1
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Jordan CZ, Tunbridge M, Husain I, Kitai H, Dilts ME, Fay OK, Abe K, Xiang C, Kwun J, Souma T, Thorp EB, Luo X. AXL inhibition suppresses early allograft monocyte-to-macrophage differentiation and prolongs allograft survival. JCI Insight 2024; 9:e178502. [PMID: 38261406 DOI: 10.1172/jci.insight.178502] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/19/2024] [Indexed: 01/25/2024] Open
Abstract
Innate immune cells are important in the initiation and potentiation of alloimmunity in transplantation. Immediately upon organ anastomosis and reperfusion, recipient monocytes enter the graft from circulation and differentiate to inflammatory macrophages to promote allograft inflammation. However, factors that drive their differentiation to inflammatory macrophages are not understood. Here, we show that the receptor tyrosine kinase AXL was a key driver of early intragraft differentiation of recipient infiltrating monocytes to inflammatory macrophages in the presence of allogeneic stimulation and cell-to-cell contact. In this context, the differentiated inflammatory macrophages were capable of efficient alloantigen presentation and allostimulation of T cells of the indirect pathway. Consequently, early and transient AXL inhibition with the pharmacological inhibitor bemcentinib resulted in a profound reduction of initial allograft inflammation and a significant prolongation of allograft survival in a murine heart transplant model. Our results support further investigation of AXL inhibition as part of an induction regimen for transplantation.
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Affiliation(s)
- Collin Z Jordan
- Division of Nephrology, Department of Medicine, and
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Matthew Tunbridge
- Division of Nephrology, Department of Medicine, and
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina, USA
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Irma Husain
- Division of Nephrology, Department of Medicine, and
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hiroki Kitai
- Division of Nephrology, Department of Medicine, and
| | - Miriam E Dilts
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Olivia K Fay
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Koki Abe
- Division of Nephrology, Department of Medicine, and
| | | | - Jean Kwun
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Edward B Thorp
- Feinberg Cardiovascular and Renal Research Institute, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Xunrong Luo
- Division of Nephrology, Department of Medicine, and
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina, USA
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2
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Obonyo NG, Lu LY, White NM, Sela DP, Rachakonda RH, Teo D, Tunbridge M, Sim B, See Hoe LE, Fanning JP, Tung JP, McKnoulty M, Bassi GL, Suen JY, Fraser JF. Effects of transfusing older red blood cells and platelets on obstetric patient outcomes: A retrospective cohort study. Int J Gynaecol Obstet 2024; 164:184-191. [PMID: 37470165 DOI: 10.1002/ijgo.14997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To investigate associations between transfusion of blood products close to the end of shelf-life and clinical outcomes in obstetric inpatients. METHODS Mortality and morbidity were compared in patients transfused exclusively with red blood cells (RBC) stored for less than 21 days (fresh) versus RBC stored for 35 days or longer (old), and platelets (PLT) stored for 3 days or fewer (fresh) versus 4 days or longer (old) in Queensland, Australia from 2007 to 2013. Multivariable models were used to examine associations between these groups of blood products and clinical end points. RESULTS There were 3371 patients who received RBC and 280 patients who received PLT of the eligible storage durations. Patients transfused with old RBC received fewer transfusions (2.7 ± 1.8 vs. 2.3 ± 1.0 units; P < 0.001). However, a higher rate of single-unit transfusions was also seen in those patients who exclusively received old RBC (252 [9.3%] vs. 92 [13.7%]; P = 0.003). Comparison of fresh vs. old blood products revealed no differences in the quantities of transfused RBC (9.5 ± 5.9 vs. 9.1 ± 5.2 units; P = 0.680) or PLT (1.5 ± 0.8 vs. 1.4 ± 1.1 units; P = 0.301) as well as the length of hospital stay for RBC (3 [2-5] vs. 3 [2-5] days; P = 0.124) or PLT (5 [4-8] vs. 6 [4-9] days; P = 0.120). CONCLUSION Transfusing exclusively older RBC or PLT was not associated with increased morbidity or mortality.
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Affiliation(s)
- Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK
- Initiative to Develop African Research Leaders (IDeAL)/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lawrence Y Lu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nicole M White
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
| | - Declan P Sela
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Reema H Rachakonda
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Derek Teo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Matthew Tunbridge
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Beatrice Sim
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Louise E See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John-Paul Tung
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Clinical Services and Research, Australian Red Cross Lifeblood, Brisbane, Australia
| | - Matthew McKnoulty
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Brisbane, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- School of Medicine, Griffith University, Gold Coast, Australia
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3
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Alcheikh A, Perkins GB, Pucar PA, Cecchin A, Chai CS, Tunbridge M, Akerman A, Aggarwal A, Milogiannakis V, Turville S, Allen S, Hissaria P, Banovic T, Coates PT, Ross DM. Humoral and cellular immunity to SARS-CoV-2 Ancestral and Omicron BA.5 variants following vaccination in myelofibrosis patients. Blood Cancer J 2023; 13:50. [PMID: 37032391 PMCID: PMC10083173 DOI: 10.1038/s41408-023-00824-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/26/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Ahmad Alcheikh
- Department of Haematology, Royal Adelaide Hospital, Adelaide, Australia.
| | - Griffith B Perkins
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
- Immunology Directorate, SA Pathology, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Phillippa A Pucar
- Immunology Directorate, SA Pathology, Adelaide, Australia
- Department of Immunology, Royal Adelaide Hospital, Adelaide, Australia
| | - Amelia Cecchin
- Immunology Directorate, SA Pathology, Adelaide, Australia
| | - Cheng Sheng Chai
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Matthew Tunbridge
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | | | | | | | - Stuart Turville
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Sharon Allen
- Department of Haematology, Royal Adelaide Hospital, Adelaide, Australia
| | - Pravin Hissaria
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
- Immunology Directorate, SA Pathology, Adelaide, Australia
- Department of Immunology, Royal Adelaide Hospital, Adelaide, Australia
| | - Tatjana Banovic
- Immunology Directorate, SA Pathology, Adelaide, Australia
- Department of Immunology, Royal Adelaide Hospital, Adelaide, Australia
| | - P Toby Coates
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - David M Ross
- Department of Haematology, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Haematology Directorate, SA Pathology, Adelaide, Australia
- Department of Haematology, Flinders University and Medical Centre, Adelaide, Australia
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4
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Sim BL, Sim BZ, Tunbridge M, Liew DFL, Robinson PC. Examining the Characteristics of Colchicine-Induced Myelosuppression in Clinical Cases: A Systematic Review. J Rheumatol 2023; 50:400-407. [PMID: 36319015 DOI: 10.3899/jrheum.220524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The use of colchicine has been associated with varying degrees of myelosuppression. Despite expanded use in cardiovascular and inflammatory conditions, there remains clinician concern because of potential myelosuppressive side effects. A systematic review was conducted to explore the reported myelosuppressive events of colchicine. METHODS A systematic review was conducted using the MeSH terms ("colchicine") AND ("myelosuppression," "bone*," "marrow," "suppression," "aplasia," "leukopenia/leucopenia," "lymphopenia," "neutropenia") on September 1, 2020, and was updated on November 30, 2021. The search was conducted in PubMed, ScienceDirect, Scopus, Embase, and Cochrane Library. The search included references published from 1978 to 2020 and was limited to English-language observational studies (ie, case reports, case series, case control studies, and cohort studies) or trial data. RESULTS In total, 3233 articles were screened, with 30 studies of 47 patients with myelosuppression from colchicine identified. Most patients with myelosuppression had comorbidities, including renal impairment (21/47, 44.7%). Out of 47 patients, 15 (31.9%) and 13 (27.7%) were reported to be concurrently taking cytochrome P450 3A4 (CYP3A4) inhibitors and P-glycoprotein (P-gp) efflux transporter inhibitors, respectively. Patients with renal impairment accounted for the majority of overall patients taking these CYP3A4 and P-gp inhibitors (8/15, 53.3%, and 8/13, 61.5%, respectively). Out of 21 patients with renal impairment, 13 had worsening cytopenia during colchicine use. The presentations ranged from moderate anemia (grade 2) to severe thrombocytopenia, neutropenia, and leukopenia (grade 4). CONCLUSION Colchicine has few reports of myelosuppression. The majority of patients with myelosuppression had preexisting renal impairment or concomitant CYP3A4 or P-gp inhibitor use. Caution should be taken in this subset of patients with increased monitoring.
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Affiliation(s)
- Bernice L Sim
- B.L. Sim, BSc, MPH, St George's Hospital Medical School, London, UK
| | - Beatrice Z Sim
- B.Z. Sim, BSc, MBBS, M. Tunbridge, BSc, MBBS, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Matthew Tunbridge
- B.Z. Sim, BSc, MBBS, M. Tunbridge, BSc, MBBS, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - David F L Liew
- D.F.L. Liew, MBBS, Department of Rheumatology and Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, and Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Philip C Robinson
- P.C. Robinson, MBChB, PhD, The University of Queensland Faculty of Medicine, School of Medicine, Royal Brisbane Hospital Herston, and Royal Brisbane and Women's Hospital, Department of Rheumatology, Herston, Queensland, Australia.
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5
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Singer J, Tunbridge M, Perkins GB, Salehi T, Ying T, Wu H, Coates PT, Chadban SJ. Rapamycin and inulin for third-dose vaccine response stimulation (RIVASTIM): Inulin - study protocol for a pilot, multicentre, randomised, double-blinded, controlled trial of dietary inulin to improve SARS-CoV-2 vaccine response in kidney transplant recipients. BMJ Open 2022; 12:e062747. [PMID: 36456021 PMCID: PMC9716412 DOI: 10.1136/bmjopen-2022-062747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Kidney transplant recipients (KTRs) are at an increased risk of hospitalisation and death from COVID-19. Vaccination against SARS-CoV-2 is our primary risk mitigation strategy, yet vaccine effectiveness in KTRs is suboptimal. Strategies to enhance vaccine efficacy are therefore required. Current evidence supports the role of the gut microbiota in shaping the immune response to vaccination. Gut dysbiosis is common in KTRs and is a potential contributor to impaired COVID-19 vaccine responses. We hypothesise that dietary fibre supplementation will attenuate gut dysbiosis and promote vaccine responsiveness in KTRs. METHODS AND ANALYSIS Rapamycin and inulin for third-dose vaccine response stimulation-inulin is a multicentre, randomised, prospective, double-blinded, placebo-controlled pilot trial examining the effect of dietary inulin supplementation prior to a third dose of COVID-19 vaccine in KTRs who have failed to develop protective immunity following a 2-dose COVID-19 vaccine schedule. Participants will be randomised 1:1 to inulin (active) or maltodextrin (placebo control), administered as 20 g/day of powdered supplement dissolved in water, for 4 weeks prior to and following vaccination. The primary outcome is the proportion of participants in each trial arm that achieve in vitro neutralisation of live SARS-CoV-2 virus at 4 weeks following a third dose of COVID-19 vaccine. Secondary outcomes include the safety and tolerability of dietary inulin, the diversity and differential abundance of gut microbiota, and vaccine-specific immune cell populations and responses. ETHICS AND DISSEMINATION Ethics approval was obtained from the Central Adelaide Local Health Network (CALHN) Human Research Ethics Committee (HREC) (approval number: 2021/HRE00354) and the Sydney Local Health District (SHLD) HREC (approval numbers: X21-0411 and 2021/STE04280). Results of this trial will be published following peer-review and presented at scientific meetings and congresses. TRIAL REGISTRATION NUMBER ACTRN12621001465842.
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Affiliation(s)
- Julian Singer
- Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Matthew Tunbridge
- Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Griffith B Perkins
- School of Biological Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Immunology, SA Pathology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Tania Salehi
- Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tracey Ying
- Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Huiling Wu
- Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - P Toby Coates
- Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Steven J Chadban
- Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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6
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Tunbridge M, Grivei A, Kassianos AJ, Davis H, Stewart A, Healy H, Mon SY, John GT. Minimal change disease with Jack jumper ant stings: A case report. Nephrology (Carlton) 2022; 27:908-909. [PMID: 36113860 PMCID: PMC9826226 DOI: 10.1111/nep.14104] [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: 08/17/2022] [Accepted: 08/28/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Matthew Tunbridge
- Kidney Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Anca Grivei
- Kidney Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Conjoint Internal Medicine LaboratoryChemical Pathology, Pathology QueenslandBrisbaneQueenslandAustralia
| | - Andrew J. Kassianos
- Kidney Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Conjoint Internal Medicine LaboratoryChemical Pathology, Pathology QueenslandBrisbaneQueenslandAustralia
| | - Helen Davis
- Kidney Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Anne Stewart
- Anatomical PathologyPathology QueenslandBrisbaneQueenslandAustralia
| | - Helen Healy
- Kidney Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Conjoint Internal Medicine LaboratoryChemical Pathology, Pathology QueenslandBrisbaneQueenslandAustralia
| | - Saw Yu Mon
- Kidney Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - George T. John
- Kidney Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
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7
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Tunbridge M, Perkins GB, Singer J, Salehi T, Ying T, Grubor-Bauk B, Barry S, Sim B, Hissaria P, Chadban SJ, Coates PT. Rapamycin and inulin for booster vaccine response stimulation (RIVASTIM)—rapamycin: study protocol for a randomised, controlled trial of immunosuppression modification with rapamycin to improve SARS-CoV-2 vaccine response in kidney transplant recipients. Trials 2022; 23:780. [PMID: 36109788 PMCID: PMC9477178 DOI: 10.1186/s13063-022-06634-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
Kidney transplant recipients are at an increased risk of severe COVID-19-associated hospitalisation and death. Vaccination has been a key public health strategy to reduce disease severity and infectivity, but the effectiveness of COVID vaccines is markedly reduced in kidney transplant recipients. Urgent strategies to enhance vaccine efficacy are needed. Methods: RIVASTIM-rapamycin is a multicentre, randomised, controlled trial examining the effect of immunosuppression modification prior to a third dose of COVID-19 vaccine in kidney transplant recipients who have failed to develop protective immunity to a 2-dose COVID-19 vaccine schedule. Participants will be randomised 1:1 to either remain on standard of care immunosuppression with tacrolimus, mycophenolate, and prednisolone (control) or cease mycophenolate and commence sirolimus (intervention) for 4 weeks prior to and following vaccination. The primary outcome is the proportion of participants in each trial arm who develop protective serological neutralisation of live SARS-CoV-2 virus at 4–6 weeks following a third COVID-19 vaccination. Secondary outcomes include SARS-CoV-receptor binding domain IgG, vaccine-specific immune cell populations and responses, and the safety and tolerability of sirolimus switch. Discussion: Immunosuppression modification strategies may improve immunological vaccine response. We hypothesise that substituting the mTOR inhibitor sirolimus for mycophenolate in a triple drug regimen will enhance humoral and cell-mediated responses to COVID vaccination for kidney transplant recipients. Trial registration: Australia New Zealand Clinical Trials Registry ACTRN12621001412820. Registered on 20 October 2021; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382891&isReview=true
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8
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Tunbridge M, Chandler S, Isbel N, Jegatheesan D, McNeill IR, Isoardi K, Viecelli AK. Sodium chlorite poisoning: a case of severe methaemoglobinaemia and dialysis-requiring kidney injury. Intern Med J 2022; 52:1452-1453. [PMID: 35973949 DOI: 10.1111/imj.15870] [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] [Received: 03/27/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew Tunbridge
- Department of Nephrology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Shaun Chandler
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Nicole Isbel
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Dev Jegatheesan
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Iain R McNeill
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Katherine Isoardi
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrea K Viecelli
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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9
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Tunbridge M, Perkins G, Lee M, Salehi T, Yuson C, Le A, Ryoo D, Kette F, Smith W, Gold M, Hissaria P. COVID vaccination can be completed in subjects with a history of allergic reactions to the vaccines or their components - experience from a specialist clinic in South Australia. Intern Med J 2022; 52:1884-1890. [PMID: 35848521 PMCID: PMC9350084 DOI: 10.1111/imj.15888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
The development of vaccines against SARS-CoV2 has been a key public health response to the COVID-19 pandemic. However, since their introduction there have been reports of anaphylactic reactions in vaccinees with history of allergy. We developed an allergy testing protocol allowing vaccination with available COVID-19 vaccines in Australia. Patients referred to a state-wide COVID-19 vaccine allergy clinic between March and August 2021 with a history of allergy underwent skin prick testing and intradermal testing to both available vaccine formulations (BNT162b2, ChAdOx1-S), excipients (polyethylene glycol, polysorbate 80), excipient-containing medications, and controls. Where available, basophil activation testing was conducted. 53 patients underwent testing for possible excipient allergy (n = 19), previous non-COVID vaccine reaction (n = 13), or previous reaction to dose 1 of COVID-19 vaccine (n = 21). Patients were predominantly female (n = 43, 81%), aged 18-83 (median 54) years. 44 patients tested negative and 42 of these received at least their first dose of a COVID-19 vaccine. 9 patients tested positive to excipients or excipient-containing medication only (n = 3), or vaccines (n = 6). 5 patients were positive to just BNT162b2, 3/5 have been vaccinated with ChAdOx1-S. 1 who was skin test positive to both vaccines, but negative BAT to ChAdOx1-S was successfully vaccinated with ChAdOx1-S. Even in a high-risk population, most patients can be vaccinated with available COVID-19 vaccines. This paper reports local experiences using a combined allergy testing protocol with skin testing and BAT during the pandemic. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matthew Tunbridge
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Griffith Perkins
- University of Adelaide, Adelaide, Australia.,SA Pathology, Adelaide, Australia
| | - Maverick Lee
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Tania Salehi
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Chino Yuson
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Adriana Le
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Dongjae Ryoo
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Frank Kette
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - William Smith
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Gold
- Women's and Children's Hospital, Royal Adelaide Hospital, Adelaide, Australia
| | - Pravin Hissaria
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia.,SA Pathology, Adelaide, Australia
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10
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Ali SB, Perkins G, Ryoo D, Lee M, Tunbridge M, Yuson C, Smith W, Hissaria P, Le TT. AstraZeneca ChAdOx1-S COVID-19 vaccine can be safely administered in patients with EDTA allergy. Allergy Asthma Clin Immunol 2022; 18:22. [PMID: 35272714 PMCID: PMC8908291 DOI: 10.1186/s13223-022-00665-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/04/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Immediate hypersensitivity reactions to COVID-19 vaccines have been postulated to be linked to their excipients, such as polyethylene glycol (PEG) in Pfizer Comirnaty, or polysorbate 80 and ethylenediaminetetracetic acid (EDTA) in AstraZeneca ChAdOx1-S [recombinant] (Vaxzevria). These excipients are found in a range of other products, including injectable and oral medications as well as intravenous radiocontrast media (RCM) and various cosmetic products. Patients with proven excipient allergy may be advised to avoid a COVID-19 vaccine containing that excipient and/or potentially cross-reactive excipients. This may result in individual patients not receiving vaccines, especially if an alternate option is not available, and on a broader level contribute to vaccine hesitancy. We present two cases of previously confirmed EDTA anaphylaxis with positive intradermal testing, who had negative Vaxzevria vaccine in-vivo testing and subsequently tolerated the vaccine. CASE 1: A patient with history of anaphylaxis to RCM and local anaesthetics (LA) had positive intradermal test (IDT) to EDTA nine years earlier. Skin testing to Vaxzeria vaccine (up to 1:10 IDT), Comirnaty vaccine (up to 1:10 IDT) and EDTA 0.3 mg/mL IDT were negative. However, following EDTA 3 mg/ml IDT, he developed immediate generalised urticaria without anaphylaxis. Basophil activation testing was negative to disodium EDTA, Vaxzevria and Cominarty vaccines. Given the negative in-vitro and in-vivo testing to Vaxzevria vaccine, he proceeded to Vaxzevria immunisation and tolerated both doses. CASE 2: A patient with history of anaphylaxis to RCM had positive skin testing to EDTA and RCM containing EDTA six years earlier. Following referral to COVID19 vaccine clinic, Vaxzevria vaccine (1:10 IDT) and Cominarty vaccine (1:10 IDT) were negative whilst EDTA was positive at 0.3 mg/mL IDT. He subsequently tolerated both Vaxzevria vaccinations. CONCLUSION Excipient allergy does not necessarily preclude a patient from receiving a vaccine containing that excipient. Allergy testing can help identify excipient-allergic patients who may still tolerate vaccination, which is important in situations where COVID-19 vaccination options are limited.
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Affiliation(s)
- Syed B Ali
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia.,Department of Immunopathology, SA Pathology, Adelaide, Australia
| | - Griffith Perkins
- Department of Immunopathology, SA Pathology, Adelaide, Australia.,School of Biological Sciences, University of Adelaide, Adelaide, Australia
| | - Dongjae Ryoo
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - Maverick Lee
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - Matthew Tunbridge
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - Chino Yuson
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - William Smith
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - Pravin Hissaria
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia.,Department of Immunopathology, SA Pathology, Adelaide, Australia
| | - Thanh-Thao Le
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia.
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Platts DG, Diab S, Dunster KR, Shekar K, Burstow DJ, Sim B, Tunbridge M, McDonald C, Chemonges S, Chan J, Fraser JF. Feasibility of perflutren microsphere contrast transthoracic echocardiography in the visualization of ventricular endocardium during venovenous extracorporeal membrane oxygenation in a validated ovine model. Echocardiography 2014; 32:548-56. [PMID: 25059883 DOI: 10.1111/echo.12695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transthoracic echocardiography (TTE) during extra corporeal membrane oxygenation (ECMO) is important but can be technically challenging. Contrast-specific TTE can improve imaging in suboptimal studies. These contrast microspheres are hydrodynamically labile structures. This study assessed the feasibility of contrast echocardiography (CE) during venovenous (VV) ECMO in a validated ovine model. METHOD Twenty-four sheep were commenced on VV ECMO. Parasternal long-axis (Plax) and short-axis (Psax) views were obtained pre- and postcontrast while on VV ECMO. Endocardial definition scores (EDS) per segment were graded: 1 = good, 2 = suboptimal 3 = not seen. Endocardial border definition score index (EBDSI) was calculated for each view. Endocardial length (EL) in the Plax view for the left ventricle (LV) and right ventricle (RV) was measured. RESULTS Summation EDS data for the LV and RV for unenhanced TTE (UE) versus CE TTE imaging: EDS 1 = 289 versus 346, EDS 2 = 38 versus 10, EDS 3 = 33 versus 4, respectively. Wilcoxon matched-pairs rank-sign tests showed a significant ranking difference (improvement) pre- and postcontrast for the LV (P < 0.0001), RV (P < 0.0001) and combined ventricular data (P < 0.0001). EBDSI for CE TTE was significantly lower than UE TTE for the LV (1.05 ± 0.17 vs. 1.22 ± 0.38, P = 0.0004) and RV (1.06 ± 0.22 vs. 1.42 ± 0.47, P = 0.0.0006) respectively. Visualized EL was significantly longer in CE versus UE for both the LV (58.6 ± 11.0 mm vs. 47.4 ± 11.7 mm, P < 0.0001) and the RV (52.3 ± 8.6 mm vs. 36.0 ± 13.1 mm, P < 0.0001), respectively. CONCLUSIONS Despite exposure to destructive hydrodynamic forces, CE is a feasible technique in an ovine ECMO model. CE results in significantly improved EDS and increased EL.
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Affiliation(s)
- David G Platts
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia
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12
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Platts D, Sim B, Tunbridge M, Diab S, Dunster K, Shekar K, Burstow D, Chan J, McDonald C, Fraser JF. O057 Feasibility of Perflutren Microsphere Contrast Transthoracic Echocardiography in Assessment of Right Ventricular Endocardial Definition During VenoVenous Extra Corporeal Membrane Oxygenation in a Validated Ovine Model. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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13
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Platts DG, Hilton A, Diab S, McDonald C, Tunbridge M, Chemonges S, Dunster KR, Shekar K, Burstow DJ, Fraser JF. A novel echocardiographic imaging technique, intracatheter echocardiography, to guide veno-venous extracorporeal membrane oxygenation cannulae placement in a validated ovine model. Intensive Care Med Exp 2014; 2:2. [PMID: 26266903 PMCID: PMC4512982 DOI: 10.1186/2197-425x-2-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/09/2013] [Indexed: 11/24/2022] Open
Abstract
Background Echocardiography plays a fundamental role in cannulae insertion and positioning for extracorporeal membrane oxygenation (ECMO). Optimal access and return cannulae orientation is required to prevent recirculation. The aim of this study was to compare a novel imaging technique, intracatheter echocardiography (iCATHe), with conventional intracardiac echocardiography (ICE) to guide placement of ECMO access and return venous cannulae. Methods Twenty sheep were commenced on veno-venous ECMO (VV ECMO). Access and return ECMO cannulae were positioned using an ICE-guided technique. Following the assessment of cannulae position, the ICE probe was then introduced inside the cannulae, noting location of the tip. After 24 h, the sheep were euthanized and cannulae position was determined at post mortem. The two-tailed McNemar test was used to compare iCATHe with ICE cannulae positioning. Results ICE and iCATHe imaging was possible in all 20 sheep commenced on ECMO. There was no significant difference between the two methods in assessing access cannula position (proportion correct for each 90%, incorrect 10%). However, there was a significant difference between ICE and iCATHe success rates for the return cannula (p = 0.001). Proportion correct for iCATHe and ICE was 80% and 15% respectively. iCATHe was 65% more successful (95% CI 27% to 75%) at predicting the placement of the return cannula. There were no complications related to the ICE or iCATHe imaging. Conclusion iCATHe is a safe and feasible imaging technique to guide real-time VV ECMO cannulae placement and improves accuracy of return cannula positioning compared to ICE. Electronic supplementary material The online version of this article (doi:10.1186/2197-425X-2-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David G Platts
- Department of Echocardiography, Cardiac Investigations Unit, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, Queensland, 4032, Australia,
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Tunbridge M, Peto T, Scott R. Training in general (internal) medicine alone. Clin Med (Lond) 2001; 1:317-8. [PMID: 11525582 PMCID: PMC4951940 DOI: 10.7861/clinmedicine.1-4-317] [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: 11/27/2022]
Abstract
A freestanding training programme for general (internal) medicine (G(I)M) alone was established in the Oxford deanery four years ago. The programme was designed to provide three years' training post-MRCP for specialist registrars, selected in open competition, and covers all aspects of acute medical care including four months in intensive care. The first four to complete training have achieved consultant level appointments. The programme also attracted a number of trainees who wished to obtain appropriate qualifications in high dependency and critical care medicine. The programme offers the opportunity to create specialists properly trained in G(I)M who will be able to continue to provide an important service as specialists or practising as consultants in G(I)M alone.
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15
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Jefferis A, Davies G, Tunbridge M. Staff grades and associate specialists: their continuing professional development and aspirations. Hosp Med 1998; 59:887-91. [PMID: 10197125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
A survey of staff grades and associate specialists in the Oxford deanery showed that there were slightly more females (53%). There were 44% who had on-call commitments, a third of these were first on call. Thirty-eight per cent of the staff grades and 55% of the associate specialists had membership or fellowship of their relevant Royal College. The majority undertake continuing professional development and a majority would like promotion but only a small minority is prepared to relocate to further their training.
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Affiliation(s)
- A Jefferis
- Department of Medicine, Wycombe General Hospital, High Wycombe, Bucks
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16
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Bouillon R, Guéritée N, Mornex R, Tunbridge M. [Quality assurance approval in European health care centers training endocrinology, diabetes and metabolism specialists ]. Ann Endocrinol (Paris) 1998; 59:43-4. [PMID: 9752400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- R Bouillon
- Onderwijs & Navorsing, Legendo, Gasthuisberg, Louvain, Belgique
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Tunbridge M. The outpatient setting as a teaching environment. Br J Hosp Med (Lond) 1996; 55:344-6. [PMID: 8696632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M Tunbridge
- University of Oxford, John Radcliffe Hospital
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Hawthorne G, Snodgrass A, Tunbridge M. Outcome of diabetic pregnancy and glucose intolerance in pregnancy: an audit of fetal loss in Newcastle General Hospital 1977-1990. Diabetes Res Clin Pract 1994; 25:183-90. [PMID: 7851273 DOI: 10.1016/0168-8227(94)90007-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The outcome of pregnancy complicated by established diabetes or gestational glucose intolerance (diabetes mellitus or impaired glucose tolerance) is compared with the outcome of non-diabetic pregnancy. Between 1977 and 1990, 169 pregnancies in women with established diabetes and 61 pregnancies in women with gestational glucose intolerance were referred to the Newcastle General Hospital. The perinatal mortality (PNM) in women with established diabetes was 8.2/1000 and the viable fetal loss (sum of PNM, neonatal and infant loss) was 41/1000. The PNM in women with gestational glucose intolerance was 49.2/1000 and the viable fetal loss was 82/1000. The PNM in the background population was 11.6/1000. The fetal malformation rate was 17.3% for established diabetes, 9.8% in gestational glucose intolerance and 2.2% in the background population. Fetal abnormality remains the major cause of viable fetal loss in both established diabetes and gestational glucose intolerance.
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Affiliation(s)
- G Hawthorne
- Department of Medicine, Newcastle General Hospital, Newcastle upon Tyne, UK
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Bloom A, Clarke CA, Tunbridge M, Whitfield AGW. Study of causes of death in younger diabetics. West J Med 1978. [DOI: 10.1136/bmj.2.6150.1492-c] [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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