hatim Al-Alwani
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Canada
| | - Khulod Almonaei
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Canada
| | - Farah Alsarraf
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Canada
| | - Severine Bacrot
- Department of Genetics, Centre Hospitalier de Versailles, Hôpital André Mignot, Versailles, France
| | - Kathryn M Dahir
- Division of Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karel Dandurand
- Department of Medicine, Endocrinology and Metabolism, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Chad Deal
- Center for Osteoporosis and Metabolic Bone Disease, Department of Rheumatology, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Serge Livio Ferrari
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Francesca Giusti
- Donatello Bone Clinic, Villa Donatello Hospital, Florence, Italy
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Erin Hatcher
- Neuromuscular Clinic, McMaster University Medical Centre, Hamilton Health Sciences, Hamilton, Canada
| | - Steven W Ing
- Division of Endocrinology, Diabetes, & Metabolism, Ohio State University Wexner Medical Center, Columbus, USA
| | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Khan
- Bone Research and Education Centre, Oakville, ON, Canada
| | - Roland Kocijan
- 1st Medical Department, Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA, Trauma Centre Meidling, Hanusch Hospital, 1140, Vienna, Austria
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - Agnes Linglart
- APHP, Bicêtre Paris-Sud, University Paris Sud, Paris-Saclay, Le Kremlin Bicêtre, Paris, France
| | - Iman M'Hiri
- Bone Research and Education Centre, Oakville, ON, Canada
| | - Francesca Marini
- F.I.R.M.O. Italian Foundation for the Research on Bone Diseases, Florence, Italy
| | - Mark E Nunes
- Division of Medical Genetics and Metabolism, Valley Children's HealthCare, Madera, CA, USA
| | | | - Christian Roux
- Rheumatology Department, Hospital Pasteur 2 CHU, 06000, Nice, France
- Inserm, CNRS, iBV, Université Côte d'Azur, 06000, Nice, France
| | - Lothar Seefried
- Musculoskeletal Center Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Susan R Starling
- Division of Clinical Genetics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, USA
| | - Leanne Ward
- Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | | | - Jill H Simmons
- Division of Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, TN, USA
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Kuring JK, Mathias JL, Ward L, Tachas G. Inflammatory markers in persons with clinically-significant depression, anxiety or PTSD: A systematic review and meta-analysis. J Psychiatr Res 2023; 168:279-292. [PMID: 37931509 DOI: 10.1016/j.jpsychires.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/30/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Depression, anxiety and PTSD appear to be risk factors for dementia, but it is unclear whether they are causal or prodromal. The inflammatory-mediated neurodegeneration hypothesis suggests a causal link, proposing that mental illness is associated with an inflammatory response which, in turn, triggers neurodegenerative changes that lead to dementia. Existing meta-analyses have yet to examine inflammatory markers in depression, anxiety or PTSD with the view to exploring the inflammatory-mediated neurodegeneration hypothesis. The current meta-analysis therefore examined whether: a) depression, anxiety and PTSD are individually associated with inflammation, independently of comorbid mental illnesses and physical health problems with known inflammatory responses, and b) there are any similarities in the inflammatory profiles of these disorders in order to provide a basis for exploring inflammation in people with dementia who have a history of clinically-significant anxiety, depression or PTSD. METHODS PubMed, EMBASE, PsycINFO and CINAHL searches identified 64 eligible studies. RESULTS Depression is associated with an inflammatory response, with tentative evidence to suggest anxiety and PTSD are also associated with inflammation. However, the specific response may differ across these disorders. LIMITATIONS The data for anxiety, PTSD and multiple inflammatory markers were limited. CONCLUSIONS Depression, anxiety, and PTSD each appear to be associated with an inflammatory response in persons who do not have comorbid mental or physical health problems that are known to be associated with inflammation. Whether this inflammatory response underlies the increased risk of dementia in persons with a history of depression and anxiety, and possibly PTSD, remains to be determined.
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Affiliation(s)
- J K Kuring
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - J L Mathias
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - L Ward
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - G Tachas
- Antisense Therapeutics Ltd, Melbourne, Australia
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Feizpour A, Doré V, Doecke JD, Saad ZS, Triana-Baltzer G, Slemmon R, Maruff P, Krishnadas N, Bourgeat P, Huang K, Fowler C, Rainey-Smith SR, Bush AI, Ward L, Robertson J, Martins RN, Masters CL, Villemagne VL, Fripp J, Kolb HC, Rowe CC. Two-Year Prognostic Utility of Plasma p217+tau across the Alzheimer's Continuum. J Prev Alzheimers Dis 2023; 10:828-836. [PMID: 37874105 DOI: 10.14283/jpad.2023.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Plasma p217+tau has shown high concordance with cerebrospinal fluid (CSF) and positron emission tomography (PET) measures of amyloid-β (Aβ) and tau in Alzheimer's Disease (AD). However, its association with longitudinal cognition and comparative performance to PET Aβ and tau in predicting cognitive decline are unknown. OBJECTIVES To evaluate whether p217+tau can predict the rate of cognitive decline observed over two-year average follow-up and compare this to prediction based on Aβ (18F-NAV4694) and tau (18F-MK6240) PET. We also explored the sample size required to detect a 30% slowing in cognitive decline in a 2-year trial and selection test cost using p217+tau (pT+) as compared to PET Aβ (A+) and tau (T+) with and without p217+tau pre-screening. DESIGN A prospective observational cohort study. SETTING Participants of the Australian Imaging, Biomarker and Lifestyle Flagship Study of Ageing (AIBL) and Australian Dementia Network (ADNeT). PARTICIPANTS 153 cognitively unimpaired (CU) and 50 cognitively impaired (CI) individuals. MEASUREMENTS Baseline p217+tau Simoa® assay, 18F-MK6240 tau-PET and 18F-NAV4694 Aβ-PET with neuropsychological follow-up (MMSE, CDR-SB, AIBL-PACC) over 2.4 ± 0.8 years. RESULTS In CI, p217+tau was a significant predictor of change in MMSE (β = -0.55, p < 0.001) and CDR-SB (β =0.61, p < 0.001) with an effect size similar to Aβ Centiloid (MMSE β = -0.48, p = 0.002; CDR-SB β = 0.43, p = 0.004) and meta-temporal (MetaT) tau SUVR (MMSE: β = -0.62, p < 0.001; CDR-SB: β = 0.65, p < 0.001). In CU, only MetaT tau SUVR was significantly associated with change in AIBL-PACC (β = -0.22, p = 0.008). Screening pT+ CI participants into a trial could lead to 24% reduction in sample size compared to screening with PET for A+ and 6-13% compared to screening with PET for T+ (different regions). This would translate to an 81-83% biomarker test cost-saving assuming the p217+tau test cost one-fifth of a PET scan. In a trial requiring PET A+ or T+, p217+tau pre-screening followed by PET in those who were pT+ would cost more in the CI group, compared to 26-38% biomarker test cost-saving in the CU. CONCLUSIONS Substantial cost reduction can be achieved using p217+tau alone to select participants with MCI or mild dementia for a clinical trial designed to slow cognitive decline over two years, compared to participant selection by PET. In pre-clinical AD trials, p217+tau provides significant cost-saving if used as a pre-screening measure for PET A+ or T+ but in MCI/mild dementia trials this may add to cost both in testing and in the increased number of participants needed for testing.
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Affiliation(s)
- A Feizpour
- Professor Christopher C Rowe, Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Road, Heidelberg, VIC. 3084, Australia. Telephone: +61-3-9496 3321. Fax +61-3-9458 5023.
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O'Grady HM, Harrison R, Snedeker K, Trufen L, Yue P, Ward L, Fifen A, Jamieson P, Weiss A, Coulthard J, Lynch T, Croxen MA, Li V, Pabbaraju K, Wong A, Zhou HY, Dingle TC, Hellmer K, Berenger BM, Fonseca K, Lin YC, Evans D, Conly JM. A two-ward acute care hospital outbreak of SARS-CoV-2 delta variant including a point-source outbreak associated with the use of a mobile vital signs cart and sub-optimal doffing of personal protective equipment. J Hosp Infect 2023; 131:1-11. [PMID: 36195200 PMCID: PMC9527227 DOI: 10.1016/j.jhin.2022.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/16/2022] [Accepted: 09/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The arrival of the Delta variant of SARS-CoV-2 was associated with increased transmissibility and illness of greater severity. Reports of nosocomial outbreaks of Delta variant COVID-19 in acute care hospitals have been described but control measures varied widely. AIM Epidemiological investigation of a linked two-ward COVID-19 Delta variant outbreak was conducted to elucidate its source, risk factors, and control measures. METHODS Investigations included epidemiologic analysis, detailed case review serial SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) testing of patients and healthcare workers (HCWs), viral culture, environmental swabbing, HCW-unaware personal protective equipment (PPE) audits, ventilation assessments, and the use of whole genome sequencing (WGS). FINDINGS This linked two-ward outbreak resulted in 17 patient and 12 HCW cases, despite an 83% vaccination rate. In this setting, suboptimal adherence and compliance to PPE protocols, suboptimal hand hygiene, multi-bedded rooms, and a contaminated vital signs cart with potential fomite or spread via the hands of HCWs were identified as significant risk factors for nosocomial COVID-19 infection. Sudden onset of symptoms, within 72 h, was observed in 79% of all Ward 2 patients, and 93% of all cases (patients and HCWs) on Ward 2 occurred within one incubation period, consistent with a point-source outbreak. RT-PCR assays showed low cycle threshold (CT) values, indicating high viral load from environmental swabs including the vital signs cart. WGS results with ≤3 SNP differences between specimens were observed. CONCLUSION Outbreaks on both wards settled rapidly, within 3 weeks, using a `back-to-basics' approach without extraordinary measures or changes to standard PPE requirements. Strict adherence to recommended PPE, hand hygiene, education, co-operation from HCWs, including testing and interviews, and additional measures such as limiting movement of patients and staff temporarily were all deemed to have contributed to prompt resolution of the outbreak.
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Affiliation(s)
- H M O'Grady
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - R Harrison
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Workplace Health and Safety, Alberta Health Services, Edmonton, Alberta, Canada
| | - K Snedeker
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L Trufen
- Workplace Health and Safety, Alberta Health Services, Edmonton, Alberta, Canada
| | - P Yue
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - L Ward
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - A Fifen
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - P Jamieson
- Department of Family Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Site Administration, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - A Weiss
- Site Administration, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - J Coulthard
- Site Administration, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - T Lynch
- Department of Pathology & Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Genomics and Bioinformatics, Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada; Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - M A Croxen
- Alberta Public Heath Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada; Department of Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - V Li
- Alberta Public Heath Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - K Pabbaraju
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - A Wong
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - H Y Zhou
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada; Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - T C Dingle
- Department of Pathology & Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - K Hellmer
- Site Administration, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - B M Berenger
- Department of Pathology & Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - K Fonseca
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada; Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Y-C Lin
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - D Evans
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - J M Conly
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada; Department of Pathology & Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
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Van Oirschot M, Bergman A, Verbakel W, Ward L, Gagne I, Huang V, Chng N, Houston P, Symes K, Thomas C, Basran P, Bowes D, Harrow S, Olson R, Senan S, Warner A, Palma D, Gaede S. Does Compromising Target Coverage Impact Overall Survival when Treating Oligometastatic Disease with Stereotactic Ablative Radiotherapy (SABR)? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.622] [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: 11/16/2022]
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Magner S, Carey S, Harrington G, Ward L, Smyth H, Purcell R, Callaly L, O'Caheny C, Pender C, Buckley B, Laguna R, Riches R, Mitchell M, Carrabine N, Ramiah V, Byrne C. 306 GERIATRICIAN-LED COMPREHENSIVE GERIATRIC ASSESSMENT IN THE EMERGENCY DEPARTMENT: A COST-EFFECTIVE SERVICE APPROVED BY PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Many older people are brought to the Emergency Department (ED) who do not require acute hospital admission but there are risks to these patients if this occurs. The Frailty Intervention Team (FIT) are an interdisciplinary team based in the ED including physiotherapy, occupational therapy, speech and language therapy, dietetics, pharmacy, advanced nurse practitioners, and a geriatric registrar and consultant. They assess frail older patients and suggest alternative care pathways to admission. We aimed to investigate the impact of FIT on admission avoidance, bed days saved and to obtain patient feedback on their experience.
Methods
Routinely collected data from May 2021 to April 2022 was reviewed retrospectively. An anonymous patient feedback questionnaire was posted to 40 patients randomised from the FIT worklist between January to May 2022.
Results
2,025 Comprehensive Geriatric Assessments (CGA) were completed between May 2021 and April 2022. 38% percent of patients were discharged home, 45% of this number had follow-up arranged. 104 patients were transferred directly to an offsite bed, mostly rehabilitation. We estimate we avoided 51 admissions to the acute hospital per month, almost half of these were patients admitted to the hospital and, who we discharged to alternative care pathways or home. The average length of stay in April 2022 was 22 days – by avoiding 615 admissions between May 2021 and April 2022 we have saved 13,530 bed days at an estimated cost saving of almost €11 million. 15 completed questionnaires were returned. 73% were very satisfied with their experience. 87% felt the FIT team helped facilitate their discharge from ED. The main themes identified from open ended questions included thorough assessment, patient centred care and satisfaction with early intervention and discharge.
Conclusion
A Frailty Intervention Team is a cost effective and patient centred way of avoiding unnecessary admissions for older people presenting to the ED.
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Affiliation(s)
- S Magner
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - S Carey
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - G Harrington
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - L Ward
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - H Smyth
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - R Purcell
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - L Callaly
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - C O'Caheny
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - C Pender
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - B Buckley
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - R Laguna
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - R Riches
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - M Mitchell
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - N Carrabine
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - V Ramiah
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - C Byrne
- Mater Misericordiae University Hospital , Dublin, Ireland
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Ciofani JL, Ward L, Liulu X, Chan R, Sampedro S, Soh HC, March L. Polymyositis and raised troponin after mRNA COVID-19 vaccination. Intern Med J 2022; 52:1840-1842. [PMID: 36000405 PMCID: PMC9538780 DOI: 10.1111/imj.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/13/2022] [Indexed: 12/01/2022]
Affiliation(s)
- J L Ciofani
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - L Ward
- Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - X Liulu
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Rcf Chan
- Electron Microscopy Unit, Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, Australia
| | - S Sampedro
- Electron Microscopy Unit, Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, Australia
| | - H C Soh
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia
| | - L March
- The University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
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Vayalumkal J, Pillai D, Oberding L, Ward L, Fonseca K, Mehrem AA, Conly J. Determination of SARS-CoV-2 Contamination in a Neonatal Intensive Care Unit (NICU) Environment Using Droplet Digital PCR (ddPCR). Int J Infect Dis 2022. [PMCID: PMC8884753 DOI: 10.1016/j.ijid.2021.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose Neonatal infections with SARS-CoV-2 are thought to be less contagious than in older children and adults. The transmission of SARS-CoV-2 from neonates and their environment has not been well studied. Droplet Digital PCR (ddPCR) is an emerging and sensitive technology that can aid infection control investigations. We sought to document surface contamination within the immediate environment of a preterm neonate with congenital COVID-19 using ddPCR. Methods & Materials On day 5 of life, a total of 23 environmental samples were collected in Eswabs (Amies media) based on proximity to the neonate, from the inside (7) and outside (16) of the neonate's incubator for ddPCR analysis. Samples were extracted, using an in-house method and each extract was run for reverse-transcription ddPCR measurement using the Bio-Rad SARS-CoV-2 ddPCR Kit. The 96-well RT-ddPCR ready plate was loaded into the QX200 Droplet Reader (Bio-Rad, Pleasanton, CA). The fluorescence intensity of each droplet was measured, and droplets were determined to be positive or negative for gene targets (N1, N2). Results All samples collected from outside of the incubator were negative.These included: a stethoscope hanging outside of the incubator, nearby keyboard/mouse, wireless phone receiver, barcode scanner, blood culture bottles, pens/pencils, light switches, weigh scale, countertop/shelf, cart with drawers and incubator port release clips. Samples collected from inside the incubator were positive for SARS-CoV-2. These results reported in copies per microlitre (cp/µL) extract included: the swaddle cloth (0.4 N2), sheets behind the neonate's head (11.4 N1, 16.9 N2), cardiorespiratory and saturation monitor leads and cables near the neonate's head (2.8 N1,4.5 N2), near the neonate's feet (2.1 N1, 3.7 N2), and nametags hanging on a panel (1.0 N1,1.2 N2). The highest levels were noted from the neonate's drool (25.2 N1, 35.2 N2). Conclusion The presence of SARS-CoV-2 was confirmed by ddPCR in environmental samples inside the incubator confirming the ability of the neonate to spread the virus in close quarters. No virus was identified outside of the incubator which suggests appropriate hand hygiene and disinfection of environmental surfaces. ddPCR appears to be a useful tool for investigating the potential role of fomites in COVID-19 transmission
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Javaid MK, Ward L, Pinedo-Villanueva R, Rylands AJ, Williams A, Insogna K, Imel EA. Musculoskeletal Features in Adults With X-linked Hypophosphatemia: An Analysis of Clinical Trial and Survey Data. J Clin Endocrinol Metab 2022; 107:e1249-e1262. [PMID: 34636401 PMCID: PMC8852215 DOI: 10.1210/clinem/dgab739] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Patients with X-linked hypophosphatemia (XLH) experience multiple musculoskeletal manifestations throughout adulthood. OBJECTIVE To describe the burden of musculoskeletal features and associated surgeries across the lifespan of adults with XLH. METHODS Three groups of adults were analyzed: subjects of a clinical trial, participants in an online survey, and a subgroup of the online survey participants considered comparable to the clinical trial subjects (according to Brief Pain Inventory worst pain scores of ≥ 4). In each group, the adults were categorized by age: 18-29, 30-39, 40-49, 50-59, and ≥ 60 years. Rates of 5 prespecified musculoskeletal features and associated surgeries were investigated across these age bands for the 3 groups. RESULTS Data from 336 adults were analyzed. In all 3 groups, 43% to 47% had a history of fracture, with the proportions increasing with age. The overall prevalence of osteoarthritis was > 50% in all 3 groups, with a rate of 23% to 37% in the 18- to 29-year-old group, and increasing with age. Similar patterns were observed for osteophytes and enthesopathy. Hip and knee arthroplasty was reported even in adults in their 30s. Spinal stenosis was present at a low prevalence, increasing with age. The proportion of adults with ≥ 2 musculoskeletal features was 59.1%, 55.0%, and 61.3% in the clinical trial group, survey group, and survey pain subgroup, respectively. CONCLUSION This analysis confirmed high rates of multiple musculoskeletal features beginning as early as age 20 years among adults with XLH and gradually accumulating with age.
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Affiliation(s)
- Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Correspondence: Dr. Muhammad Kassim Javaid, Associate Professor in Metabolic Bone Disease, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK.
| | - Leanne Ward
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Angela J Rylands
- Health Economics and Outcomes Research, Kyowa Kirin International, Marlow, UK
| | - Angela Williams
- Health Economics and Outcomes Research, Kyowa Kirin International, Marlow, UK
| | - Karl Insogna
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Erik A Imel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Carsen S, Grammatopoulos G, Zaltz I, Ward L, Smit K, Beaulé PE. The Effects of Physical Activity on Physeal and Skeletal Development. JBJS Rev 2021; 9:01874474-202110000-00002. [PMID: 34637401 DOI: 10.2106/jbjs.rvw.21.00060] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» There is increasing evidence in the literature regarding the important health impact of and risk factors for injury in youth sport. » Increasing pediatric and adolescent activity intensity, such as is seen in earlier single-sport focus and specialization, may be associated with morphological changes in the growing skeleton. » Chronic subacute injury to the developing physes in the active child can lead to stress on the growth plate and surrounding tissues that induces developmental morphological changes in the joint. » There is evidence to suggest that frequent participation in sports that place particular stress across the physes of the proximal humerus, the proximal femur, and the distal radius can be associated with an increased risk of inducing developmental and morphological changes that could lead to future joint dysfunction and premature degeneration. » Additional research is necessary to better define the pathoetiology of activity-mediated morphological changes, as well as to create and validate parameters for safe involvement in competitive physical activities.
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Affiliation(s)
- Sasha Carsen
- Division of Orthopaedic Surgery, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | | | - Ira Zaltz
- Department of Orthopedic Surgery, Beaumont Health, Royal Oak, Michigan
| | - Leanne Ward
- Division of Endocrinology, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | - Kevin Smit
- Division of Orthopaedic Surgery, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Alt J, Eveland R, Fiorello A, Haas B, Meszaros J, McEvoy B, Ridenour C, Shaffer D, Yirava W, Ward L. Development and validation of technologies suitable for the decontamination and re-use of contaminated N95 filtering facepiece respirators in response to the COVID-19 pandemic. J Hosp Infect 2021; 119:141-148. [PMID: 34637850 PMCID: PMC8501551 DOI: 10.1016/j.jhin.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has brought significant challenges to society globally, particularly in the area of healthcare provision. A pressing need existed in protecting those tasked with delivering healthcare solutions during the COVID-19 crisis by providing solutions for preserving adequate supplies of effective personal protective equipment (PPE). Aim To evaluate and validate available methods for the decontamination of N95 filtering facepiece respirators (FFRs) while maintaining functionality during re-use. Methods Multiple low-temperature steam and vaporized hydrogen peroxide (VHP) technologies were assessed for inactivation of Mycobacterium spp. and feline calicivirus (employed as representatives of the contamination challenge). Findings Virus (≥3log10) and Mycobacterium spp. (≥6log10) inactivation was achieved on various types of N95 FFRs using an array of heat (65–71oC), humidity (>50% relative humidity) and VHP without affecting the performance of the PPE. Conclusion The methods have been validated and were authorized by the US Food and Drug Administration under a temporary emergency use authorization. Based on the findings, opportunities exist for development and deployment of decontamination methods made from simple, general purpose materials and equipment should a future need arise.
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Affiliation(s)
- J Alt
- STERIS Healthcare, Mentor, OH, USA
| | | | | | - B Haas
- STERIS Canada ULC, Québec, QC, Canada
| | | | - B McEvoy
- STERIS Applied Sterilization Technologies, Tullamore, Ireland.
| | | | | | - W Yirava
- STERIS Healthcare, Mentor, OH, USA
| | - L Ward
- STERIS Healthcare, Mentor, OH, USA
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Hoffman E, Dang U, Clemens P, Gordish-Dressman H, Schwartz B, Mengle-Gaw L, Leinonen M, Smith E, Castro D, Kuntz N, Finkel R, Tulinius M, Nevo Y, Ryan M, Webster R, van den Anker J, Ward L, Damsker J, McDonald C, Guglieri M, Mah J. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Ward L, Jackowski S, Ma J, Scharke M, Konji V, Jaremko J, Koujok K, Matzinger M, Shenouda N, Walker S, McMillan H, Siminoski K, Bista P, Mancini M, Donovan J. DMD – BIOMARKERS & OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.124] [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: 10/23/2022]
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14
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Kuring JK, Mathias JL, Ward L. Risk of Dementia in persons who have previously experienced clinically-significant Depression, Anxiety, or PTSD: A Systematic Review and Meta-Analysis. J Affect Disord 2020; 274:247-261. [PMID: 32469813 DOI: 10.1016/j.jad.2020.05.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/16/2020] [Accepted: 05/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depression, anxiety and PTSD appear to be linked to dementia, but it is unclear whether they are risk factors (causal or prodromal) for, comorbid with, or sequelae to (secondary effect of) dementia. Existing meta-analyses have examined depression or anxiety in all-cause dementia, Alzheimer's disease (AD) and vascular dementia (VaD), but have not considered post-traumatic stress disorder (PTSD), dementia with Lewy bodies (DLB), or frontotemporal dementia (FTD). The current meta-analysis examined the risk of developing dementia (AD, VaD, DLB, FTD, all-cause) in people with and without a history of clinically-significant depression, anxiety or PTSD in order to better understand the link between mental illness and dementia (PROSPERO number: CRD42018099872). METHODS PubMed, EMBASE, PsycINFO and CINAHL searches identified 36 eligible studies. RESULTS There is a higher risk of developing all-cause dementia and AD in people with previous depression, and a higher risk of all-cause dementia in people with prior anxiety, than in persons without this history. Prior PTSD was not associated with a higher risk of later being diagnosed with dementia. LIMITATIONS The data for anxiety, PTSD, DLB and FTD were limited. CONCLUSIONS Depression and anxiety appear to be risk factors for dementia, but longitudinal studies across adulthood (young adult/mid-life/older adult) are needed to evaluate the likely causal or prodromal nature of this risk. The link between PTSD and dementia remains unclear. Regular screening for new onset mental illness and for cognitive changes in older adults with a history of mental illness may assist with earlier identification of dementia.
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Affiliation(s)
- J K Kuring
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - J L Mathias
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - L Ward
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
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15
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Shelmerdine SC, Hutchinson JC, Ward L, Sekar T, Ashworth MT, Levine S, Sebire NJ, Arthurs OJ. Feasibility of INTACT (INcisionless TArgeted Core Tissue) biopsy procedure for perinatal autopsy. Ultrasound Obstet Gynecol 2020; 55:667-675. [PMID: 31271478 PMCID: PMC7317589 DOI: 10.1002/uog.20387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the feasibility and tissue yield of a perinatal incisionless ultrasound-guided biopsy procedure, the INcisionless Targeted Core Tissue (INTACT) technique, in the context of minimally invasive autopsy. METHODS Cases of perinatal death in which the parents consented for minimally invasive autopsy underwent postmortem magnetic resonance imaging and an INTACT biopsy procedure, defined as needle biopsy of organs via the umbilical cord, performed under ultrasound guidance. In each case, three cores of tissue were obtained from seven target organs (both lungs, both kidneys, heart, spleen and liver). Biopsy success was predefined as an adequate volume of the intended target organ for pathological analysis, as judged by a pathologist blinded to the case and biopsy procedure. RESULTS Thirty fetuses underwent organ sampling. Mean gestational age was 30 weeks (range, 18-40 weeks) and mean delivery-to-biopsy interval was 12 days (range, 6-22 days). The overall biopsy success rate was 153/201 (76.1%) samples, with the success rates in individual organs being highest for the heart and lungs (93% and 91%, respectively) and lowest for the spleen (11%). Excluding splenic samples, the biopsy success rate was 150/173 (86.7%). Histological abnormalities were found in 4/201 (2%) samples, all of which occurred in the lungs and kidneys of a fetus with pulmonary hypoplasia and multicystic kidney disease. CONCLUSIONS Incisionless ultrasound-guided organ biopsy using the INTACT procedure is feasible, with an overall biopsy success rate of over 75%. This novel technique offers the ideal combination of an imaging-led autopsy with organ sampling for parents who decline the conventional invasive approach. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S. C. Shelmerdine
- Department of Clinical RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
| | - J. C. Hutchinson
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - L. Ward
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - T. Sekar
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - M. T. Ashworth
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - S. Levine
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - N. J. Sebire
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - O. J. Arthurs
- Department of Clinical RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
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16
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Kinnear D, Allan L, Morrison J, Finlayson J, Sherriff A, Macpherson L, Henderson A, Ward L, Muir M, Cooper SA. Prevalence of factors associated with edentulousness (no natural teeth) in adults with intellectual disabilities. J Intellect Disabil Res 2019; 63:1475-1481. [PMID: 31062460 DOI: 10.1111/jir.12628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/18/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Poor oral health is largely preventable. Prevention includes toothbrushing and regular dental checks. Oral health has important consequences for general nutrition, chewing, communication, wider systemic disease, self-confidence and participation in society. This study investigated the prevalence of edentulousness (no natural teeth) in adults with intellectual disabilities (IDs) compared with the general population and associated factors. METHODS An adult cohort with IDs residing in Greater Glasgow and Clyde, Scotland, underwent detailed health assessments between 2002 and 2004. Between 2004 and 2006, a subsample had an oral check. Data on edentulousness in the cohort were compared with adult participants from Greater Glasgow and Clyde in the 2008 Scottish Health Survey. Within the IDs cohort, binary logistic regression analyses investigated potential relationships between edentulousness and demographic and clinical factors. RESULTS Five hundred sixty adults with IDs were examined [53.2% (298) male, mean age = 46.3 years, range 18-81 years] and compared with 2547 general population: edentulousness was 9% vs. 1% aged 25-34 years; 22% vs. 2% aged 35-44 years; 39% vs. 7% aged 45-54 years; 41% vs. 18% aged 55-64 years; and 76% vs. 34% aged 65-74 years. In both groups, edentulousness increased with age. After stratification for age, rates of edentulousness were consistently higher in the ID cohort. Odds ratios within age strata were not homogenous (Mantel-Haenszel test, P < 0.0001). Edentulousness was more likely in those with more severe IDs (adjusted odds ratio (AOR) = 2.36; 95% confidence interval (CI) [1.23 to 4.51]); those taking antipsychotics (AOR = 2.09; 95% CI [1.25 to 3.51]) and those living in the most deprived neighbourhoods (AOR = 2.69; 95% CI [1.11 to 6.50]). There was insufficient evidence for associations with sex, type of accommodation/support, antiepileptics, problem behaviours or autism. CONCLUSIONS Adults with IDs have a high prevalence of edentulousness and need supported daily oral care to reduce the need for extractions. Despite previous reports on poor oral care and the move towards person-centred care, carers and care-giving organisations need greater support to implement daily oral care. Prescribers need awareness of the potentially contributory role of antipsychotics, which may relate to xerostomia.
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Affiliation(s)
- D Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - L Allan
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - J Morrison
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - J Finlayson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - A Sherriff
- School of Medicine, Dentistry & Nursing, Glasgow Dental Hospital & School, Glasgow, UK
| | - L Macpherson
- School of Medicine, Dentistry & Nursing, Glasgow Dental Hospital & School, Glasgow, UK
| | - A Henderson
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - L Ward
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - M Muir
- Department of Public Health, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - S A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
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17
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Hutchinson JC, Shelmerdine SC, Lewis C, Parmenter J, Simcock IC, Ward L, Ashworth MT, Chitty LS, Arthurs OJ, Sebire NJ. Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure. Ultrasound Obstet Gynecol 2019; 54:661-669. [PMID: 30620444 DOI: 10.1002/uog.20211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Less invasive autopsy techniques in cases of fetal or infant death have good acceptability among parents, but the published sampling adequacy in needle biopsy studies is generally poor. Minimally Invasive Autopsy with Laparoscopically assisted sampling (MinImAL) has the potential to increase the diagnostic yield of less invasive autopsy by improving the quality and quantity of tissue samples obtained, whilst permitting visualization, extraction and examination of internal organs through a small incision. The aim of this study was to present the findings of our experience with the MinImAL procedure in cases of fetal, neonatal and pediatric death. METHODS This was a retrospective analysis of 103 prospectively recruited unselected cases of fetal, neonatal or pediatric death that underwent the MinImAL procedure at a tertiary referral center over a 5-year period. Following preprocedure 1.5-T whole-body postmortem magnetic resonance imaging, MinImAL autopsy was performed. Procedure duration, sampling adequacy and cause of death were assessed. Chi-square analysis was used to compare the 'unexplained' rate of intrauterine deaths in the cohort with that in a previously published cohort of > 1000 cases of intrauterine death examined by standard autopsy. RESULTS MinImAL autopsy was performed successfully in 97.8% (91/93) of the cases undergoing a complete procedure. There was a satisfactory rate of adequate histological sampling in most major organs; heart (100%, 91 cases), lung (100%, 91 cases), kidney (100%, 91 cases), liver (96.7%, 88 cases), spleen (94.5%, 86 cases), adrenal glands (89.0%, 81 cases), pancreas (82.4%, 75 cases) and thymus (56.0%, 51 cases). Procedure duration was similar to that of standard autopsy in a previously published cohort of intrauterine deaths. The unexplained rate in stillbirths and intrauterine fetal deaths that underwent MinImAL autopsy was not significantly different from that following standard autopsy. CONCLUSIONS The MinImAL procedure provides good histological yield from major organs with minimal cosmetic damage and can be learned by an autopsy practitioner. The MinImAL procedure is an appropriate minimally invasive alternative for the investigation of perinatal and pediatric deaths in which consent to full autopsy is withheld, and may have applications in both high- and low/middle-income settings. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - S C Shelmerdine
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - C Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Parmenter
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - I C Simcock
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - L Ward
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - M T Ashworth
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - L S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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Howard A, Banks S, Owens R, Ward L, Warner N, Mukherjee S. The role of active nutritional intervention in patients receiving chemoradiation (CRT) for oesophageal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Imel E, Whyte M, Munns C, Portale A, Ward L, Nilsson O, Simmons J, Padidela R, Namba N, Cheong HI, Mao M, Chen CY, Skrinar A, San Martin J, Glorieux F. OR13-2 Burosumab Resulted in Greater Improvement in Rickets Than Conventional Therapy in Children with X-Linked Hypophosphatemia (XLH). J Endocr Soc 2019. [PMCID: PMC6555067 DOI: 10.1210/js.2019-or13-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
XLH is characterized by excess FGF23, hypophosphatemia, skeletal deformities, and growth impairment. For the last 40 years, XLH has been treated with multiple daily doses of oral phosphate and active vitamin D (Pi/D). Burosumab, a fully human monoclonal antibody to FGF23, has been approved by the FDA for the treatment of XLH in patients ≥1 year-old. In this Phase 3 trial (NCT02915705), 61 children with XLH (1-12 years old) were randomized (1:1) to receive subcutaneous burosumab starting at 0.8 mg/kg every 2 weeks or continue Pi/D titrated and individualized for each subject by investigators. Eligibility criteria included a Total Rickets Severity Score (RSS) ≥2.0 despite prior treatment with Pi/D (>7-day washout before baseline). The primary endpoint was healing of rickets at Week 40 assessed by radiologists blinded to treatment using the Radiographic Global Impression of Change (RGI-C). The mean ± SE daily oral phosphate dose from baseline to Week 40 was 37.8 ± 3.2 mg/kg, with >99% compliance reported based on days of dosing. Compared with Pi/D, 40 weeks of burosumab resulted in a greater LS mean ± SE increase in serum phosphorus (0.92 ± 0.08 vs 0.20 ± 0.06 mg/dL), TmP/GFR (1.19 ± 0.11 vs -0.16 ± 0.05 mg/dL), and 1,25(OH)2D (30 ± 4 vs 19 ± 4 pg/mL). At Week 40, rickets improved in both groups; RGI-C global score was significantly higher in burosumab subjects than in Pi/D subjects (LS mean ± SE: +1.9 ± 0.1 vs +0.8 ± 0.1; p<0.0001). More burosumab subjects had substantial healing (RGI-C ≥+2.0), compared with Pi/D subjects (21/29, 72% vs 2/32, 6%; odds ratio of 39.1, p<0.0001). Improvement in the RGI-C lower limb deformity score was greater with burosumab than with Pi/D (+0.62 ± 0.12 vs +0.21 ± 0.12; p=0.02). Alkaline phosphatase decreased more with burosumab compared with Pi/D (-131 ± 13 vs 35 ± 19; p<0.0001). Consistent with decreases in rickets severity, burosumab improved growth and mobility. Standing height Z-score increased by a LS mean change (95% CI) of +0.15 (0.05, 0.25) for burosumab and +0.08 (-0.02, 0.19) for Pi/D. The 6 Minute Walk Test percent predicted distance increased with burosumab (Baseline to Week 40: 62% to 72%) and was unchanged with Pi/D (76% to 75%). Nephrocalcinosis score (range 0-4) shifted 0 in 20 Pi/D and 24 burosumab subjects; +1 in 3 Pi/D and 0 burosumab subjects; and -1 in 3 Pi/D and 2 burosumab subjects. Pre-defined adverse events (AEs) of interest, including hypersensitivity and injection site reactions, were higher in the burosumab group and were mild to moderate in severity overall. There were 4 serious AEs (3 burosumab, 1 Pi/D); none were treatment-related and all resolved. No subject discontinued study drug in either group. Data after 64 weeks of treatment will be available at the time of presentation. In this randomized Phase 3 trial, burosumab resulted in increases in growth and mobility, and significantly greater improvements in rickets than Pi/D in 1-12 year-old children with XLH.
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Affiliation(s)
- Erik Imel
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michael Whyte
- Shriners Hospital for Children, Saint Louis, MO, United States
| | - Craig Munns
- Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, , Australia
| | - Anthony Portale
- Dept of Endo-Rm U585, University of California - San Francisco, San Francisco, CA, United States
| | | | - Ola Nilsson
- Karolinska Institutet, Karolinska Institutet and Örebro University, Stockholm, , Sweden
| | - Jill Simmons
- Pediatric Endocrinology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Raja Padidela
- Royal Manchester Children's Hospital, Manchester, , United Kingdom
| | - Noriyuki Namba
- Dept of Pediatrics, Osaka Hospital, Japan Community Healthcare Organization and Osaka University Graduate School of Medicine, Osaka, , Japan
| | - Hae Il Cheong
- Seoul National University Children’s Hospital, Seoul, , Korea, Republic of
| | - Meng Mao
- Ultragenyx Pharmaceutical Inc., Novato, CA, United States
| | - Chao-Yin Chen
- Ultragenyx Pharmaceutical Inc., Novato, CA, United States
| | - Alison Skrinar
- Ultragenyx Pharmaceutical Inc., Novato, CA, United States
| | - Javier San Martin
- Clinical Sciences, Ultragenyx Pharmaceutical Inc., Novato, CA, United States
| | - Francis Glorieux
- Shriners Hospital for Children-Canada, McGill University, Montreal, QC, Canada
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Lentle B, Koromani F, Brown JP, Oei L, Ward L, Goltzman D, Rivadeneira F, Leslie WD, Probyn L, Prior J, Hammond I, Cheung AM, Oei EH. The Radiology of Osteoporotic Vertebral Fractures Revisited. J Bone Miner Res 2019; 34:409-418. [PMID: 30645770 DOI: 10.1002/jbmr.3669] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/17/2018] [Accepted: 01/05/2019] [Indexed: 01/31/2023]
Abstract
Until recently there has been little evidence available to validate any method by which to make an accurate diagnosis of an osteoporotic vertebral fractures (OVFs) from plain radiographs. In part this reflects a lack of a completely satisfactory "gold standard," but primarily it relates to the absence of well-designed prospective studies in this context. Historically, OVFs were recognized by evidence of macroscopic structural failure in vertebrae using the criteria applied elsewhere in the skeleton. This comprised altered alignment, fragmentation, cortical disruptions, and breaks, among other changes. However, these morphological criteria were replaced by vertebral morphometry, referring to the use of quantitative or quasi-quantitative measurement tools for fracture diagnosis. Vertebral morphometry emerged as an understanding of and treatment for osteoporosis evolved, mainly in response to the need for expeditious assessments of large numbers of spine images for epidemiological and pharmaceutical purposes. Although most of the descriptions of such morphometric tools have stressed that they were not to be applied to clinical diagnosis with respect to individual patients, this constraint has been widely disregarded. Here we review the major attempts to develop a diagnostic strategy for OVF and describe their characteristics in adults and children. Recent evidence suggests that morphometric (quantitative; ie, based on measurement of dimensions and shape description) criteria are inferior to morphologic (qualitative; ie, based on structural integrity) vertebral damage assessment in identifying people with low bone density and at an increased risk of future fracture. Thus there is now an evidentiary basis for suggesting that morphological assessment is the preferred strategy for use in diagnosing OVF from radiographs. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Brian Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Fjorda Koromani
- Department of Radiology and Nuclear Medicine, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands.,Department of Internal Medicine, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Jacques P Brown
- Department of Medicine, Division of Rheumatology, CHU de Québec Research Centre, Laval University, Québec City, QC, Canada
| | - Ling Oei
- Department of Internal Medicine, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Leanne Ward
- Division of Bone Health, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - David Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montréal, QC, Canada
| | - Fernando Rivadeneira
- Department of Internal Medicine, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Linda Probyn
- Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jerilynn Prior
- Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Ian Hammond
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Angela M Cheung
- Department of Medicine and Joint Department of Medical Imaging, Centre of Excellence in Skeletal Health Assessment, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Edwin H Oei
- Department of Radiology and Nuclear Medicine, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
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Kuring JK, Mathias JL, Ward L. Prevalence of Depression, Anxiety and PTSD in People with Dementia: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2018; 28:393-416. [PMID: 30536144 DOI: 10.1007/s11065-018-9396-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
Abstract
There appears to be a link between depression/anxiety/PTSD and dementia, although the evidence is incomplete and the reason is unclear. Mental illness may cause dementia or may be prodromal or comorbid with dementia, or dementia may trigger a relapse of symptoms in individuals with a history of mental illness. This study examined the link between depression/anxiety/PTSD and dementia by evaluating the prevalence of these disorders in people with dementia, relative to their healthy peers. Existing meta-analyses have examined the prevalence of clinically-significant depression and anxiety in Alzheimer's disease (AD), and depression in frontotemporal dementia (FTD), but have not considered vascular dementia (VaD), dementia with Lewy bodies (DLB), PTSD, or anxiety in FTD. The current meta-analysis compared the prevalence of clinically-significant depression, anxiety and PTSD in the four most common types of dementia (AD, VaD, DLB, FTD) and in unspecified dementia to that of healthy controls (PROSPERO number: CRD42017082086). PubMed, EMBASE, PsycINFO and CINAHL database searches identified 120 eligible studies. Prevalence rates were calculated for depression and anxiety in AD, VaD, DLB, FTD, unspecified dementia, and controls. PTSD data were only available for unspecified dementia. Subgroup analyses indicated that depression, but not anxiety, was more prevalent in people with dementia compared to controls; however, the anxiety analyses were probably under-powered. The results support a link between depression and dementia; however, the link between anxiety or PTSD and dementia remains unclear due to insufficient data. Longitudinal data is now needed to clarify whether depression/anxiety/PTSD may be risk factors for dementia.
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Affiliation(s)
- J K Kuring
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - J L Mathias
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - L Ward
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia
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Boulanger Piette A, Hamoudi D, Marcadet L, Morin F, Argaw A, Ward L, Frenette J. Targeting the Muscle-Bone Unit: Filling Two Needs with One Deed in the Treatment of Duchenne Muscular Dystrophy. Curr Osteoporos Rep 2018; 16:541-553. [PMID: 30225627 DOI: 10.1007/s11914-018-0468-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW In Duchenne muscular dystrophy (DMD), the progressive skeletal and cardiac muscle dysfunction and degeneration is accompanied by low bone mineral density and bone fragility. Glucocorticoids, which remain the standard of care for patients with DMD, increase the risk of developing osteoporosis. The scope of this review emphasizes the mutual cohesion and common signaling pathways between bone and skeletal muscle in DMD. RECENT FINDINGS The muscle-bone interactions involve bone-derived osteokines, muscle-derived myokines, and dual-origin cytokines that trigger common signaling pathways leading to fibrosis, inflammation, or protein synthesis/degradation. In particular, the triad RANK/RANKL/OPG including receptor activator of NF-kB (RANK), its ligand (RANKL), along with osteoprotegerin (OPG), regulates bone matrix modeling and remodeling pathways and contributes to muscle pathophysiology in DMD. This review discusses the importance of the muscle-bone unit in DMD and covers recent research aimed at determining the muscle-bone interactions that may eventually lead to the development of multifunctional and effective drugs for treating muscle and bone disorders regardless of the underlying genetic mutations in DMD.
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Affiliation(s)
- Antoine Boulanger Piette
- Centre Hospitalier Universitaire de Québec, Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ-CHUL), Axe Neurosciences, Université Laval, Quebec City, QC, G1V 4G2, Canada
| | - Dounia Hamoudi
- Centre Hospitalier Universitaire de Québec, Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ-CHUL), Axe Neurosciences, Université Laval, Quebec City, QC, G1V 4G2, Canada
| | - Laetitia Marcadet
- Centre Hospitalier Universitaire de Québec, Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ-CHUL), Axe Neurosciences, Université Laval, Quebec City, QC, G1V 4G2, Canada
| | - Françoise Morin
- Centre Hospitalier Universitaire de Québec, Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ-CHUL), Axe Neurosciences, Université Laval, Quebec City, QC, G1V 4G2, Canada
| | - Anteneh Argaw
- Centre Hospitalier Universitaire de Québec, Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ-CHUL), Axe Neurosciences, Université Laval, Quebec City, QC, G1V 4G2, Canada
| | - Leanne Ward
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, ON, K1H 8L1, Canada
| | - Jérôme Frenette
- Centre Hospitalier Universitaire de Québec, Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ-CHUL), Axe Neurosciences, Université Laval, Quebec City, QC, G1V 4G2, Canada.
- Département de Réadaptation, Faculté de Médecine, Université Laval, Quebec City, QC, G1V 0A6, Canada.
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Wallace E, Mathias J, Ward L. The relationship between diffusion tensor imaging findings and cognitive outcomes following adult traumatic brain injury: A meta-analysis. Neurosci Biobehav Rev 2018; 92:93-103. [DOI: 10.1016/j.neubiorev.2018.05.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/04/2018] [Accepted: 05/22/2018] [Indexed: 12/20/2022]
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Tinson RA, Hughes DL, Ward L, Stephenson GR. Unusual Nucleophilic Addition of Grignard Reagents in the Synthesis of 4-Amino-pyrimidines. ACS Omega 2018; 3:8937-8944. [PMID: 31459026 PMCID: PMC6644423 DOI: 10.1021/acsomega.8b01137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/18/2018] [Indexed: 06/10/2023]
Abstract
Pyrimidines have always received considerable attention because of their importance in synthesis and elucidation of biochemical roles, in particular that of vitamin B1. Herein, we describe a reaction pathway in a Grignard reagent-based synthesis of substituted pyrimidines. A general synthesis of α-keto-2-methyl-4-amino pyrimidines and their C6-substituted analogues from 4-amino-5-cyano-2-methylpyrimidine is reported. The presence of the nitrile substituent in the starting material also results in an unusual reaction pathway leading to C6-substituted 1,2-dihydropyrimidines. Grignard reagents that give normal pyrimidine products under standard reaction conditions can be switched to give dihydropyrimidines by holding the reaction at 0 °C before quenching.
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Trejo P, Rauch F, Ward L. Hypercalcemia and hypercalciuria during denosumab treatment in children with osteogenesis imperfecta type VI. J Musculoskelet Neuronal Interact 2018; 18:76-80. [PMID: 29504582 PMCID: PMC5881132] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Children with osteogenesis imperfecta (OI) type VI often have high fracture rates despite the current standard treatment with bisphosphonates. Subcutaneous injections of denosumab have been proposed as an alternative treatment approach, but safety data on denosumab in children are limited. Here we describe fluctuations in bone and mineral metabolism during denosumab treatment in four children with OI type VI who started denosumab (basic protocol: 1 mg per kg body mass every 3 months) between 1.9 and 9.0 years of age, after having received intravenous bisphosphonates previously. All four children developed hypercalciuria during active denosumab therapy. In two children aged 3.9 and 4.6 years, episodes of hypercalcemia were observed between 7 and 12 weeks after the preceding denosumab injection. During times when the interval between denosumab injections was increased to 6 months for clinical reasons, lumbar spine bone mineral density z-scores decreased rapidly. It appears that the duration of action of denosumab is short and variable in children with OI type VI. These observations call into question the concept that denosumab can be used as a stand-alone alternative to bisphosphonates to treat children with OI.
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Affiliation(s)
- Pamela Trejo
- Shriners Hospital for Children and McGill University, Montreal, Quebec, Canada
| | - Frank Rauch
- Shriners Hospital for Children and McGill University, Montreal, Quebec, Canada,Corresponding author: Frank Rauch, Shriners Hospital for Children, 1003 Boulevard Decarie, Montreal, Quebec, Canada H4A 0A9 E-mail:
| | - Leanne Ward
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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Li G, Jin Y, Levine MA, Hoyer-Kuhn H, Ward L, Adachi JD. Systematic review of the effect of denosumab on children with osteogenesis imperfecta showed inconsistent findings. Acta Paediatr 2018; 107:534-537. [PMID: 29154388 DOI: 10.1111/apa.14154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 11/29/2022]
Affiliation(s)
- Guowei Li
- Department of Health Research Methods, Evidence, and Impact; McMaster University; Hamilton ON Canada
- Programs for Assessment of Technology in Health (PATH); Centre for Evaluation of Medicines; Hamilton ON Canada
- St. Joseph's Healthcare Hamilton; Hamilton ON Canada
| | - Yanling Jin
- Department of Health Research Methods, Evidence, and Impact; McMaster University; Hamilton ON Canada
| | - Mitchell A.H. Levine
- Department of Health Research Methods, Evidence, and Impact; McMaster University; Hamilton ON Canada
- Programs for Assessment of Technology in Health (PATH); Centre for Evaluation of Medicines; Hamilton ON Canada
- St. Joseph's Healthcare Hamilton; Hamilton ON Canada
- Department of Medicine; McMaster University; Hamilton ON Canada
| | | | - Leanne Ward
- Children's Hospital of Eastern Ontario; Ottawa ON Canada
| | - Jonathan D. Adachi
- St. Joseph's Healthcare Hamilton; Hamilton ON Canada
- Department of Medicine; McMaster University; Hamilton ON Canada
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Courtice S, Mohanlal A, Ward L, Naidu S, Finucane J, Wright O. MON-LB341: ‘Feed not Fast’: A Multidisciplinary Systems Approach to Malnutrition in an Acute Hospital. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31085-3] [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: 11/16/2022]
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Steel A, Sundberg T, Reid R, Ward L, Bishop F, Leach M, Cramer H, Wardle J, Adams J. Corrigendum to "Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research" [Musculoskelet. Sci. Pract. 27 165-175]. Musculoskelet Sci Pract 2017; 30:86. [PMID: 28283320 DOI: 10.1016/j.msksp.2017.02.005] [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: 11/30/2022]
Affiliation(s)
- A Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia.
| | - T Sundberg
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Research Unit for Studies of Integrative Health Care, Karolinska Institutet (NVS/OMV), Alfred Nobels Alle 23, 141 83, Stockholm, Sweden
| | - R Reid
- Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia
| | - L Ward
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), B4495, OX3 7LD, University of Oxford, Oxford, United Kingdom
| | - F Bishop
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Centre for Applications of Health Psychology, Faculty of Social Human and Mathematical Sciences, Building 44 Highfield Campus, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - M Leach
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; School of Nursing & Midwifery, Health Economics & Social Policy Group, University of South Australia, 101 Currie St, Adelaide, Australia
| | - H Cramer
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45141, Duisburg, Germany
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Thomaz FS, Panchal S, Ward L, Worrall S. Effect of wasabi (Wasabia japonica) on metabolic parameters of diet-induced obese Wistar rats. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- FS Thomaz
- University of Queensland, St Lucia, Australia
| | - S Panchal
- University of Southern Queensland, Toowoomba, Australia
| | - L Ward
- University of Queensland, St Lucia, Australia
| | - S Worrall
- University of Queensland, St Lucia, Australia
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Gonzalez Ballesteros LF, Ma NS, Gordon RJ, Ward L, Backeljauw P, Wasserman H, Weber DR, DiMeglio LA, Gagne J, Stein R, Cody D, Simmons K, Zimakas P, Topor LS, Agrawal S, Calabria A, Tebben P, Faircloth R, Imel EA, Casey L, Carpenter TO. Unexpected widespread hypophosphatemia and bone disease associated with elemental formula use in infants and children. Bone 2017; 97:287-292. [PMID: 28167344 PMCID: PMC5884631 DOI: 10.1016/j.bone.2017.02.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Hypophosphatemia occurs with inadequate dietary intake, malabsorption, increased renal excretion, or shifts between intracellular and extracellular compartments. We noticed the common finding of amino-acid based elemental formula [EF] use in an unexpected number of cases of idiopathic hypophosphatemia occurring in infants and children evaluated for skeletal disease. We aimed to fully characterize the clinical profiles in these cases. METHODS A retrospective chart review of children with unexplained hypophosphatemia was performed as cases accumulated from various centres in North America and Ireland. Data were analyzed to explore any relationships between feeding and biochemical or clinical features, effects of treatment, and to identify a potential mechanism. RESULTS Fifty-one children were identified at 17 institutions with EF-associated hypophosphatemia. Most children had complex illnesses and had been solely fed Neocate® formula products for variable periods of time prior to presentation. Feeding methods varied. Hypophosphatemia was detected during evaluation of fractures or rickets. Increased alkaline phosphatase activity and appropriate renal conservation of phosphate were documented in nearly all cases. Skeletal radiographs demonstrated fractures, undermineralization, or rickets in 94% of the cases. Although the skeletal disease had often been attributed to underlying disease, most all improved with addition of supplemental phosphate or change to a different formula product. CONCLUSION The observed biochemical profiles indicated a deficient dietary supply or severe malabsorption of phosphate, despite adequate formula composition. When transition to an alternate formula was possible, biochemical status improved shortly after introduction to the alternate formula, with eventual improvement of skeletal abnormalities. These observations strongly implicate that bioavailability of formula phosphorus may be impaired in certain clinical settings. The widespread nature of the findings lead us to strongly recommend careful monitoring of mineral metabolism in children fed EF. Transition to alternative formula use or implementation of phosphate supplementation should be performed cautiously with as severe hypocalcemia may develop.
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Affiliation(s)
| | - Nina S Ma
- Boston Children's Hospital, Boston, MA, United States
| | | | - Leanne Ward
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | - David R Weber
- University of Rochester, Rochester, NY, United States
| | - Linda A DiMeglio
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Julie Gagne
- Centre Hospitalier de l'Université Laval, Quebec City, QC, Canada
| | - Robert Stein
- Children's Hospital of Western Ontario, London, ON, Canada
| | - Declan Cody
- Our Lady's Children's Hospital, Crumlin, Ireland
| | | | - Paul Zimakas
- University of Vermont Medical Center, Burlington, VT, United States
| | - Lisa Swartz Topor
- Alpert Medical School of Brown University, Providence, RI, United States; Hasbro Children's Hospital, Providence, RI, United States
| | - Sungeeta Agrawal
- Alpert Medical School of Brown University, Providence, RI, United States; Hasbro Children's Hospital, Providence, RI, United States
| | - Andrew Calabria
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Ruth Faircloth
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Erik A Imel
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Linda Casey
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Thomas O Carpenter
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT, United States.
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Chhabra P, Gregoricus N, Weinberg G, Halasa N, Chappell JD, Hassan F, Selvarangan R, Ward L, Bowen MD, Payne D, Vinjé J. Comparison of Three Commercial Multiplex Gastrointestinal Platforms for the Detection of Gastroenteritis Viruses. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Preeti Chhabra
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Gregoricus
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Geoffrey Weinberg
- Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Ferdaus Hassan
- Children's Mercy Hospital and Clinics, Kansas City, Missouri
| | | | - Leanne Ward
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael D. Bowen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, Michigami T, Tiosano D, Mughal MZ, Mäkitie O, Ramos-Abad L, Ward L, DiMeglio LA, Atapattu N, Cassinelli H, Braegger C, Pettifor JM, Seth A, Idris HW, Bhatia V, Fu J, Goldberg G, Sävendahl L, Khadgawat R, Pludowski P, Maddock J, Hyppönen E, Oduwole A, Frew E, Aguiar M, Tulchinsky T, Butler G, Högler W. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Horm Res Paediatr 2016; 85:83-106. [PMID: 26741135 DOI: 10.1159/000443136] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. EVIDENCE A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. PROCESS Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. RESULTS This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. CONCLUSION Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.
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Morley SA, Coe HJ, Duda JJ, Dunphy LS, McHenry ML, Beckman BR, Elofson M, Sampson EM, Ward L. Seasonal variation exceeds effects of salmon carcass additions on benthic food webs in the Elwha River. Ecosphere 2016. [DOI: 10.1002/ecs2.1422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- S. A. Morley
- Fish Ecology Division Northwest Fisheries Science Center National Marine Fisheries Service, NOAA Seattle Washington 98112 USA
| | - H. J. Coe
- Ocean Associates Arlington Virginia 22207 USA
| | - J. J. Duda
- Western Fisheries Research Center U.S. Geological Survey Seattle Washington 98115 USA
| | - L. S. Dunphy
- School of Aquatic and Fishery Sciences University of Washington Seattle Washington 98105 USA
| | - M. L. McHenry
- Natural Resources Department Lower Elwha Klallam Tribe Port Angeles Washington 98363 USA
| | - B. R. Beckman
- Environmental and Fisheries Sciences Division Northwest Fisheries Science Center National Marine Fisheries Service, NOAA Seattle Washington 98112 USA
| | - M. Elofson
- Natural Resources Department Lower Elwha Klallam Tribe Port Angeles Washington 98363 USA
| | - E. M. Sampson
- Natural Resources Department Lower Elwha Klallam Tribe Port Angeles Washington 98363 USA
| | - L. Ward
- Natural Resources Department Lower Elwha Klallam Tribe Port Angeles Washington 98363 USA
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White GA, Ward L, Pink C, Craigon J, Millar KM. "Who's been a good dog?" - Owner perceptions and motivations for treat giving. Prev Vet Med 2016; 132:14-19. [PMID: 27664444 DOI: 10.1016/j.prevetmed.2016.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/22/2016] [Accepted: 08/11/2016] [Indexed: 11/27/2022]
Abstract
Complex relationships commonly exist between owners and their companion animals, particularly around feeding behaviour with an owner's affection or love for their animal most pronounced through the provision of food. It is notable that the pet food market is experiencing strong year-on-year growth in sales of dog and cat treats. Recognising the impact of treat giving in pet nutrition, the objective of the study was to investigate owner attitudes and motivations towards feeding treats (shop bought and other) to their dogs. A researcher-mediated questionnaire consisting of both quantitative and qualitative questions was used to interview dog owners (n=280) at two locations: an out-of-town retail park and a country park in the East Midlands. Owners almost unanimously viewed the word 'treat' within a nutritional context, as opposed to a new toy or other pleasure. The majority (96%) of owners interviewed reported feeding treats to their dog, with 69% feeding shop-bought treats on a daily basis. A wide range of treats was reportedly given by owners and the majority of owners interviewed fed multiple treat types. No association was found between owner age and frequency of shop-bought treats fed (P=0.659) nor between owner age and frequency of food given to the dog from the owner's plate (P=0.083). A wide range of foods which would not be considered balanced for the animal's nutritional requirements was viewed as a treat by some dog owners. A range of positive and negative views around the feeding of treats were expressed by dog owners, with some citing beneficial effects while others were clearly aware of the association between treat feeding and potential weight gain/obesity. Owner views included themes around positive reinforcement and responsibility but also reflected relational aspects of the human-animal bond. The results of the study show that treat giving is commonplace in feeding regimes and that treats are embedded in the feeding behaviour of many dog owners. However, the different views expressed around the motivations for, and feeding of, dog treats, reinforce the need to better understand owner psychology linked to this area, and the role this may play in the growing pet obesity epidemic.
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Affiliation(s)
- G A White
- School of Biosciences, Sutton Bonington Campus, University of Nottingham, Loughborough, Leicestershire, LE12 5RD, UK.
| | - L Ward
- School of Biosciences, Sutton Bonington Campus, University of Nottingham, Loughborough, Leicestershire, LE12 5RD, UK
| | - C Pink
- School of Biosciences, Sutton Bonington Campus, University of Nottingham, Loughborough, Leicestershire, LE12 5RD, UK
| | - J Craigon
- School of Biosciences, Sutton Bonington Campus, University of Nottingham, Loughborough, Leicestershire, LE12 5RD, UK
| | - K M Millar
- Centre for Applied Bioethics, School of Biosciences and School of Veterinary Medicine and Science, University of Nottingham, Loughborough, Leicestershire, LE12 5RD, UK
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Belinsky GS, Ward L, Chung C. Pigment epithelium-derived factor (PEDF) normalizes matrix defects in iPSCs derived from Osteogenesis imperfecta Type VI. Rare Dis 2016; 4:e1212150. [PMID: 27579219 PMCID: PMC4986704 DOI: 10.1080/21675511.2016.1212150] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/14/2016] [Accepted: 07/06/2016] [Indexed: 01/28/2023] Open
Abstract
Osteogenesis imperfecta (OI) Type VI is characterized by a defect in bone mineralization, which results in multiple fractures early in life. Null mutations in the PEDF gene, Serpinf1, are the cause of OI VI. Whether PEDF restoration in a murine model of OI Type VI could improve bone mass and function was previously unknown. In Belinsky et al, we provided evidence that PEDF delivery enhanced bone mass and improved parameters of bone function in vivo. Further, we demonstrated that PEDF temporally inhibits Wnt signaling to enhance osteoblast differentiation. Here, we demonstrate that generation of induced pluripotent stem cells (iPSCs) from a PEDF null patient provides additional evidence for PEDF's role in regulating extracellular matrix proteins secreted from osteoblasts. PEDF null iPSCs have marked abnormalities in secreted matrix proteins, capturing a key feature of human OI Type VI, which were normalized by exogenous PEDF. Lastly, we place our recent findings within the broader context of PEDF biology and the developmental signaling pathways that are implicated in its actions.
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Affiliation(s)
- Glenn S Belinsky
- Department of Medicine, Yale University School of Medicine , New Haven, CT, USA
| | - Leanne Ward
- Children's Hospital of Eastern Ontario , Ottawa, Canada
| | - Chuhan Chung
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA; VA CT Healthcare System, West Haven, CT, USA
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Ross HS, Siddiqui A, Ram A, Ward L. Perspectives on self and other in children’s representations of sibling conflict. International Journal of Behavioral Development 2016. [DOI: 10.1080/01650250344000253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Seventy-six siblings (3–9 years) were individually interviewed concerning their recent conflicts. Analyses compared goals, requests, and voluntary actions attributed to self and other. Children were adept at describing both own and others’ goals, requests, and actions, and these formed coherent hierarchies in which overarching explicit goals motivated actions and requests attributed to each protagonist. Children also recognised the basic opposition between antagonists’ goals. A majority of explicitly stated goals matched those attributed by both narrators to the same sibling, an agreement rate exceeding that found for requests or actions. Older siblings also focused more on goals of others; their accounts contained more spontaneous explicit goals of others and more complex goal hierarchies for others in comparison both to their reports for self and to the reports of their younger counterparts. The discussion emphasises the development and importance of understanding others’ perspectives on interpersonal conflict.
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Ward L, Bardai G, Moffatt P, Al-Jallad H, Trejo P, Glorieux FH, Rauch F. Osteogenesis Imperfecta Type VI in Individuals from Northern Canada. Calcif Tissue Int 2016; 98:566-72. [PMID: 26815784 DOI: 10.1007/s00223-016-0110-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 10/26/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
Osteogenesis imperfecta (OI) type VI is a recessively inherited form of OI that is caused by mutations in SERPINF1, the gene coding for pigment-epithelium derived factor (PEDF). Here, we report on two apparently unrelated children with OI type VI who had the same unusual homozygous variant in intron 6 of SERPINF1 (c.787-10C>G). This variant created a novel splice site that led to the in-frame addition of three amino acids to PEDF (p.Lys262_Ile263insLeuSerGln). Western blotting showed that skin fibroblasts with this mutation produced PEDF but failed to secrete it. Both children were treated with intravenous bisphosphonates, but the treatment of Individual 1 was switched to subcutaneous injections of denosumab (dose 1 mg per kg body weight, repeated every 3 months). An iliac bone sample obtained after 5 denosumab injections (and 3 months after the last injection) showed no change in the increased osteoid parameters that are typical of OI type VI, but the number of osteoclasts in trabecular bone was markedly increased. This suggests that the effect of denosumab on osteoclast suppression is of shorter duration in children with OI type VI than what has previously been reported on adults with osteoporosis.
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Affiliation(s)
- Leanne Ward
- Childrens Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Ghalib Bardai
- Shriners Hospital for Children and McGill University, 1529 Cedar Avenue, Montreal, QC, H3G 1A6, Canada
| | - Pierre Moffatt
- Shriners Hospital for Children and McGill University, 1529 Cedar Avenue, Montreal, QC, H3G 1A6, Canada
| | - Hadil Al-Jallad
- Shriners Hospital for Children and McGill University, 1529 Cedar Avenue, Montreal, QC, H3G 1A6, Canada
| | - Pamela Trejo
- Shriners Hospital for Children and McGill University, 1529 Cedar Avenue, Montreal, QC, H3G 1A6, Canada
| | - Francis H Glorieux
- Shriners Hospital for Children and McGill University, 1529 Cedar Avenue, Montreal, QC, H3G 1A6, Canada
| | - Frank Rauch
- Shriners Hospital for Children and McGill University, 1529 Cedar Avenue, Montreal, QC, H3G 1A6, Canada.
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Lebas BSM, Veerakone S, Liefting LW, Tang J, Perez-Egusquiza Z, von Bargen S, Ward L. Comparison of diagnostic techniques for the detection and differentiation of Cherry leaf roll virus strains for quarantine purposes. J Virol Methods 2016; 234:142-51. [PMID: 27129669 DOI: 10.1016/j.jviromet.2016.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/22/2016] [Accepted: 04/24/2016] [Indexed: 10/21/2022]
Abstract
Some strains of Cherry leaf roll virus (CLRV) are considered as quarantine pests in New Zealand. CLRV was detected in seven plant host species: Actinidia chinensis, Hydrangea macrophylla, Malus domestica, Plantago major, Ribes rubrum, Rubus idaeus and Rumex sp. collected from New Zealand between 2005 and 2012. Biological, serological and molecular techniques were compared for the detection and differentiation of CLRV isolates. The biological analysis revealed differences in symptomatology and disease severity among the isolates. The five isolates tested by ELISA were serologically related to each other using polyclonal antisera with only one out of four commercially-available antisera successfully detecting all of them. The phylogenetic analysis of sequences obtained from parts of the coat protein, polymerase and 3'-untranslated regions revealed that the New Zealand CLRV isolates clustered into two closely related but distinct phylogenetic groups with some isolates grouping differently depending on the gene studied. The New Zealand CLRV isolates were clearly distinct to overseas isolates found in phylogenetic groups A, D and E. The conventional RT-PCR using primers targeting the CLRV coat protein coding region is recommended for determining sequence differences between strains. These findings will be useful in making regulatory decisions with regard to the testing requirements and the CLRV strains to be regulated in New Zealand.
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Affiliation(s)
- B S M Lebas
- Plant Health and Environment Laboratory, Ministry for Primary Industries, PO Box 2095, Auckland 1140, New Zealand.
| | - S Veerakone
- Plant Health and Environment Laboratory, Ministry for Primary Industries, PO Box 2095, Auckland 1140, New Zealand
| | - L W Liefting
- Plant Health and Environment Laboratory, Ministry for Primary Industries, PO Box 2095, Auckland 1140, New Zealand
| | - J Tang
- Plant Health and Environment Laboratory, Ministry for Primary Industries, PO Box 2095, Auckland 1140, New Zealand
| | - Z Perez-Egusquiza
- Plant Health and Environment Laboratory, Ministry for Primary Industries, PO Box 2095, Auckland 1140, New Zealand
| | - S von Bargen
- Humboldt-Universität zu Berlin, Faculty of Life Sciences, Division Phytomedicine, Lentzeallee 55/57, Berlin, D-14195, Germany
| | - L Ward
- Plant Health and Environment Laboratory, Ministry for Primary Industries, PO Box 2095, Auckland 1140, New Zealand
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Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, Michigami T, Tiosano D, Mughal MZ, Mäkitie O, Ramos-Abad L, Ward L, DiMeglio LA, Atapattu N, Cassinelli H, Braegger C, Pettifor JM, Seth A, Idris HW, Bhatia V, Fu J, Goldberg G, Sävendahl L, Khadgawat R, Pludowski P, Maddock J, Hyppönen E, Oduwole A, Frew E, Aguiar M, Tulchinsky T, Butler G, Högler W. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab 2016; 101:394-415. [PMID: 26745253 PMCID: PMC4880117 DOI: 10.1210/jc.2015-2175] [Citation(s) in RCA: 611] [Impact Index Per Article: 76.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. EVIDENCE A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. PROCESS Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. RESULTS This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. CONCLUSION Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.
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Bardai G, Lemyre E, Moffatt P, Palomo T, Glorieux FH, Tung J, Ward L, Rauch F. Osteogenesis Imperfecta Type I Caused by COL1A1 Deletions. Calcif Tissue Int 2016; 98:76-84. [PMID: 26478226 DOI: 10.1007/s00223-015-0066-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/26/2015] [Indexed: 01/09/2023]
Abstract
Osteogenesis imperfecta (OI) type I is usually caused by COL1A1 stop or frameshift mutations, leading to COL1A1 haploinsufficiency. Here we report on 12 individuals from 5 families who had OI type I due to an unusual cause—heterozygous deletions of the entire COL1A1 gene. The deletions were initially detected by semiconductor-based sequencing of genomic DNA and confirmed by quantitative PCR. Array comparative genomic hybridization in DNA of the index patient in each family showed that deletion size varied from 18.5 kb to 2.23 Mb between families, encompassing between 1 and 47 genes (COL1A1 included). The skeletal phenotype of the affected individuals was similar to that of patients with haploinsufficiency caused by COL1A1 stop or frameshift mutations. However, one individual with a deletion that included also DLX3 and DLX4 had tooth discoloration and bone fragility. Three individuals from 2 families had deletions that included also CACNA1G, and these individuals had learning disabilities. These features are not usually observed in COL1A1 haploinsufficiency, but are in accordance with previously described individuals in whom deletions included the same genes. In summary, we found deletions of COL1A1 in 5 out of 161 families (3 %) with OI type I that were evaluated. Deletions encompassing not only COL1A1 but also neighboring genes can lead to contiguous gene syndromes that may include dental involvement and learning disability.
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Guzman J, Kerr T, Ward L, Ma J, Oen K, Boire G, Feldman B, Scuccimarri R, Houghton K, Bruns A, Dancey P, Rosenberg A, Tucker L. SAT0507 Growth and Weight Gain in Children with Juvenile Idiopathic Arthritis: Results from the Reacch-Out Cohort. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Serious illness in children and its therapy can cause osteoporosis, manifesting as vertebral and nonvertebral fractures, pain, skeletal deformity and temporary or even permanent loss of ambulation. In contrast to adults, skeletal growth in children offers tremendous potential to recover bone mineral density and to reshape fractured vertebral bodies, even without bone-targeted therapy, provided that bone health threats are transient and residual growth is sufficient. Here, we outline the principles of bone strength development and the risk factors for osteoporosis due to various paediatric systemic illnesses. We also explain why the approach to the diagnosis and monitoring of childhood osteoporosis has moved away from a bone density-centric focus to a more functional assessment. Finally, we discuss the best candidates for and current approaches to the treatment of osteoporosis in children.
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Lin SX, Zhang Q, Zhang H, Yan K, Ward L, Lu YB, Feng JQ. Nucleus-targeted Dmp1 transgene fails to rescue dental defects in Dmp1 null mice. Int J Oral Sci 2014; 6:133-41. [PMID: 25105818 PMCID: PMC4170153 DOI: 10.1038/ijos.2014.44] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 01/06/2023] Open
Abstract
Dentin matrix protein 1 (DMP1) is essential to odontogenesis. Its mutations in human subjects lead to dental problems such as dental deformities, hypomineralization and periodontal impairment. Primarily, DMP1 is considered as an extracellular matrix protein that promotes hydroxyapatite formation and activates intracellular signaling pathway via interacting with αvβ3 integrin. Recent in vitro studies suggested that DMP1 might also act as a transcription factor. In this study, we examined whether full-length DMP1 could function as a transcription factor in the nucleus and regulate odontogenesis in vivo. We first demonstrated that a patient with the DMP1 M1V mutation, which presumably causes a loss of the secretory DMP1 but does not affect the nuclear translocation of DMP1, shows a typical rachitic tooth defect. Furthermore, we generated transgenic mice expressing (NLS)DMP1, in which the endoplasmic reticulum (ER) entry signal sequence of DMP1 was replaced by a nuclear localization signal (NLS) sequence, under the control of a 3.6 kb rat type I collagen promoter plus a 1.6 kb intron 1. We then crossbred the (NLS)DMP1 transgenic mice with Dmp1 null mice to express the (NLS)DMP1 in Dmp1-deficient genetic background. Although immunohistochemistry demonstrated that (NLS)DMP1 was localized in the nuclei of the preodontoblasts and odontoblasts, the histological, morphological and biochemical analyses showed that it failed to rescue the dental and periodontal defects as well as the delayed tooth eruption in Dmp1 null mice. These data suggest that the full-length DMP1 plays no apparent role in the nucleus during odontogenesis.
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Affiliation(s)
- Shu-Xian Lin
- 1] Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, USA [2] The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine, Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qi Zhang
- Laboratory of Oral Biomedical Science and Translational Medicine, Department of Endodontics, School of Stomatology, Tongji University, Shanghai, China
| | - Hua Zhang
- Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, USA
| | - Kevin Yan
- Department of Biological Sciences, Columbia University, New York, USA
| | - Leanne Ward
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Yong-Bo Lu
- Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, USA
| | - Jian-Quan Feng
- Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, USA
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Bianchi ML, Leonard MB, Bechtold S, Högler W, Mughal MZ, Schönau E, Sylvester FA, Vogiatzi M, van den Heuvel-Eibrink MM, Ward L. Bone health in children and adolescents with chronic diseases that may affect the skeleton: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:281-94. [PMID: 24656723 DOI: 10.1016/j.jocd.2014.01.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [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: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 12/11/2022]
Abstract
The aim of this Task Force was to review the use of dual-energy X-ray absorptiometry (DXA) in children and adolescents with underlying chronic diseases that pose risk factors for compromised bone health, such as inflammation, glucocorticoid therapy, or decreased mobility. The Task Force systematically analyzed more than 270 studies, with an emphasis on those published in the interval since the original 2007 Position Statements. Important developments over this period included prospective cohort studies demonstrating that DXA measures of areal bone mineral density (aBMD) predicted incident fractures and the development of robust reference data and strategies to adjust for bone size in children with growth impairment. In this report, we summarize the current literature on the relationship between DXA-based aBMD and both fracture (vertebral and non-vertebral) outcomes and non-fracture risk factors (e.g., disease characteristics, ambulatory status, and glucocorticoid exposure) in children with chronic illnesses. Most publications described the aBMD profile of children with underlying diseases, as well as the cross-sectional or longitudinal relationship between aBMD and clinically relevant non-fracture outcomes. Studies that addressed the relationship between aBMD and prevalent or incident fractures in children with chronic illnesses are now emerging. In view of these updated data, this report provides guidelines for the use of DXA-based aBMD in this setting. The initial recommendation that DXA is part of a comprehensive skeletal healthy assessment in patients with increased risk of fracture is unchanged. Although the prior guidelines recommended DXA assessment in children with chronic diseases at the time of clinical presentation with ongoing monitoring, this revised Position Statement focuses on the performance of DXA when the patient may benefit from interventions to decrease their elevated risk of a clinically significant fracture and when the DXA results will influence that management.
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Affiliation(s)
- Maria Luisa Bianchi
- Experimental Laboratory for Children's Bone Metabolism Research, Istituto Auxologico Italiano IRCCS, Milano, Italy.
| | - Mary B Leonard
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Susanne Bechtold
- Department of Pediatrics, Medical University Munich, Munich, Germany
| | - Wolfgang Högler
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK
| | - M Zulf Mughal
- Department of Paediatric Medicine, Royal Manchester Children's Hospital, Manchester, UK
| | - Eckhart Schönau
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinik Köln, Köln, Germany
| | | | - Maria Vogiatzi
- Department of Pediatric Endocrinology, Weill Medical College of Cornell University, New York, NY, USA
| | | | - Leanne Ward
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Peplow CL, Ward L, Thickett D, Thompson R. P67 Electronic prescribing alerts significantly increase oxygen prescribing. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.217] [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: 11/03/2022]
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Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, Brown JP, Cohen A, Kim H. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol 2013; 9:30. [PMID: 23947590 PMCID: PMC3765115 DOI: 10.1186/1710-1492-9-30] [Citation(s) in RCA: 656] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/25/2013] [Indexed: 02/06/2023] Open
Abstract
Systemic corticosteroids play an integral role in the management of many inflammatory and immunologic conditions, but these agents are also associated with serious risks. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing’s syndrome, psychiatric disturbances and immunosuppression are among the more serious side effects noted with systemic corticosteroid therapy, particularly when used at high doses for prolonged periods. This comprehensive article reviews these adverse events and provides practical recommendations for their prevention and management based on both current literature and the clinical experience of the authors.
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Affiliation(s)
- Dora Liu
- Western University, London, ON, Canada.
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De Grood J, Ward L, Harman S, Duchscherer C, Ward M, McClure J, Hope K, Kim J, Vayalumkal J, Zhang K, Louie T, Conly J. O069: Efficacy of cleaning methods post-inoculation of pathogenic microorganisms of conventional and novel cleankeys computer keyboards. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687830 DOI: 10.1186/2047-2994-2-s1-o69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ward L, Wernham A, Deeming A, Carruthers D, Buckley C, Raza K, De Pablo P. SAT0046 Should there be Different Disease Activity Criteria for Assessment of Patients with Rheumatoid Arthritis According to Ethnic Backgrounds? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1772] [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: 11/04/2022]
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Mehta P, Holder S, Fisher B, Vincent T, Nadesalingam K, Maciver H, Shingler W, Bakshi J, Hassan S, D'Cruz D, Chan A, Litwic AE, McCrae F, Seth R, McCrae F, Nandagudi A, Jury E, Isenberg D, Karjigi U, Paul A, Rees F, O'Dowd E, Kinnear W, Johnson S, Lanyon P, Bakshi J, Stevens R, Narayan N, Marguerie C, Robinson H, Ffolkes L, Worsnop F, Ostlere L, Kiely P, Dharmapalaiah C, Hassan N, Nandagudi A, Bharadwaj A, Skibinska M, Gendi N, Davies EJ, Akil M, Kilding R, Ramachandran Nair J, Walsh M, Farrar W, Thompson RN, Borukhson L, McFadyen C, Singh D, Rajagopal V, Chan AML, Wearn Koh L, Christie JD, Croot L, Gayed M, Disney B, Singhal S, Grindulis K, Reynolds TD, Conway K, Williams D, Quin J, Dean G, Churchill D, Walker-Bone KE, Goff I, Reynolds G, Grove M, Patel P, Lazarus MN, Roncaroli F, Gabriel C, Kinderlerer AR, Nikiphorou E, Hall FC, Bruce E, Gray L, Krutikov M, Wig S, Bruce I, D'Agostino MA, Wakefield R, Berner Hammer H, Vittecoq O, Galeazzi M, Balint P, Filippucci E, Moller I, Iagnocco A, Naredo E, Ostergaard M, Gaillez C, Kerselaers W, Van Holder K, Le Bars M, Stone MA, Williams F, Wolber L, Karppinen J, Maatta J, Thompson B, Atchia I, Lorenzi A, Raftery G, Platt P, Platt PN, Pratt A, Turmezei TD, Treece GM, Gee AH, Poole KE, Chandratre PN, Roddy E, Clarson L, Richardson J, Hider S, Mallen C, Lieberman A, Prouse PJ, Mahendran P, Samarawickrama A, Churchill D, Walker-Bone KE, Ottery FD, Yood R, Wolfson M, Ang A, Riches P, Thomson J, Nuki G, Humphreys J, Verstappen SM, Chipping J, Hyrich K, Marshall T, Symmons DP, Roy M, Kirwan JR, Marshall RW, Matcham F, Scott IC, Rayner L, Hotopf M, Kingsley GH, Scott DL, Steer S, Ma MH, Dahanayake C, Scott IC, Kingsley G, Cope A, Scott DL, Dahanayake C, Ma MH, Scott IC, Kingsley GH, Cope A, Scott DL, Wernham A, Ward L, Carruthers D, Deeming A, Buckley C, Raza K, De Pablo P, Nikiphorou E, Carpenter L, Jayakumar K, Solymossy C, Dixey J, Young A, Singh A, Penn H, Ellerby N, Mattey DL, Packham J, Dawes P, Hider SL, Ng N, Humby F, 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Case Reports * 1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGF Receptor Mutations in Benign Joint Hypermobility. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket197] [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: 11/12/2022] Open
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