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Oja P, Memon AR, Titze S, Jurakic D, Chen ST, Shrestha N, Em S, Matolic T, Vasankari T, Heinonen A, Grgic J, Koski P, Kokko S, Kelly P, Foster C, Podnar H, Pedisic Z. Health Benefits of Different Sports: a Systematic Review and Meta-Analysis of Longitudinal and Intervention Studies Including 2.6 Million Adult Participants. Sports Med Open 2024; 10:46. [PMID: 38658416 PMCID: PMC11043276 DOI: 10.1186/s40798-024-00692-x] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Several reviews have examined the health benefits of participation in specific sports, such as baseball, cricket, cross-country skiing, cycling, downhill skiing, football, golf, judo, rugby, running and swimming. However, new primary studies on the topic have recently been published, and the respective meta-analytic evidence needs to be updated. OBJECTIVES To systematically review, summarise and appraise evidence on physical health benefits of participation in different recreational sports. METHODS Searches for journal articles were conducted in PubMed/MEDLINE, Scopus, SpoLit, SPORTDiscus, Sports Medicine & Education Index and Web of Science. We included longitudinal and intervention studies investigating physical health outcomes associated with participation in a given sport among generally healthy adults without disability. RESULTS A total of 136 papers from 76 studies conducted among 2.6 million participants were included in the review. Our meta-analyses of available evidence found that: (1) cycling reduces the risk of coronary heart disease by 16% (pooled hazard ratio [HR] = 0.84; 95% confidence interval [CI]: 0.80, 0.89), all-cause mortality by 21% (HR = 0.79; 95% CI: 0.73, 0.84), cancer mortality by 10% (HR = 0.90; 95% CI: 0.85, 0.96) and cardiovascular mortality by 20% (HR = 0.80; 95% CI: 0.74, 0.86); (2) football has favourable effects on body composition, blood lipids, fasting blood glucose, blood pressure, cardiovascular function at rest, cardiorespiratory fitness and bone strength (p < 0.050); (3) handball has favourable effects on body composition and cardiorespiratory fitness (p < 0.050); (4) running reduces the risk of all-cause mortality by 23% (HR = 0.77; 95% CI: 0.70, 0.85), cancer mortality by 20% (HR = 0.80; 95% CI: 0.72, 0.89) and cardiovascular mortality by 27% (HR = 0.73; 95% CI: 0.57, 0.94) and improves body composition, cardiovascular function at rest and cardiorespiratory fitness (p < 0.010); and (5) swimming reduces the risk of all-cause mortality by 24% (HR = 0.76; 95% CI: 0.63, 0.92) and improves body composition and blood lipids (p < 0.010). CONCLUSIONS A range of physical health benefits are associated with participation in recreational cycling, football, handball, running and swimming. More studies are needed to enable meta-analyses of health benefits of participation in other sports. PROSPERO registration number CRD42021234839.
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Affiliation(s)
- Pekka Oja
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Aamir Raoof Memon
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Sylvia Titze
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Danijel Jurakic
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Si-Tong Chen
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Nipun Shrestha
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Sowannry Em
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Tena Matolic
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jozo Grgic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Pasi Koski
- Department of Teacher Education, University of Turku, Rauma, Finland
| | - Sami Kokko
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Paul Kelly
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Charlie Foster
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Hrvoje Podnar
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
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Chandwe K, Bwakura-Dangarembizi M, Amadi B, Tawodzera G, Ngosa D, Dzikiti A, Chulu N, Makuyana R, Zyambo K, Mutasa K, Mulenga C, Besa E, Sturgeon JP, Mudzingwa S, Simunyola B, Kazhila L, Zyambo M, Sonkwe H, Mutasa B, Chipunza M, Sauramba V, Langhaug L, Mudenda V, Murch SH, Hill S, Playford RJ, VanBuskirk K, Prendergast AJ, Kelly P. Malnutrition enteropathy in Zambian and Zimbabwean children with severe acute malnutrition: A multi-arm randomized phase II trial. Nat Commun 2024; 15:2910. [PMID: 38632262 PMCID: PMC11024201 DOI: 10.1038/s41467-024-45528-0] [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: 04/28/2023] [Accepted: 01/26/2024] [Indexed: 04/19/2024] Open
Abstract
Malnutrition underlies almost half of all child deaths globally. Severe Acute Malnutrition (SAM) carries unacceptable mortality, particularly if accompanied by infection or medical complications, including enteropathy. We evaluated four interventions for malnutrition enteropathy in a multi-centre phase II multi-arm trial in Zambia and Zimbabwe and completed in 2021. The purpose of this trial was to identify therapies which could be taken forward into phase III trials. Children of either sex were eligible for inclusion if aged 6-59 months and hospitalised with SAM (using WHO definitions: WLZ <-3, and/or MUAC <11.5 cm, and/or bilateral pedal oedema), with written, informed consent from the primary caregiver. We randomised 125 children hospitalised with complicated SAM to 14 days treatment with (i) bovine colostrum (n = 25), (ii) N-acetyl glucosamine (n = 24), (iii) subcutaneous teduglutide (n = 26), (iv) budesonide (n = 25) or (v) standard care only (n = 25). The primary endpoint was a composite of faecal biomarkers (myeloperoxidase, neopterin, α1-antitrypsin). Laboratory assessments, but not treatments, were blinded. Per-protocol analysis used ANCOVA, adjusted for baseline biomarker value, sex, oedema, HIV status, diarrhoea, weight-for-length Z-score, and study site, with pre-specified significance of P < 0.10. Of 143 children screened, 125 were randomised. Teduglutide reduced the primary endpoint of biomarkers of mucosal damage (effect size -0.89 (90% CI: -1.69,-0.10) P = 0.07), while colostrum (-0.58 (-1.4, 0.23) P = 0.24), N-acetyl glucosamine (-0.20 (-1.01, 0.60) P = 0.67), and budesonide (-0.50 (-1.33, 0.33) P = 0.32) had no significant effect. All interventions proved safe. This work suggests that treatment of enteropathy may be beneficial in children with complicated malnutrition. The trial was registered at ClinicalTrials.gov with the identifier NCT03716115.
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Affiliation(s)
- Kanta Chandwe
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Mutsa Bwakura-Dangarembizi
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Beatrice Amadi
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Gertrude Tawodzera
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
| | - Deophine Ngosa
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Anesu Dzikiti
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
| | - Nivea Chulu
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Robert Makuyana
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
| | - Kanekwa Zyambo
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
| | - Chola Mulenga
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Ellen Besa
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Jonathan P Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, Newark Street, London, UK
| | - Shepherd Mudzingwa
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
| | - Bwalya Simunyola
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Lydia Kazhila
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Masuzyo Zyambo
- Department of Anaesthesia, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Hazel Sonkwe
- Department of Anaesthesia, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
| | - Miyoba Chipunza
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Virginia Sauramba
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
| | - Lisa Langhaug
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
| | - Victor Mudenda
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | | | - Susan Hill
- Great Ormond Street Hospital, London, UK
| | - Raymond J Playford
- University of West London, Ealing, London, UK
- University College Cork, College Road, Cork, Ireland
| | - Kelley VanBuskirk
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, McLaughlin Avenue, Meyrick Park, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, Newark Street, London, UK
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.
- Blizard Institute, Queen Mary University of London, Newark Street, London, UK.
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Evans C, Mutasa K, Rukobo S, Govha M, Mushayanembwa P, Chasekwa B, Majo FD, Tavengwa NV, Broad J, Noble C, Gough EK, Kelly P, Bourke CD, Humphrey JH, Ntozini R, Prendergast AJ. Inflammation and cytomegalovirus viremia during pregnancy drive sex-differentiated differences in mortality and immune development in HIV-exposed infants. Nat Commun 2024; 15:2909. [PMID: 38632279 PMCID: PMC11024190 DOI: 10.1038/s41467-023-44166-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/04/2023] [Indexed: 04/19/2024] Open
Abstract
Children who are HIV-exposed but uninfected have increased infectious mortality compared to HIV-unexposed children, raising the possibility of immune abnormalities following exposure to maternal viraemia, immune dysfunction, and co-infections during pregnancy. In a secondary analysis of the SHINE trial in rural Zimbabwe we explored biological pathways underlying infant mortality, and maternal factors shaping immune development in HIV-exposed uninfected infants. Maternal inflammation and cytomegalovirus viraemia were independently associated with infant deaths: mortality doubled for each log10 rise in maternal C-reactive protein (adjusted hazard ratio (aHR) 2.09; 95% CI 1.33-3.27), and increased 1.6-fold for each log10 rise in maternal cytomegalovirus viral load (aHR 1.62; 95% CI 1.11-2.36). In girls, mortality was more strongly associated with maternal C-reactive protein than cytomegalovirus; in boys, mortality was more strongly associated with cytomegalovirus than C-reactive protein. At age one month, HIV-exposed uninfected infants had a distinct immune milieu, characterised by raised soluble CD14 and an altered CD8 + T-cell compartment. Alterations in immunophenotype and systemic inflammation were generally greater in boys than girls. Collectively, these findings show how the pregnancy immune environment in women with HIV underlies mortality and immune development in their offspring in a sex-differentiated manner, and highlights potential new intervention strategies to transform outcomes of HIV-exposed children. ClinicalTrials.gov/NCT01824940.
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Affiliation(s)
- Ceri Evans
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
- Blizard Institute, Queen Mary University of London, London, UK.
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Sandra Rukobo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Margaret Govha
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jonathan Broad
- Blizard Institute, Queen Mary University of London, London, UK
| | - Christie Noble
- Blizard Institute, Queen Mary University of London, London, UK
| | - Ethan K Gough
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul Kelly
- Blizard Institute, Queen Mary University of London, London, UK
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Claire D Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Kayamba V, Mubbunu M, Kelly P. Endoscopic diagnosis of gastric and oesophageal cancer in Lusaka, Zambia: a retrospective analysis. BMC Gastroenterol 2024; 24:122. [PMID: 38561688 PMCID: PMC10983744 DOI: 10.1186/s12876-024-03187-x] [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: 03/22/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION There are uncertainties surrounding the spectrum of upper gastrointestinal (UGI) diseases in sub-Saharan Africa. This is mainly due to the limitations of data collection and recording. We previously reported an audit of UGI endoscopic diagnoses in Zambia spanning from 1977 to 2014. We now have extended this analysis to include subsequent years, in order to provide a more comprehensive picture of how the diagnoses have evolved over 4 decades. METHODS We combined data collected from the endoscopy unit at the University Teaching Hospital (UTH) in Lusaka during a previous review with that collected from the beginning of 2015 to the end of 2021. Since 2015, an electronic data base of endoscopy reports at the UTH was kept. The electronic data base was composed of drop-down menus that allowed for standardised reporting of findings. Collected data were coded by two experienced endoscopists and analysed. RESULTS In total, the analysis included 25,849 endoscopic records covering 43 years. The number of endoscopic procedures performed per year increased drastically in 2010. With the exception of the last 2 years, the proportion of normal endoscopies also increased during the time under review. In total, the number of gastric cancer (GC) cases was 658 (3%) while that of oesophageal cancer (OC) was 1168 (5%). The number of GC and OC diagnoses increased significantly over the period under review, (p < 0.001 for both). For OC the increase remained significant when analysed as a percentage of all procedures performed (p < 0.001). Gastric ulcers (GU) were diagnosed in 2095 (8%) cases, duodenal ulcers (DU) in 2276 (9%) cases and 239 (1%) had both ulcer types. DU diagnosis showed a significantly decreasing trend over each decade (p < 0.001) while GU followed an increasing trend (p < 0.001). CONCLUSIONS UGI endoscopic findings in Lusaka, Zambia, have evolved over the past four decades with a significant increase of OC and GU diagnoses. Reasons for these observations are yet to be established.
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Affiliation(s)
- Violet Kayamba
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Nationalist Road, PO Box 50398, Lusaka, Zambia.
| | - Malambo Mubbunu
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Nationalist Road, PO Box 50398, Lusaka, Zambia
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Nationalist Road, PO Box 50398, Lusaka, Zambia
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, E1 2AT, London, UK
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Sturgeon JP, Tome J, Dumbura C, Majo FD, Ngosa D, Mutasa K, Zyambo K, Besa E, Chandwe K, Kapoma C, Mwapenya B, Nathoo KJ, Bourke CD, Ntozini R, Chasekwa B, Smuk M, Bwakura-Dangarembizi M, Amadi B, Kelly P, Prendergast AJ. Inflammation and epithelial repair predict mortality, hospital readmission, and growth recovery in complicated severe acute malnutrition. Sci Transl Med 2024; 16:eadh0673. [PMID: 38416844 PMCID: PMC7615785 DOI: 10.1126/scitranslmed.adh0673] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
Severe acute malnutrition (SAM) is the most high-risk form of undernutrition, particularly when children require hospitalization for complications. Complicated SAM is a multisystem disease with high inpatient and postdischarge mortality, especially in children with comorbidities such as HIV; however, the underlying pathogenesis of complicated SAM is poorly understood. Targeted multiplex biomarker analysis in children hospitalized with SAM (n = 264) was conducted on plasma samples, and inflammatory markers were assessed on stool samples taken at recruitment, discharge, and 12 to 24 and 48 weeks after discharge from three hospitals in Zimbabwe and Zambia. Compared with adequately nourished controls (n = 173), we found that at baseline, complicated SAM was characterized by systemic, endothelial, and intestinal inflammation, which was exacerbated by HIV infection. This persisted over 48 weeks despite nutritional recovery and was associated with children's outcomes. Baseline plasma concentrations of vascular endothelial growth factor, glucagon-like peptide-2, and intestinal fatty acid-binding protein were independently associated with lower mortality or hospital readmission over the following 48 weeks. Following principal components analysis of baseline biomarkers, higher scores of a component representing growth factors was associated with greater weight-for-height z score recovery and lower mortality or hospital readmission over the 48 weeks. Conversely, components representing higher gut and systemic inflammation were associated with higher mortality or hospital readmission. These findings highlight the interplay between inflammation, which damages tissues, and growth factors, which mediate endothelial and epithelial regeneration, and support further studies investigating interventions to reduce inflammation and promote epithelial repair as an approach to reducing mortality and improving nutritional recovery.
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Affiliation(s)
- Jonathan P Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Joice Tome
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Cherlynn Dumbura
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Deophine Ngosa
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kanekwa Zyambo
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Ellen Besa
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Kanta Chandwe
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Chanda Kapoma
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Benjamin Mwapenya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kusum J Nathoo
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Claire D Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Melanie Smuk
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Mutsa Bwakura-Dangarembizi
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Paul Kelly
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
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Sharma V, Choudhury A, Basavarajaiah S, Rashid M, Yuan M, Jefferey D, Vanezis AP, Sall H, Smith WHT, Parasa R, Kelly P, Kinnaird T, Mamas MA. Chronic total occlusion in non-ST elevation myocardial infarction - A multi-centre observational study. Cardiovasc Revasc Med 2024:S1553-8389(24)00049-6. [PMID: 38395628 DOI: 10.1016/j.carrev.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To evaluate the characteristics and outcomes of patients with a chronic total occlusion (CTO) in a Non-ST Elevation Myocardial Infarction (NSTEMI) cohort. BACKGROUND There is limited data on the clinical characteristics, revascularisation strategies and outcomes of patients presenting with a NSTEMI and a CTO. METHODS Retrospective analysis of a six-centre percutaneous coronary intervention (PCI) registry in the UK between January 2015 and December 2020 was performed. Patients with a NSTEMI with and without a CTO were compared for baseline characteristics and outcomes. RESULTS There were 17,355 NSTEMI patients in total of whom 1813 patients had a CTO (10.4 %). Patients with a CTO were more likely to be older (CTO: 67.8 (±11.5) years vs. no CTO: 67.2 (±12) years, p = 0.04), male (CTO: 81.1 % vs.71.9 %, p < 0.0001) with a greater prevalence of cardiovascular risk factors. All-cause mortality at 30 days: HR 2.63, 95 % CI 1.42-4.84, p = 0.002 and at 1 year: HR: 1.87, 95 % CI 1.25-2.81, p = 0.003 was higher in the CTO cohort. CTO patients who underwent revascularisation were younger (Revascularisation 66.4 [±11.7] years vs. no revascularisation 68.4 [±11.4] years, p = 0.001). Patients with failed CTO revascularisation had lower survival (HR 0.21, 95 % CI 0.10-0.42, p < 0.0001). The mean time to revascularisation was 13.4 days. There was variation in attempt at CTO revascularisation between the 6 centres for (16 % to 100 %) with success rates ranging from 65 to 100 %. CONCLUSIONS In conclusion, the presence of a CTO in NSTEMI patients undergoing PCI was associated with worse in-hospital and long-term outcomes.
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Affiliation(s)
- Vinoda Sharma
- Birmingham City Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland; University of Birmingham, United Kingdom of Great Britain and Northern Ireland.
| | - Anirban Choudhury
- Morriston Cardiac Centre, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Sandeep Basavarajaiah
- Heartlands Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Muhammad Rashid
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland; Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Mengshi Yuan
- Birmingham City Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Jefferey
- Morriston Cardiac Centre, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Andrew P Vanezis
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Hanish Sall
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - William H T Smith
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Ramya Parasa
- The Essex Cardiothoracic Centre, Basildon, United Kingdom of Great Britain and Northern Ireland
| | - Paul Kelly
- The Essex Cardiothoracic Centre, Basildon, United Kingdom of Great Britain and Northern Ireland
| | - Tim Kinnaird
- University Hospital Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Mamas A Mamas
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland; Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
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7
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Musonda T, Wallace MS, Patel H, Martin OP, Oetheimer C, Mwakamui S, Sinkala E, Nsokolo B, Kanunga A, Lauer G, Chung RT, Wandeler G, Bhattacharya D, Kelly P, Alatrakchi N, Vinikoor MJ. New window into hepatitis B in Africa: Liver sampling combined with single cell omics enables deep and longitudinal assessment of intrahepatic immunity in Zambia. J Infect Dis 2024:jiae054. [PMID: 38332750 DOI: 10.1093/infdis/jiae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
In Lusaka, Zambia, we introduced liver fine needle aspiration (FNA) into a research cohort of adults with treatment-naïve chronic hepatitis B virus (HBV) infection, with and without HIV coinfection, as well as with acute HBV infection. Over 117 enrollment and 47 longitudinal FNAs (at 1 year follow-up), we established participant acceptability and safety. We also demonstrated the quality of the material through single cell RNA sequencing of selected enrollment FNAs, which revealed a range of immune cells. This approach can drive new insights into HBV immunology, informing cure strategies, and can improve our understanding of HBV natural history in Africa.
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Affiliation(s)
- Taonga Musonda
- Tropical Gastroenterology & Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Michael S Wallace
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hailey Patel
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Owen P Martin
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher Oetheimer
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Simutanyi Mwakamui
- Tropical Gastroenterology & Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Edford Sinkala
- Tropical Gastroenterology & Nutrition Group, University of Zambia, Lusaka, Zambia
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Bright Nsokolo
- Department of Medicine, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | - Annie Kanunga
- Tropical Gastroenterology & Nutrition Group, University of Zambia, Lusaka, Zambia
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Georg Lauer
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raymond T Chung
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Debika Bhattacharya
- Division of Infectious Diseases, University of California at Los Angeles, Los Angeles, California, USA
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition Group, University of Zambia, Lusaka, Zambia
- Queen Mary University of London, London, UK
| | - Nadia Alatrakchi
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael J Vinikoor
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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8
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Olson R, Abraham H, Leclerc C, Benny A, Baker S, Matthews Q, Chng N, Bergman A, Mou B, Dunne EM, Schellenberg D, Jiang W, Chan E, Atrchian S, Lefresne S, Carolan H, Valev B, Tyldesley S, Bang A, Berrang T, Clark H, Hsu F, Louie AV, Warner A, Palma DA, Howell D, Barry A, Dawson L, Grendarova P, Walker D, Sinha R, Tsai J, Bahig H, Thibault I, Koul R, Senthi S, Phillips I, Grose D, Kelly P, Armstrong J, McDermott R, Johnstone C, Vasan S, Aherne N, Harrow S, Liu M. Single vs. multiple fraction non-inferiority trial of stereotactic ablative radiotherapy for the comprehensive treatment of oligo-metastases/progression: SIMPLIFY-SABR-COMET. BMC Cancer 2024; 24:171. [PMID: 38310262 PMCID: PMC10838428 DOI: 10.1186/s12885-024-11905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Radiotherapy delivery regimens can vary between a single fraction (SF) and multiple fractions (MF) given daily for up to several weeks depending on the location of the cancer or metastases. With limited evidence comparing fractionation regimens for oligometastases, there is support to explore toxicity levels to nearby organs at risk as a primary outcome while using SF and MF stereotactic ablative radiotherapy (SABR) as well as explore differences in patient-reported quality of life and experience. METHODS This study will randomize 598 patients in a 1:1 ratio between the standard arm (MF SABR) and the experimental arm (SF SABR). This trial is designed as two randomized controlled trials within one patient population for resource efficiency. The primary objective of the first randomization is to determine if SF SABR is non-inferior to MF SABR, with respect to healthcare provider (HCP)-reported grade 3-5 adverse events (AEs) that are related to SABR. Primary endpoint is toxicity while secondary endpoints include lesional control rate (LCR), and progression-free survival (PFS). The second randomization (BC Cancer sites only) will allocate participants to either complete quality of life (QoL) questionnaires only; or QoL questionnaires and a symptom-specific survey with symptom-guided HCP intervention. The primary objective of the second randomization is to determine if radiation-related symptom questionnaire-guided HCP intervention results in improved reported QoL as measured by the EuroQoL-5-dimensions-5levels (EQ-5D-5L) instrument. The primary endpoint is patient-reported QoL and secondary endpoints include: persistence/resolution of symptom reporting, QoL, intervention cost effectiveness, resource utilization, and overall survival. DISCUSSION This study will compare SF and MF SABR in the treatment of oligometastases and oligoprogression to determine if there is non-inferior toxicity for SF SABR in selected participants with 1-5 oligometastatic lesions. This study will also compare patient-reported QoL between participants who receive radiation-related symptom-guided HCP intervention and those who complete questionnaires alone. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05784428. Date of Registration: 23 March 2023.
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Affiliation(s)
- Robert Olson
- University of British Columbia, Vancouver, Canada.
- University of Northern British Columbia, Prince George, Canada.
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada.
- Department of Radiation Oncology, BC Cancer - Centre for the North, 1215 Lethbridge Street, Prince George, British Columbia, V2M 7E9, Canada.
| | - Hadassah Abraham
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Curtis Leclerc
- University of British Columbia, Vancouver, Canada
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | | | - Sarah Baker
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Quinn Matthews
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Nick Chng
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Alanah Bergman
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Benjamin Mou
- BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - Emma M Dunne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Will Jiang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Elisa Chan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Shilo Lefresne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Hannah Carolan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Boris Valev
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | | | - Andrew Bang
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Tanya Berrang
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | - Haley Clark
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Fred Hsu
- BC Cancer- Abbotsford, Abbotsford, British Columbia, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Warner
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Laura Dawson
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Debra Walker
- Patient partner, BC Cancer-Prince George, Prince George, BC, Canada
| | - Rishi Sinha
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jillian Tsai
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | | | - Rashmi Koul
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | - Iain Phillips
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Derek Grose
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Paul Kelly
- Bon Secours Radiotherapy Cork (In Partnership with UPMC Hillman Cancer Centre), Cork, Ireland
| | | | | | - Candice Johnstone
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Srini Vasan
- Precision Cancer Center, Ashland, Kentucky, United States of America
| | - Noel Aherne
- Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
| | - Stephen Harrow
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Mitchell Liu
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
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9
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Sanchez EM, Avery J, Gan J, Qian J, Mandal N, Agarwal A, Mwiinga M, Banda R, Darzi A, Kelly P, Thompson AJ. Transcutaneous fluorescence spectroscopy: development and characterization of a compact, portable, and fiber-optic sensor. J Biomed Opt 2024; 29:027003. [PMID: 38419754 PMCID: PMC10900991 DOI: 10.1117/1.jbo.29.2.027003] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/27/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Abstract
Significance The integrity of the intestinal barrier is gaining recognition as a significant contributor to various pathophysiological conditions, including inflammatory bowel disease, celiac disease, environmental enteric dysfunction (EED), and malnutrition. EED, for example, manifests as complex structural and functional changes in the small intestine leading to increased intestinal permeability, inflammation, and reduced absorption of nutrients. Despite the importance of gut function, current techniques to assess intestinal permeability (such as endoscopic biopsies or dual sugar assays) are either highly invasive, unreliable, and/or difficult to perform in certain patient populations (e.g., infants). Aim We present a portable, optical sensor based on transcutaneous fluorescence spectroscopy to assess gut function (in particular, intestinal permeability) in a fast and noninvasive manner. Approach Participants receive an oral dose of a fluorescent contrast agent, and a wearable fiber-optic probe detects the permeation of the contrast agent from the gut into the blood stream by measuring the fluorescence intensity noninvasively at the fingertip. We characterized the performance of our compact optical sensor by comparing it against an existing benchtop spectroscopic system. In addition, we report results from a human study in healthy volunteers investigating the impact of skin tone and contrast agent dose on transcutaneous fluorescence signals. Results The first study with eight healthy participants showed good correlation between our compact sensor and the existing benchtop spectroscopic system [correlation coefficient ( r ) > 0.919 , p < 0.001 ]. Further experiments in 14 healthy participants revealed an approximately linear relationship between the ingested contrast agent dose and the collected signal intensity. Finally, a parallel study on the impact of different skin tones showed no significant differences in signal levels between participants with different skin tones (p > 0.05 ). Conclusions In this paper, we demonstrate the potential of our compact transcutaneous fluorescence sensor for noninvasive monitoring of intestinal health.
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Affiliation(s)
- Elena Monfort Sanchez
- Institute of Global Health Innovation, Imperial College London, The Hamlyn Centre, London, United Kingdom
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - James Avery
- Institute of Global Health Innovation, Imperial College London, The Hamlyn Centre, London, United Kingdom
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Jonathan Gan
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Jingjing Qian
- Institute of Global Health Innovation, Imperial College London, The Hamlyn Centre, London, United Kingdom
| | - Nilanjan Mandal
- Institute of Global Health Innovation, Imperial College London, The Hamlyn Centre, London, United Kingdom
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Arjun Agarwal
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Mulima Mwiinga
- University of Zambia School of Medicine, Tropical Gastroenterology and Nutrition Group, Lusaka, Zambia
| | - Rose Banda
- University of Zambia School of Medicine, Tropical Gastroenterology and Nutrition Group, Lusaka, Zambia
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, The Hamlyn Centre, London, United Kingdom
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Paul Kelly
- University of Zambia School of Medicine, Tropical Gastroenterology and Nutrition Group, Lusaka, Zambia
- Queen Mary University of London, Blizard Institute, London, United Kingdom
| | - Alex J. Thompson
- Institute of Global Health Innovation, Imperial College London, The Hamlyn Centre, London, United Kingdom
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
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10
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Chun J, Moore M, Kelly P, Kanzawa M, Itoh T, Hong SM, Zen Y. Enteroblastic cholangiocarcinoma: An uncommon, underrecognized subtype of bile duct cancer. Hum Pathol 2024; 144:46-52. [PMID: 38301963 DOI: 10.1016/j.humpath.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
Enteroblastic carcinoma is clinically characterized by an elevated serum level of alpha-fetoprotein (AFP) and is histologically characterized by cancer cells with a clear cytoplasm and 'blastic' coarse chromatin. It sometimes has an element of hepatoid carcinoma; therefore, these two neoplasms are often regarded as sister entities. Although hepatoid carcinoma in the biliary tree has been reported, enteroblastic cholangiocarcinoma is extremely uncommon. In the present study, four cases of enteroblastic cholangiocarcinoma were examined. Tumors were located inside the liver (n = 2) or common bile duct (n = 2). The two intrahepatic cases had a history of primary sclerosing cholangitis, and serum AFP levels were elevated in both. One unresectable case was diagnosed by needle liver biopsy, while the remaining three underwent surgical resection. Histologically, all cases showed similar microscopic features. Cuboidal or polygonal cancer cells with the characteristic clear cytoplasm and subnuclear vacuoles were arranged in a papillary, micropapillary, tubular, or solid architecture. One case had an element of pancreatobiliary-type adenocarcinoma, while a hepatoid carcinoma element was not observed in any cases. All cases were positive for AFP, glypican 3, and SALL4, with SALL4 being the most widely expressed. Heppar-1 and arginase-1 were negative, except for one case, which was positive for Heppar-1. In conclusion, enteroblastic cholangiocarcinoma is an uncommon subtype of biliary tract malignancy. These cases may have been categorized as 'clear cell' cholangiocarcinoma. Although enteroblastic cholangiocarcinoma seems to occur more commonly in extrahepatic regions, including the gallbladder, it may also develop in the liver, particularly in patients with primary sclerosing cholangitis.
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Affiliation(s)
- Jihyun Chun
- Institute of Liver Studies, King's College Hospital, London, SE5 9RS, UK; Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Michelle Moore
- Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, BT12 6BA, UK
| | - Paul Kelly
- Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, BT12 6BA, UK
| | - Maki Kanzawa
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Yoh Zen
- Institute of Liver Studies, King's College Hospital, London, SE5 9RS, UK.
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11
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Kebotsamang T, Munkombwe D, Bwalya L, Kelly P, Kayamba V. Prevalence of Clarithromycin-Resistant Helicobacter pylori Strains in Zambia: A Sub-Saharan African Country. Dig Dis 2024; 42:154-160. [PMID: 38185098 PMCID: PMC10997253 DOI: 10.1159/000535454] [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: 07/17/2023] [Accepted: 11/19/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Helicobacter pylori (H. pylori) is one of the most important infections globally, affecting more than 50% of the human population. Clarithromycin (CLA)-containing regimens are recommended for empirical eradication of H. pylori in populations with less than 15% resistance. The aim of this study was to estimate the prevalence of CLA resistance in samples collected from Zambian patients to determine if CLA is suitable for first-line H. pylori empirical treatment. METHODOLOGY We used archival biopsy samples collected from dyspeptic patients undergoing endoscopy. The samples had been snap-frozen immediately after collection and stored at -80°C. We performed multiplex real-time PCR using Bosphore Helicobacter pylori Genotyping Kits v1, Istanbul, Turkey, to determine the presence of wild-type H. pylori and three mutations, A2142G, A2142C, and A2143G, of domain V in 23s rRNA gene. RESULTS We tested 259 gastric biopsy samples from patients with dyspepsia, of which 136 (53%) were from females. The median age was 48 years (IQR 40-61 years). Endoscopically, most of the patients, 164 (63%), had a normal gastric mucosa. CLA resistance was found in 48 (28%) samples, with A2142G mutation in 23 (13%), A2143G mutation in 32 (18%), and double mutations A2142C and A2143G in 6 (3%). CONCLUSIONS The presence of significant levels of CLA resistance in Zambia suggests that it should not be used as first-line empirical treatment for H. pylori infection. However, with a limitation of suitable alternatives, there is an urgent need to formulate new treatment approaches.
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Affiliation(s)
| | | | - Lalusha Bwalya
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Violet Kayamba
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
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12
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Malique A, Sun S, Chandwe K, Amadi B, Haritunians T, Jain U, Muegge BD, Frein J, Sasaki Y, Foster A, Storer CE, Mengesha E, Kern J, McGovern DPB, Head RD, Kelly P, Liu TC. NAD + precursors and bile acid sequestration treat preclinical refractory environmental enteric dysfunction. Sci Transl Med 2024; 16:eabq4145. [PMID: 38170788 DOI: 10.1126/scitranslmed.abq4145] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
Environmental enteric dysfunction (EED) is a diffuse small bowel disorder associated with poor growth, inadequate responses to oral vaccines, and nutrient malabsorption in millions of children worldwide. We identify loss of the small intestinal Paneth and goblet cells that are critical for innate immunity, reduced villous height, increased bile acids, and dysregulated nicotinamide adenine dinucleotide (NAD+) synthesis signaling as potential mechanisms underlying EED and which also correlated with diminished length-for-age z score. Isocaloric low-protein diet (LPD) consumption in mice recapitulated EED histopathology and transcriptomic changes in a microbiota-independent manner, as well as increases in serum and fecal bile acids. Children with refractory EED harbor single-nucleotide polymorphisms in key enzymes involved in NAD+ synthesis. In mice, deletion of Nampt, the gene encoding the rate-limiting enzyme in the NAD+ salvage pathway, from intestinal epithelium also reduced Paneth cell function, a deficiency that was further aggravated by LPD. Separate supplementation with NAD+ precursors or bile acid sequestrant partially restored LPD-associated Paneth cell defects and, when combined, fully restored all histopathology defects in LPD-fed mice. Therapeutic regimens that increase protein and NAD+ contents while reducing excessive bile acids may benefit children with refractory EED.
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Affiliation(s)
- Atika Malique
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Shengxiang Sun
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Kanta Chandwe
- Tropical Gastroenterology and Nutrition Group, Department of Medicine, University of Zambia School of Medicine, P.O. Box 50398, Lusaka, Zambia
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition Group, Department of Medicine, University of Zambia School of Medicine, P.O. Box 50398, Lusaka, Zambia
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Umang Jain
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Brian D Muegge
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Jennifer Frein
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Yo Sasaki
- Department of Genetics, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Amanda Foster
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Chad E Storer
- Department of Genetics, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Emebet Mengesha
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Justin Kern
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Richard D Head
- Department of Genetics, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, Department of Medicine, University of Zambia School of Medicine, P.O. Box 50398, Lusaka, Zambia
- Blizard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
| | - Ta-Chiang Liu
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
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13
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Shivakumar N, Kelly P. Protein status in relation to linear growth faltering and environmental enteropathy. Curr Opin Clin Nutr Metab Care 2024; 27:55-60. [PMID: 37922120 DOI: 10.1097/mco.0000000000000989] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
PURPOSE OF REVIEW Children with linear growth faltering refractory to nutritional management show evidence of environmental enteropathy, which may compromise nutrient availability. Protein could be particularly affected, due to the possibility of sub-optimal digestibility and/or increase in requirement for immune response. This increase in protein requirement along with poor intake could potentially lead to increased breakdown of body protein sources and in turn a depleted protein state. The present review focuses on protein status in children at risk of linear growth faltering and environmental enteropathy. One pig study is also presented. RECENT FINDINGS There is consistent evidence of low circulating essential and conditionally essential amino acids, in children. One study showed no difference in protein synthesis/breakdown, and fat free mass (FFM) in children at risk of linear growth faltering and environmental enteropathy. Weanling pigs exposed to nutrient deprivation showed a decrease in plasma albumin, with a slower rate of weight and length accretion, and a lower FFM. SUMMARY These findings emphasize the need for improving intake of high-quality protein in children living in regions with a high prevalence of environmental enteropathy, with careful studies of the effect on growth rate and protein status.
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Affiliation(s)
- Nirupama Shivakumar
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Blizard Institute, Faculty of Medicine, Queen Mary University of London, London, UK
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14
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Sturgeon JP, Njunge JM, Bourke CD, Gonzales GB, Robertson RC, Bwakura-Dangarembizi M, Berkley JA, Kelly P, Prendergast AJ. Inflammation: the driver of poor outcomes among children with severe acute malnutrition? Nutr Rev 2023; 81:1636-1652. [PMID: 36977352 PMCID: PMC10639108 DOI: 10.1093/nutrit/nuad030] [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] [Indexed: 03/30/2023] Open
Abstract
Severe acute malnutrition (SAM) is the most life-threatening form of undernutrition and underlies at least 10% of all deaths among children younger than 5 years in low-income countries. SAM is a complex, multisystem disease, with physiological perturbations observed in conjunction with the loss of lean mass, including structural and functional changes in many organ systems. Despite the high mortality burden, predominantly due to infections, the underlying pathogenic pathways remain poorly understood. Intestinal and systemic inflammation is heightened in children with SAM. Chronic inflammation and its consequent immunomodulation may explain the increased morbidity and mortality from infections in children with SAM, both during hospitalization and in the longer term after discharge. Recognition of the role of inflammation in SAM is critical in considering new therapeutic targets in this disease, which has not seen a transformational approach to treatment for several decades. This review highlights the central role of inflammation in the wide-ranging pathophysiology of SAM, as well as identifying potential interventions that have biological plausibility based on evidence from other inflammatory syndromes.
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Affiliation(s)
- Jonathan P Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - James M Njunge
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Claire D Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Gerard Bryan Gonzales
- Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Ruairi C Robertson
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | | | - James A Berkley
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Paul Kelly
- is with the Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
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Phiri TN, Mutasa K, Rukobo S, Govha M, Mushayanembwa P, Mwakamui S, Haider T, Zyambo K, Dumbura C, Tome J, Runodamoto T, Chidamba L, Majo FD, Ngosa D, Chandwe K, Kapoma C, Mwapenya B, Mufukari W, Sturgeon JP, Robertson RC, Smuk M, Ntozini R, Nathoo K, Amadi B, Kelly P, Bwakura-Dangarembizi M, Prendergast AJ, Bourke CD. Severe acute malnutrition promotes bacterial binding over proinflammatory cytokine secretion by circulating innate immune cells. Sci Adv 2023; 9:eadh2284. [PMID: 37910623 PMCID: PMC10619937 DOI: 10.1126/sciadv.adh2284] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023]
Abstract
Children with severe acute malnutrition (SAM) have high infectious mortality and morbidity, implicating defects in their immune defenses. We hypothesized that circulating innate immune cells from children (0 to 59 months) hospitalized with SAM in Zambia and Zimbabwe (n = 141) have distinct capacity to respond to bacteria relative to adequately nourished healthy controls (n = 92). SAM inpatients had higher neutrophil and monocyte Escherichia coli binding capacity but lower monocyte activation and proinflammatory mediator secretion in response to lipopolysaccharide or heat-killed Salmonella typhimurium than controls. Among SAM cases, wasting severity was negatively associated with cytokine secretion, children with HIV had lower monocyte activation, and the youngest children released the least myeloperoxidase upon stimulation. Inpatient bacterial binding capacity and monocyte activation were associated with higher odds of persistent SAM at discharge, a risk factor for subsequent mortality. Thus, SAM shifts innate immune cell function, favoring bacterial containment over proinflammatory activation, which may contribute to health deficits after discharge.
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Affiliation(s)
- Tracy N. Phiri
- Tropical Gastroenterology and Nutrition group (TROPGAN), University of Zambia School of Medicine, Lusaka, Zambia
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Sandra Rukobo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Margaret Govha
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Simutanyi Mwakamui
- Tropical Gastroenterology and Nutrition group (TROPGAN), University of Zambia School of Medicine, Lusaka, Zambia
| | - Tafhima Haider
- Blizard Institute, Queen Mary University of London, London, UK
| | - Kanekwa Zyambo
- Tropical Gastroenterology and Nutrition group (TROPGAN), University of Zambia School of Medicine, Lusaka, Zambia
| | - Cherlynn Dumbura
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Joice Tome
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Leah Chidamba
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D. Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Deophine Ngosa
- Tropical Gastroenterology and Nutrition group (TROPGAN), University of Zambia School of Medicine, Lusaka, Zambia
| | - Kanta Chandwe
- Tropical Gastroenterology and Nutrition group (TROPGAN), University of Zambia School of Medicine, Lusaka, Zambia
| | - Chanda Kapoma
- Tropical Gastroenterology and Nutrition group (TROPGAN), University of Zambia School of Medicine, Lusaka, Zambia
| | - Benjamin Mwapenya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Wadzanai Mufukari
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jonathan P. Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | | | - Melanie Smuk
- Blizard Institute, Queen Mary University of London, London, UK
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kusum Nathoo
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition group (TROPGAN), University of Zambia School of Medicine, Lusaka, Zambia
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition group (TROPGAN), University of Zambia School of Medicine, Lusaka, Zambia
- Blizard Institute, Queen Mary University of London, London, UK
| | - Mutsa Bwakura-Dangarembizi
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Claire D. Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
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Kelly P, Bourne J, Richards J, Salvo D, Gill JMR. Editorial: Walking, cycling and active travel as part of physical activity and public health systems. Front Sports Act Living 2023; 5:1321450. [PMID: 38022780 PMCID: PMC10646603 DOI: 10.3389/fspor.2023.1321450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Paul Kelly
- Institute of Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jessica Bourne
- School of Health and Exercise Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Justin Richards
- Te Hau Kori—the Centre for Physical Activity and Wellbeing, Victoria University of Wellington, Wellington, New Zealand
| | - Deborah Salvo
- Prevention Research Centre, Washington University in St. Louis, St. Louis, MO, United States
| | - Jason M. R. Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
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McKaig T, Logan K, Nesbitt H, Callan B, McKeown S, O'Sullivan JM, Kelly P, O'Rourke D, McHale AP, Callan JF. Ultrasound targeted microbubble destruction using docetaxel and Rose Bengal loaded Microbubbles for targeted Chemo-Sonodynamic therapy treatment of prostate cancer. Eur J Pharm Biopharm 2023; 192:196-205. [PMID: 37858804 DOI: 10.1016/j.ejpb.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
Docetaxel (DTX) chemotherapy is commonly used in the treatment of patients with advanced prostate cancer demonstrating modest improvements in survival. As these patients are often elderly and the chemotherapy treatment is not targeted, it is often poorly tolerated. More targeted approaches that increase therapeutic efficacy yet reduce the amount of toxic chemotherapy administered are needed. In this manuscript, we investigate the potential of ultrasound targeted microbubble destruction (UTMD) to deliver a combination of docetaxel chemotherapy and Rose Bengal mediated sonodynamic therapy (SDT) in pre-clinical prostate cancer models. A Rose Bengal modified phospholipid was synthesized and used as a component lipid to prepare a microbubble (MB) formulation that was also loaded with DTX. The DTX-MB-RB formulation was used in the UTMD mediated treatment of androgen sensitive and androgen resistant 3D spheroid and murine models of prostate cancer. Results from the 3D spheroid experiments showed UTMD mediated DTX-MB-RB chemo-sonodynamic therapy to be significantly more effective at reducing cell viability than UTMD mediated DTX or SDT treatment alone. In an androgen sensitive murine model of prostate cancer, UTMD mediated DTX-MB-RB chemo-sonodynamic therapy was as effective as androgen deprivation therapy (ADT) at controlling tumour growth. However, when both treatments were combined, a significant improvement in tumour growth delay was observed. In an androgen resistant murine model, UTMD mediated DTX-MB-RB chemo-sonodynamic therapy was significantly more effective than standard DTX monotherapy. Indeed, the DTX dose administered using the DTX-MB-RB formulation was 91% less than standard DTX monotherapy. As a result, UTMD mediated DTX-MB-RB treatment was well tolerated while animals treated with DTX monotherapy displayed significant weight loss which was attributed to acute toxic effects. These results highlight the potential of UTMD mediated DTX-MB-RB chemo-sonodynamic therapy as a targeted, well tolerated alternative treatment for advanced prostate cancer.
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Affiliation(s)
- Thomas McKaig
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK
| | - Keiran Logan
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK
| | - Heather Nesbitt
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK
| | - Bridgeen Callan
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK
| | - Stephanie McKeown
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK
| | - Joe M O'Sullivan
- Patrick G. Johnston Centre for Cancer Research , Queens University of Belfast, Belfast Northern Ireland, BT9 7AE, UK
| | - Paul Kelly
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Declan O'Rourke
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Anthony P McHale
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK
| | - John F Callan
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK.
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Dvorak T, Shah AP, Rineer JM, Kelly P, Dvorak C, Salazar J. Carbon Footprint of Photon Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e579-e580. [PMID: 37785760 DOI: 10.1016/j.ijrobp.2023.06.1919] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Rising carbon dioxide levels have hazardous impact on human health and climate change. This study estimates the energy utilization of radiation therapy and estimates corresponding carbon footprint. MATERIALS/METHODS Patients treated between 07/2020 and 06/2021 using a Varian LINAC system were evaluated. Power draw was directly measured in 1 second increments, from the LINAC machine and the radiation department facility. Patients treated were reviewed for number of fractions and beam duration during each fraction. kWh power consumption was calculated per fraction and per treatment course. Patient commute distance was evaluated using Google Maps. EPA calculator was used to calculate CO2 equivalent (CO2e) footprint. RESULTS There were 176 patients treated for 191 treatment courses. Total of 4,517 fractions were delivered (avg 23.6, range 1 to 48). Average BeamOn time was 141 seconds per fraction (22 to 310 sec); electron plans (n = 8) 29 sec, 2D/3D (n = 63) 77 sec, and IMRT (n = 120) 182 sec. BeamOn power draw was ∼36.3 kW. Power consumption per fraction was 1.4 kWh (0.2 to 3.0 kWh), and per course 37.5 kWh (0.9 to 109.1 kWh). LINAC was otherwise in standby mode 71% of time (∼7.3 kW) and ON/ready mode 25% (∼12.5 kW). Patient BeamOn time accounted for 2% of total its time and 8% of its power use during the year. Incremental standby/ready energy contribution per treatment course was 410 kWh (78,332/191). The building power draw was 12.5 kW, for incremental contribution of 576 kWh per course. Average patient travel distance was 9.6 miles (0.7 miles to 73.5 miles), resulting in 711-mile round trip per course (6 miles to 5620 miles). Corresponding carbon footprint for BeamOn time was 0.6 kg CO2e per fraction (electrons 0.1 kg, 2D/3D 0.3 kg, and IMRT 1.1 kg per fx). The treatment course footprint was 16.2 kg CO2e (0.4 kg to 47.2 kg). The attributed standby/ready LINAC footprint was 177.8 kg CO2e per course. The attributed facility footprint was further 250.0 kg CO2e per course. The attributed commute footprint was further 286.3 kg CO23 per course (2.4 kg to 2264.0 kg). The entire treatment course was 730.4 kg CO2e. As such, single fraction was 0.1% of the total CO2e course (0.01% to 0.27%), BeamOn was 2.3% (0.1% to 7.1%), LINAC standby/ready was 28.0% (6.5% to 41.3%), building was 39.4% (9.2% to 58%), and commute was 30.3% (0.6% to 82.9%). The entire program generated 139.5 metric tons of CO2e during the year. CONCLUSION Linear accelerator BeamOn carbon footprint varied as a function of technique but was only 2% of the overall patient treatment footprint. The LINAC standby electricity contributed 28%, building electricity 39%, and commute 30%, though this varied significantly per patient, as a function of number of fractions and treatment distance. Fixed CO2e contribution from the standby LINAC and the building draw accounted for ∼67% of the footprint. However, radiation oncologists can potentially impact the overall carbon footprint by prescribing fewer fractions to lower total commute, as clinically indicated.
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Affiliation(s)
- T Dvorak
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - A P Shah
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - J M Rineer
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - P Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - C Dvorak
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - J Salazar
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
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Cabrera J, Kelly P, Rineer JM, Swanick CW, Shah AP, Zeidan OA, Demez N, Erhart K. Defining the Role of Intensity Modulation in Electron Conformal Therapy for the Treatment of Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e646. [PMID: 37785923 DOI: 10.1016/j.ijrobp.2023.06.2063] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The use of bolus electron conformal therapy (BECT) in the treatment of cancers of the head and neck is often limited by an inability to reduce dosimetric hot spots resulting from surface or tissue heterogeneity. In this study, we examined the potential benefits of using a recently patented, low-cost form of Intensity Modulation for electron therapy (IM-BECT) to reduce treatment hotspots in patients undergoing electron beam therapy for cancer of the Head and Neck (HN). MATERIALS/METHODS The treatment plans from twelve patients with HN cancer previously treated with BECT were identified (treatment energies ranged from 6-18 MeV and field sizes of 36-625 cm2). Each case included the treatment targets and at least one primary OAR that were defined by the original treating radiation oncologist. Additionally, a target + 2 cm rind structure was created for analysis of the dose deposition in areas immediately surrounding the target volume as a measure of conformality. Each patient plan was transferred into a novel IM-BECT planning software and each case was recomputed as per the original prescription, gantry, couch, collimator angles, and original clinically used bolus. Next, each case was replanned with the inclusion of intensity modulation, as well as a new custom conformal bolus that was designed for optimized range compensation. The patient plans were then normalized such that 100% equals the prescription dose value and then transferred to a plan analysis software for comparison of the target coverage/dose and OAR dose. RESULTS Comparison of the BECT and IM-BECT treatment plans demonstrated that IM-BECT was able to significantly reduce dosimetric hotspots for this cohort of patients undergoing radiation therapy for HN cancer, bringing the average maximum dose down from 130.6% to only 120.6% (p = 0.044, paired t-test). Moreover, the impact of IM-BECT appeared to be most substantial in the patients with the highest baseline maximum dose. For patients who had a hotspot of 125% or greater, the hotspot was on average reduced by 19%. Further dosimetric analysis demonstrated a small resultant increase in the low dose deposition to the surrounding normal tissues. For BECT, the average primary OAR mean dose and Target+2cm rind mean dose were 27.5% and 60.0%, respectively. For IM-BECT, the average primary OAR mean dose and Target+2cm rind mean dose increased slightly to 30.9% and 64.6%, respectively [Primary OAR mean (P = 0.0008), and Target+2cm rind mean (P = 0.0001), paired t-test]. CONCLUSION IM-BECT is an effective method of reducing dosimetric hotspots in patients undergoing radiation therapy for cancer of the HN. This improvement came at the expense of a small increase in dose to the underlying tissues. This retrospective planning study represents the first example of IM-BECT being applied to real patient cases and suggests further development of IM-BECT is warranted.
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Affiliation(s)
- J Cabrera
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - P Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - J M Rineer
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - C W Swanick
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - A P Shah
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - O A Zeidan
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - N Demez
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
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Worby CJ, Sridhar S, Turbett SE, Becker MV, Kogut L, Sanchez V, Bronson RA, Rao SR, Oliver E, Walker AT, Walters MS, Kelly P, Leung DT, Knouse MC, Hagmann SHF, Harris JB, Ryan ET, Earl AM, LaRocque RC. Gut microbiome perturbation, antibiotic resistance, and Escherichia coli strain dynamics associated with international travel: a metagenomic analysis. Lancet Microbe 2023; 4:e790-e799. [PMID: 37716364 PMCID: PMC10680401 DOI: 10.1016/s2666-5247(23)00147-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Culture-based studies have shown that acquisition of extended-spectrum β-lactamase-producing Enterobacterales is common during international travel; however, little is known about the role of the gut microbiome before and during travel, nor about acquisition of other antimicrobial-resistant organisms. We aimed to identify (1) whether the gut microbiome provided colonisation resistance against antimicrobial-resistant organism acquisition, (2) the effect of travel and travel behaviours on the gut microbiome, and (3) the scale and global heterogeneity of antimicrobial-resistant organism acquisition. METHODS In this metagenomic analysis, participants were recruited at three US travel clinics (Boston, MA; New York, NY; and Salt Lake City, UT) before international travel. Participants had to travel internationally between Dec 8, 2017, and April 30, 2019, and have DNA extractions for stool samples both before and after travel for inclusion. Participants were excluded if they had at least one low coverage sample (<1 million read pairs). Stool samples were collected at home before and after travel, sent to a clinical microbiology laboratory to be screened for three target antimicrobial-resistant organisms (extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales, and mcr-mediated colistin-resistant Enterobacterales), and underwent DNA extraction and shotgun metagenomic sequencing. We profiled metagenomes for taxonomic composition, antibiotic-resistant gene content, and characterised the Escherichia coli population at the strain level. We analysed pre-travel samples to identify the gut microbiome risk factors associated with acquisition of the three targeted antimicrobial resistant organisms. Pre-travel and post-travel samples were compared to identify microbiome and resistome perturbation and E coli strain acquisition associated with travel. FINDINGS A total of 368 individuals travelled between the required dates, and 296 had DNA extractions available for both before and after travel. 29 travellers were excluded as they had at least one low coverage sample, leaving a final group of 267 participants. We observed a perturbation of the gut microbiota, characterised by a significant depletion of microbial diversity and enrichment of the Enterobacteriaceae family. Metagenomic strain tracking confirmed that 67% of travellers acquired new strains of E coli during travel that were phylogenetically distinct from their pre-travel strains. We observed widespread enrichment of antibiotic-resistant genes in the gut, with a median 15% (95% CI 10-20, p<1 × 10-10) increase in burden (reads per kilobase per million reads). This increase included antibiotic-resistant genes previously classified as threats to public health, which were 56% (95% CI 36-91, p=2 × 10-11) higher in abundance after travel than before. Fluoroquinolone antibiotic-resistant genes were aquired by 97 (54%) of 181 travellers with no detected pre-travel carriage. Although we found that visiting friends or relatives, travel to south Asia, and eating uncooked vegetables were risk factors for acquisition of the three targeted antimicrobial resistant organisms, we did not observe an association between the pre-travel microbiome structure and travel-related antimicrobial-resistant organism acquisition. INTERPRETATION This work highlights a scale of E coli and antimicrobial-resistant organism acquisition by US travellers not apparent from previous culture-based studies, and suggests that strategies to control antimicrobial-resistant organisms addressing international traveller behaviour, rather than modulating the gut microbiome, could be worthwhile. FUNDING US Centers for Disease Control and Prevention and National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Colin J Worby
- Infectious Disease and Microbiome Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sushmita Sridhar
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah E Turbett
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret V Becker
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Lucyna Kogut
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Vanessa Sanchez
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan A Bronson
- Infectious Disease and Microbiome Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth Oliver
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Taylor Walker
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Kelly
- Division of Infectious Diseases, Bronx Care Center, Bronx, NY, USA
| | - Daniel T Leung
- Division of Infectious Diseases and Division of Microbiology and Immunology, University of Utah, Salt Lake City, UT, USA
| | - Mark C Knouse
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health, New Hyde Park, NY, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of Pediatric Global Health, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Edward T Ryan
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Travellers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA
| | - Ashlee M Earl
- Infectious Disease and Microbiome Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Regina C LaRocque
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Travellers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA
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21
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Ugurluer G, Schneiders FL, Corradini S, Boldrini L, Kotecha R, Kelly P, Portelance L, Camilleri P, Ben-David MA, Poiset SJ, Marschner S, Panza G, Kutuk T, Palacios M, Mustafayev TZ, Atalar B, Senan S, Ozyar E. Outcomes of MR-Guided Stereotactic Body Radiotherapy (MRgSBRT) for Adrenal Metastases: A Multi-Institutional Pooled Analysis. Int J Radiat Oncol Biol Phys 2023; 117:S111-S112. [PMID: 37784293 DOI: 10.1016/j.ijrobp.2023.06.439] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) is an effective treatment for adrenal metastases, but it is technically challenging and there are concerns about toxicity due to the proximity of organs at risk. We hypothesized that MR-guided SBRT (MRgSBRT) using a 0.35 T MR-Linac for adrenal metastases can achieve durable local control (LC) with a low probability of toxicity. MATERIALS/METHODS In an ethics-approved study, we analyzed clinical and dosimetric data of patients treated with MRgSBRT at 10 institutions between 2016-2022. LC, local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS) were estimated using Kaplan-Meier method and log-rank test. Responses were evaluated using RECIST criteria. Toxicity was graded according to CTCAE (v4.0). OS and DPFS were calculated on a per-patient basis, while LC and LPFS were calculated on a per-lesion basis. RESULTS A total of 249 patients (260 adrenal lesions) were included; median age was 65 years (range 28-91), 65.5% were male, 83.9% had ECOG PS 0-1. The most common primary tumor was lung cancer (69.1%). Adrenal metastases were synchronous, metachronous, oligoprogressive or oligopersistent in 20%, 41.5%, 35.8% and 2.7% of patients, respectively. Metastatic pattern was solitary in 26.9%, oligometastatic in 57.3% and polymetastatic in 15.8% of patients. Right-sided metastases comprised 40%, left-sided 51.5% and lesions were bilateral in 8.5%. Chemotherapy and immunotherapy were administered in 67.1% and 60.6% of patients, respectively. Median gross tumor volume was 21.8 cc (range 1.1-383.2) and median planning target volume was 36.9 cc (range 3.6-516.9). Median total dose was 45 Gy (range 16-60), median fraction number was 5 (range 1-8) and median fraction dose used was 10 Gy (range 5-24). Median BED10 was 100 Gy (range 37.5-132); 87.8% of fractions used adapted plans. At a median follow-up was 17.7 months (IQR 5.5-21.7), local responses were scored as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD) in 36.9%, 28.2%, 25.7%, and 9.1%, respectively. Median OS was 30.4 months, with 1- and 2- year OS rates of 75.3% and 57.1%, respectively. On multivariate analysis, significantly higher OS rates were seen in patients achieving a CR (p = 0.007, HR 0.50) and with ECOG scores of 0-1 (p = 0.001, HR 0.43). One- and 2- year LPFS rates were 94.5% and 88.8%, respectively. No local recurrences were observed after treatment to a BED10>100 or with single fraction (range 16-24 Gy). Only 2 patients (0.8%) had ≥grade 3 chronic toxicity. CONCLUSION This multi-institutional study of MRgSBRT outcomes for adrenal metastases revealed a 2-year LPFS of 89%, with a <1% risk of ≥grade 3 toxicity. Daily adaptation was performed in 90% of plans, indicating a beneficial role for MR guidance.
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Affiliation(s)
- G Ugurluer
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - F L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - L Boldrini
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - R Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - P Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - L Portelance
- Department of Radiation Oncology, University of Miami, Miami, FL
| | - P Camilleri
- Radiation Oncology, GenesisCare, Oxford, United Kingdom
| | - M A Ben-David
- Department of Radiation Oncology, Assuta Medical Center, Tel Aviv, Israel
| | - S J Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA
| | - S Marschner
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - G Panza
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - T Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - T Zoto Mustafayev
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - B Atalar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - S Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - E Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
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22
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Bwakura-Dangarembizi M, Dumbura C, Ngosa D, Majo FD, Piper JD, Sturgeon JP, Nathoo KJ, Amadi B, Norris S, Chasekwa B, Ntozini R, Wells JC, Kelly P, Prendergast AJ. Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia. Br J Nutr 2023; 130:1024-1033. [PMID: 36573378 PMCID: PMC10442795 DOI: 10.1017/s0007114522004056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z-score increase in impedance index and triceps skinfolds was associated with 48 % (adjusted hazard ratio 0·52, 95 % CI (0·30, 0·90)) and 17 % (adjusted hazard ratio 0·83, 95 % CI (0·71, 0·96)) lower hazard of death/readmission, respectively. HIV-positive v. HIV-negative children had lower gains in sum of skinfolds (mean difference -1·49, 95 % CI (-2·01, -0·97)) and impedance index Z-scores (-0·13, 95 % CI (-0·24, -0·01)) over 52 weeks. Children with non-oedematous v. oedematous SAM had lower mean changes in the sum of skinfolds (-1·47, 95 % CI (-1·97, -0·97)) and impedance index Z-scores (-0·23, 95 % CI (-0·36, -0·09)). Risk stratification to identify children at risk for mortality or readmission, and interventions to increase lean and peripheral fat mass, should be considered in the post-discharge care of these children.
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Affiliation(s)
- Mutsa Bwakura-Dangarembizi
- University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- University of Witwatersrand, Johannesburg, South Africa
| | - Cherlynn Dumbura
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Deophine Ngosa
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Florence D. Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Joe D. Piper
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Jonathan P. Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Kusum J. Nathoo
- University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Shane Norris
- University of Witwatersrand, Johannesburg, South Africa
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jonathan C. Wells
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
- Blizard Institute, Queen Mary University of London, London, UK
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
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23
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Mweetwa MN, Haritunians T, Dube S, Chandwe K, Amadi B, Zyambo K, Liu TC, McGovern D, Kelly P. Genetic variation in environmental enteropathy and stunting in Zambian children: A pilot genome wide association study using the H3Africa chip. PLoS One 2023; 18:e0291311. [PMID: 37756315 PMCID: PMC10529557 DOI: 10.1371/journal.pone.0291311] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Stunting is known to be heavily influenced by environmental factors, so the genetic contribution has received little attention. Here we report an exploration of genetic influences in stunted Zambian children with environmental enteropathy. METHOD Children with stunting (LAZ < -2) were enrolled and given nutritional therapy. Those that were non-responsive to therapy were designated as cases, and children with good growth (LAZ > -1) from the same community as controls. Blood and stool samples were taken to measure biomarkers of intestinal inflammation, epithelial damage, and microbial translocation. Single nucleotide polymorphism array genotyping was carried out on saliva samples using the H3Africa consortium array. RESULTS Genome wide associations were analysed in 117 cases and 41 controls. While no significant associations with stunting were observed at P<5x10-8, likely due to the small sample size, interesting associations were observed at lower thresholds. SNPs associated with stunting were in genomic regions known to modulate neuronal differentiation and fatty acid biosynthesis. SNPs associated with increased microbial translocation were associated with non-integrin membrane ECM interactions, tight junctions, hemostasis, and G-alpha signalling events. SNPs associated with increased inflammation were associated with, ECM interactions, purine metabolism, axon guidance, and cell motility. SNPs negatively associated with inflammation overlapped genes involved in semaphoring interactions. We explored the existing coeliac disease risk HLA genotypes and found present: DQ2.5 (7.5%), DQ8 (3.5%) and DQ2.2 (3.8%); however, no children were positive for coeliac antibodies. We detected HLA-DRB:1301 and HLA-C:1802 with high odds ratios and P<0.05 in stunted children compared to controls. CONCLUSION Genetic variations associated with stunting and the enteropathy underlying it, include variants associated with multiple pathways relating to gene expression, glycosylation, nerve signalling, and sensing of the nutritional and microbiological milieu.
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Affiliation(s)
- Monica N. Mweetwa
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Physiology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Shishir Dube
- F. Widjaja Foundation Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Kanta Chandwe
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Paediatrics, University of Zambia School of Medicine, Lusaka, Zambia
| | - Beatrice Amadi
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Paediatrics, University of Zambia School of Medicine, Lusaka, Zambia
| | - Kanekwa Zyambo
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Ta-Chiang Liu
- Washington University in St. Louis (WUSTL), St. Louis, Missouri, United States of America
| | - Dermot McGovern
- F. Widjaja Foundation Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Washington University in St. Louis (WUSTL), St. Louis, Missouri, United States of America
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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24
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Logan G, Somers C, Baker G, Connell H, Gray S, Kelly P, McIntosh E, Welsh P, Gray CM, Gill JMR. Benefits, risks, barriers, and facilitators to cycling: a narrative review. Front Sports Act Living 2023; 5:1168357. [PMID: 37795314 PMCID: PMC10546027 DOI: 10.3389/fspor.2023.1168357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
There is large potential to increase cycling participation worldwide. Participation in cycling is associated with lower risk of mortality from any cause, and incidence of cardiovascular disease and type 2 diabetes, as well as positive mental health and well-being. The largest potential for health gains likely to come from increasing participation amongst those who do not currently cycle regularly, rather than encouraging those who already cycle regularly to cycle more. Replacing car journeys with cycling can lead to reductions in air pollution emissions and lower pollutant exposure to the general population. Important gaps and uncertainties in the existing evidence base include: the extent to which the health benefits associated with cycling participation are fully causal due to the observational nature of much of the existing evidence base; the real-world economic cost-benefits of pragmatic interventions to increase cycling participation; and the most effective (combination of) approaches to increase cycling participation. To address these uncertainties, large-scale, long-term randomised controlled trials are needed to: evaluate the effectiveness, and cost-effectiveness, of (combinations of) intervention approaches to induce sustained long-term increases in cycling participation in terms of increases in numbers of people cycling regularly and number of cycling journeys undertaken, across a range of population demographic groups; establish the effects of such interventions on relevant outcomes related to health and wellbeing, economic productivity and wider societal impacts; and provide more robust quantification of potential harms of increasing cycling participation, such as collision risks.
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Affiliation(s)
- Greig Logan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Camilla Somers
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Graham Baker
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Hayley Connell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Stuart Gray
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Emma McIntosh
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jason M. R. Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
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25
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Sturgeon JP, Mufukari W, Tome J, Dumbura C, Majo FD, Ngosa D, Chandwe K, Kapoma C, Mutasa K, Nathoo KJ, Bourke CD, Ntozini R, Bwakura-Dangarembizi M, Amadi B, Kelly P, Prendergast AJ. Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia. Eur J Clin Nutr 2023; 77:895-904. [PMID: 37553508 PMCID: PMC10473959 DOI: 10.1038/s41430-023-01320-9] [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: 05/03/2022] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition underlies 45% of deaths in children under-5 years annually. Children hospitalised with complicated severe acute malnutrition (SAM) have unacceptably high mortality. We aimed to identify variables from early hospital admission (baseline factors) independently associated with inpatient mortality in this cohort to identify those most at risk. SUBJECTS/METHODS Observational study of 745 children aged 0-59 months admitted with complicated SAM at three hospitals in Zimbabwe/Zambia. Children underwent anthropometry and clinical assessment by a study physician within 72 h of enrolment, and caregivers provided sociodemographic data. Children were followed-up daily until discharge/death. A multivariable survival analysis identified the baseline factors independently associated with mortality. RESULTS 70/745 (9.4%) children died in hospital. Age between 6-23 months [aHR 6.53, 95%CI 2.24-19.02], higher mid-upper arm circumference [aHR 0.73, 95%CI 0.59-0.89], presence of oedema [aHR 2.22, 95%CI 1.23-4.05], shock [aHR 8.18, 95%CI 3.79-17.65], sepsis [aHR 3.13, 95%CI 1.44-6.80], persistent diarrhoea [aHR 2.27, 95%CI 1.18-4.37], lack of a toilet at home [aHR 4.35, 95%CI 1.65-11.47], and recruitment at one Harare site [aHR 0.38, 95%CI 0.18-0.83] were all independently associated with inpatient mortality. Oedematous children had a significantly higher birthweight [2987 g vs 2757 g, p < 0.001] than those without oedema; higher birthweight was weakly associated with mortality [aHR 1.50 95%CI 0.97-2.31]. CONCLUSIONS Children with oedema, low MUAC, baseline infections, shock and lack of home sanitation had a significantly increased risk of inpatient mortality following hospitalisation for complicated SAM. Children with high-risk features may require additional care. A better understanding of the pathophysiology of SAM is needed to identify adjunctive interventions.
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Affiliation(s)
- Jonathan P Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe.
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Wadzanai Mufukari
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe
| | - Joice Tome
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe
| | - Cherlynn Dumbura
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe
| | - Florence D Majo
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe
| | - Deophine Ngosa
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Kanta Chandwe
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Chanda Kapoma
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe
| | - Kusum J Nathoo
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Claire D Bourke
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
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26
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Garcia L, Pearce M, Abbas A, Mok A, Strain T, Ali S, Crippa A, Dempsey PC, Golubic R, Kelly P, Laird Y, McNamara E, Moore S, de Sa TH, Smith AD, Wijndaele K, Woodcock J, Brage S. Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose-response meta-analysis of large prospective studies. Br J Sports Med 2023; 57:979-989. [PMID: 36854652 PMCID: PMC10423495 DOI: 10.1136/bjsports-2022-105669] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To estimate the dose-response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population. DESIGN Systematic review and cohort-level dose-response meta-analysis. DATA SOURCES PubMed, Scopus, Web of Science and reference lists of published studies. ELIGIBILITY CRITERIA Prospective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney). RESULTS 196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted. CONCLUSIONS Inverse non-linear dose-response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. PROSPERO registration number CRD42018095481.
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Affiliation(s)
- Leandro Garcia
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ali Abbas
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alexander Mok
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Tessa Strain
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Sara Ali
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paddy C Dempsey
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rajna Golubic
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh Institute for Sport, Physical Education and Health Sciences, Edinburgh, UK
| | - Yvonne Laird
- Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Eoin McNamara
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Economic and Social Research Institute, Dublin, Ireland
| | - Samuel Moore
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Thiago Herick de Sa
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Andrea D Smith
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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27
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Huits R, Angelo KM, Amatya B, Barkati S, Barnett ED, Bottieau E, Emetulu H, Epelboin L, Eperon G, Medebb L, Gobbi F, Grobusch MP, Itani O, Jordan S, Kelly P, Leder K, Díaz-Menéndez M, Okumura N, Rizwan A, Rothe C, Saio M, Waggoner J, Yoshimura Y, Libman M, Hamer DH, Schwartz E. Clinical Characteristics and Outcomes Among Travelers With Severe Dengue : A GeoSentinel Analysis. Ann Intern Med 2023; 176:940-948. [PMID: 37335991 PMCID: PMC10760980 DOI: 10.7326/m23-0721] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited. OBJECTIVE To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue). DESIGN Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022. SETTING 20 of 71 international GeoSentinel sites. PATIENTS Returning travelers with complicated dengue. MEASUREMENTS Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue. RESULTS Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue. LIMITATIONS Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited. CONCLUSION Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.
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Affiliation(s)
- Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy (R.H.)
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (K.M.A.)
| | - Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal (B.A.)
| | - Sapha Barkati
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada (S.B.)
| | - Elizabeth D Barnett
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts (E.D.B., M.L.)
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium (E.B.)
| | - Hannah Emetulu
- International Society of Travel Medicine, Atlanta, Georgia (H.E., A.R.)
| | - Loïc Epelboin
- Infectious and Tropical Diseases Unit and CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana (L.E.)
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland (G.E.)
| | - Line Medebb
- Aix Marseille University, AP-HM, IHU-Méditerranée Infection, Marseille, France (L.M.)
| | - Federico Gobbi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (F.G.)
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands (M.P.G.)
| | - Oula Itani
- Institut Pasteur, Centre Médical, Centre d'Infectiologie Necker-Pasteur, Paris, France (O.I.)
| | - Sabine Jordan
- Division of Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, and Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany (S.J.)
| | - Paul Kelly
- BronxCare Hospital Center, Bronx, New York (P.K.)
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, and Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Victoria, Australia (K.L.)
| | - Marta Díaz-Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz-Carlos III, IdIPAz, and CIBERINFECT, Madrid, Spain (M.D.)
| | - Nobumasa Okumura
- Center Hospital of the National Center for Global Health and Medicine, Shinjuku City, Tokyo, Japan (N.O.)
| | - Aisha Rizwan
- International Society of Travel Medicine, Atlanta, Georgia (H.E., A.R.)
| | - Camilla Rothe
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität München, Munich, Germany (C.R.)
| | - Mauro Saio
- Doctor's Plaza, Nairobi Hospital, Nairobi, Kenya (M.S.)
| | - Jesse Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia (J.W.)
| | | | - Michael Libman
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts (E.D.B., M.L.)
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, Boston University School of Medicine, Center for Emerging Infectious Disease Policy and Research, Boston University, and National Emerging Infectious Disease Laboratory, Boston, Massachusetts (D.H.H.)
| | - Eli Schwartz
- The Center of Geographical Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer, and Ramat Gan & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (E.S.)
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Sturgiss E, Ball L, Hall Dykgraaf S, Kidd M, Kelly P, Simpson N. Community-based access to oral antiviral treatments for COVID-19 in Australia. Aust J Gen Pract 2023; 52:409-412. [PMID: 37291821 DOI: 10.31128/ajgp-01-23-6673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The availability of oral antivirals for SARS-CoV-2 infection reduces the risk of severe, acute illness in people at higher risk for death and hospitalisation. OBJECTIVE The process for antiviral prescription and dispensing in Australia is outlined using nationwide data. DISCUSSION Australia has focused on providing rapid access to antivirals to high-risk people in the community via general practices and community pharmacies. Although the introduction of oral antiviral treatments is an important part of the response to the COVID-19 pandemic, vaccination remains the most effective way of mitigating the risk of developing severe complications of COVID-19, including hospitalisation and death.
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Affiliation(s)
- Elizabeth Sturgiss
- Elizabeth Sturgiss FRACGP, PhD, BMed, MPH, MForensMed, FHEA, Senior Research Fellow, School of Primary and Allied Health Care, Monash University, Frankston, Vic
| | - Lauren Ball
- BAppSc, Grad Cert Higher Ed, Grad Dip@Health Economics and Health Policy, MNutrDiet,@PhD, Chair of Community Health and Wellbeing,@The University of Queensland, Brisbane, Qld
| | - Sally Hall Dykgraaf
- RN, Grad Cert ClinMan, PhD, Action Research Fellow, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, Canberra, ACT; Research Manager, Rural Clinical School, Australian National University, Canberra, ACT
| | - Michael Kidd
- AM MBBS, MD, FAHMS, Deputy Chief Medical Officer, Australian Government Department of Health and Aged Care, Canberra, ACT; Professor of Primary Care Reform, Australian National University, Canberra, ACT
| | - Paul Kelly
- MBBS, PhD, FAFPHM, Chief Medical Officer, Australian Government Department of Health and Aged Care, Canberra, ACT
| | - Nick Simpson
- MBBS, Medical Adviser, Australian Government Department of Health and Aged Care, Canberra, ACT
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Mak JWY, Sun Y, Limsrivilai J, Abdullah M, Kaibullayeva J, Balderramo D, Vergara BI, Paudel MS, Banerjee R, Hilmi I, Ali RAR, Wei SC, Ng KK, Altuwaijri M, Kelly P, Yamamoto-Furusho JK, Kotze PG, Ahuja V, Chong VH, Dao HV, Abbey Y, Ching JYL, Ho A, Chan AKW, Bernstein CN, Gearry RB, Abreu M, Rubin DT, Dotan I, Hracs L, Kaplan GG, Ng SC. Development of the global inflammatory bowel disease visualization of epidemiology studies in the 21 st century (GIVES-21). BMC Med Res Methodol 2023; 23:129. [PMID: 37231405 DOI: 10.1186/s12874-023-01944-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND There is a rapid increase in the incidence of inflammatory bowel diseases (IBD) in newly industrialized countries, yet epidemiological data is incomplete. We herein report the methodology adopted to study the incidence of IBD in newly industrialized countries and to evaluate the effect of environmental factors including diet on IBD development. METHODS Global IBD Visualization of Epidemiology Studies in the 21st Century (GIVES-21) is a population-based cohort of newly diagnosed persons with Crohn's disease and ulcerative colitis in Asia, Africa, and Latin America to be followed prospectively for 12 months. New cases were ascertained from multiple sources and were entered into a secured online system. Cases were confirmed using standard diagnostic criteria. In addition, endoscopy, pathology and pharmacy records from each local site were searched to ensure completeness of case capture. Validated environmental and dietary questionnaires were used to determine exposure in incident cases prior to diagnosis. RESULTS Through November 2022, 106 hospitals from 24 regions (16 Asia; 6 Latin America; 2 Africa) have joined the GIVES-21 Consortium. To date, over 290 incident cases have been reported. All patients have demographic data, clinical disease characteristics, and disease course data including healthcare utilization, medication history and environmental and dietary exposures data collected. We have established a comprehensive platform and infrastructure required to examine disease incidence, risk factors and disease course of IBD in the real-world setting. CONCLUSIONS The GIVES-21 consortium offers a unique opportunity to investigate the epidemiology of IBD and explores new clinical research questions on the association between environmental and dietary factors and IBD development in newly industrialized countries.
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Affiliation(s)
- Joyce W Y Mak
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yang Sun
- The First Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | | | | | - Jamilya Kaibullayeva
- Research Institute of Cardiology and Internal Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | | | | | - Rupa Banerjee
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Ida Hilmi
- University of Malaya, Kuala Lumpur, Malaysia
| | | | - Shu Chen Wei
- National Taiwan University Hospital, Taipei, Taiwan
| | - Ka Kei Ng
- Conde S. Januário Hospital, Macao SAR, China
| | - Mansour Altuwaijri
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | | | | | - Vineet Ahuja
- All India Institute of Medical Sciences, Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | | | - Jessica Y L Ching
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Agnes Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alicia K W Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Maria Abreu
- Department of Medicine, University of Miami Miller School of Medicine, Florida, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah-Tikva, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lindsay Hracs
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Siew C Ng
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Olsen J, Angulo FJ, Pilz A, Halsby K, Kelly P, Brestrich G, Stark JH, Jodar L. Estimated number of symptomatic Lyme borreliosis cases in Germany in 2021 after adjusting for under-ascertainment. Public Health 2023; 219:1-9. [PMID: 37075486 DOI: 10.1016/j.puhe.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Although nine of 16 federal states in Germany conduct public health surveillance for Lyme borreliosis (LB), the extent of under-ascertainment is unknown. OBJECTIVE As a model for European countries that conduct LB surveillance, we sought to estimate the population-based incidence of symptomatic LB after adjusting for under-ascertainment. METHODS Estimating seroprevalence-derived under-ascertainment relies on data from seroprevalence studies, public health surveillance, and published literature. The number of symptomatic LB cases in states that conduct LB surveillance was estimated from studies reporting the seroprevalence of antibodies against Borrelia burgdorferi sensu lato, the proportion of LB cases that are asymptomatic, and the duration of antibody detection. The number of estimated incident symptomatic LB cases was compared with the number of surveillance-reported LB cases to derive under-ascertainment multipliers. The multipliers were applied to the number of 2021 surveillance-reported LB cases to estimate the population-based incidence of symptomatic LB in Germany. RESULTS Adjusting for seroprevalence-based under-ascertainment multipliers, the estimated number of symptomatic LB cases in states that conducted surveillance was 129,870 (408 per 100,000 population) in 2021. As there were 11,051 surveillance-reported cases in 2021 in these states, these data indicate there were 12 symptomatic LB cases for every surveillance-reported LB case. CONCLUSIONS We demonstrate that symptomatic LB is underdetected in Germany and that this seroprevalence-based approach can be applied elsewhere in Europe where requisite data are available. Nationwide expansion of LB surveillance would further elucidate the true LB disease burden in Germany and could support targeted disease prevention efforts to address the high LB disease burden.
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Affiliation(s)
- J Olsen
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA.
| | - F J Angulo
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - A Pilz
- Vaccines, Pfizer Corporation Austria, Floridsdorfer Hauptstrasse 1, 1210 Wien, Vienna, Austria
| | - K Halsby
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - P Kelly
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - G Brestrich
- Vaccines, Pfizer Pharma GmbH, Linkstrasse 10, 10785 Berlin, Germany
| | - J H Stark
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - L Jodar
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
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31
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Cabrera LY, Kelly P, Vega IE. Correction to: Knowledge and Attitudes of Two Latino Groups About Alzheimer Disease: A Qualitative Study. J Cross Cult Gerontol 2023:10.1007/s10823-023-09478-2. [PMID: 37017804 DOI: 10.1007/s10823-023-09478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Laura Y Cabrera
- Department of Engineering Science and Mechanics, Center for Neural Engineering, College of Engineering, Pennsylvania State University, W-316 Millennium Science Complex, University Park, PA, 16802, USA.
- Rock Ethics Institute and Huck Institute of Life Sciences, Pennsylvania State University, University Park, PA, USA.
| | - P Kelly
- College of Natural Science, Michigan State University, East Lansing, MI, USA
| | - I E Vega
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Besa E, Tembo MJ, Mulenga C, Mweetwa M, Choudhry N, Chandwe K, Storer C, Head R, Amadi B, Haritunians T, McGovern D, Kwenda G, Peiris M, Kelly P. Potential determinants of low circulating glucagon-like peptide 2 concentrations in Zambian children with non-responsive stunting. Exp Physiol 2023; 108:568-580. [PMID: 36744850 PMCID: PMC10103869 DOI: 10.1113/ep090492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/19/2023] [Indexed: 02/07/2023]
Abstract
NEW FINDINGS What is the central question of this study? Non-responsive stunting is characterised by a progressive decline of circulating glucagon-like peptide 2: what are the possible causes of this decline? What is the main finding and its importance? In contrast with the established loss of Paneth and goblet cells in environmental enteropathy, there was no evidence of a parallel loss of enteroendocrine cells as seen by positive tissue staining for chromogranin A. Transcriptomic and genomic analyses showed evidence of genetic transcripts that could account for some of the variability seen in circulating glucagon-like peptide 2 values. ABSTRACT Nutrient sensing determines digestive and hormonal responses following nutrient ingestion. We have previously reported decreased levels of glucagon-like peptide 2 (GLP-2) in children with stunting. Here we demonstrate the presence of enteroendocrine cells in stunted children and explore potential pathways that may be involved in reduced circulating levels of GLP-2. At the time of performing diagnostic endoscopies for non-responsive stunted children, intestinal biopsies were collected for immunofluorescence staining of enteroendocrine cells and transcriptomic analysis. Circulating levels of GLP-2 were also measured and correlated with transcriptomic data. An exploratory genome-wide association study (GWAS) was conducted on DNA samples (n = 158) to assess genetic contribution to GLP-2 variability. Intestinal tissue sections collected from non-responsive stunted children stained positive for chromogranin A (88/89), alongside G-protein-coupled receptors G-protein receptor 119 (75/87), free fatty acid receptor 3 (76/89) and taste 1 receptor 1 (39/45). Transcriptomic analysis found three pathways correlated with circulating GLP-2: sugar metabolism, epithelial transport, and barrier function, which likely reflect downstream events following receptor-ligand interaction. GWAS analysis revealed potential genetic contributions to GLP-2 half-life and receptor binding. Enteroendocrine cell loss was not identified in stunted Zambian children as has been observed for goblet and Paneth cells. Transcriptomic analysis suggests that GLP-2 has pleiotrophic actions on the intestinal mucosa in malnutrition, but further work is needed to dissect pathways leading to perturbations in nutrient sensing.
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Affiliation(s)
- Ellen Besa
- Tropical Gastroenterology and Nutrition Group, School of MedicineUniversity of ZambiaLusakaZambia
| | - Mizinga Jacqueline Tembo
- Tropical Gastroenterology and Nutrition Group, School of MedicineUniversity of ZambiaLusakaZambia
| | - Chola Mulenga
- Tropical Gastroenterology and Nutrition Group, School of MedicineUniversity of ZambiaLusakaZambia
| | - Monica Mweetwa
- Tropical Gastroenterology and Nutrition Group, School of MedicineUniversity of ZambiaLusakaZambia
| | - Naheed Choudhry
- Blizard Institute, Centre for Neuroscience, Surgery and Trauma, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Kanta Chandwe
- Tropical Gastroenterology and Nutrition Group, School of MedicineUniversity of ZambiaLusakaZambia
| | - Chad Storer
- Genome Technology Access Center at McDonnell Genome InstituteWashington University in St LouisSt LouisMOUSA
| | - Richard Head
- Genome Technology Access Center at McDonnell Genome InstituteWashington University in St LouisSt LouisMOUSA
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition Group, School of MedicineUniversity of ZambiaLusakaZambia
| | - Talin Haritunians
- Cedars‐Sinai Medical CenterInflammatory Bowel and Immunobiology Research InstituteLos AngelesCAUSA
| | - Dermot McGovern
- Cedars‐Sinai Medical CenterInflammatory Bowel and Immunobiology Research InstituteLos AngelesCAUSA
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health SciencesUniversity of ZambiaLusakaZambia
| | - Madusha Peiris
- Blizard Institute, Centre for Neuroscience, Surgery and Trauma, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, School of MedicineUniversity of ZambiaLusakaZambia
- Blizard Institute, Centre for Neuroscience, Surgery and Trauma, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
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Mweemba A, Kelly P, Heimburger DC, Mutale W, Nzala S, Wester WC, Banda J, Mulenga L, Siwingwa M, Todd J. Effect of anti-retroviral regimen on proximal tubular function in Zambian adolescents and young adults living with HIV: A cross sectional study. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.14458.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Background: Tenofovir regimens remain the preferred formulations in the HIV guidelines for adolescents and young adults in Zambia and globally. However, some adolescents and young adults are maintained on abacavir by clinicians because of anxiety about possible proximal tubular dysfunction from tenofovir. We assessed the effect of two regimens on proximal tubular function in adolescents and young adults living with HIV. Methods: This was a cross-sectional study involving 180 participants with HIV receiving either tenofovir or abacavir for ≥12 months at the largest tertiary teaching hospital. Two first-morning urine and blood specimens were collected and analyzed for proximal tubular markers, glomerular function, electrolytes, and routine monitoring tests. Proximal tubular function was determined by measuring the fractional excretion of phosphate (FePO4). Proximal tubular dysfunction was defined by FePO4 ≥20% regardless of serum phosphate and FePO4 ≥10-20% when serum phosphate was below 0.81mmol/L. Results: The prevalence of proximal tubular dysfunction was 6% and was higher in the tenofovir group than the abacavir (10% vs. 2%, p<0.058). However, after adjusting for potential confounders, tenofovir was not associated with worse proximal tubular function. Age, urine b2-microglobulin: creatinine ratio, C-reactive protein, and urine protein: creatinine ratio was all associated with worsening proximal tubular dysfunction. Reduced estimated glomelurar filtration rate (eGFR) was found in four (2.2%) participants; three of which were on tenofovir. Conclusions: Proximal tubular dysfunction defined by FePO4 was more prevalent in the tenofovir group than the abacavir group, but not after adjusting for age. Our findings should be interpreted with caution as age differences between the two groups confounded the results.
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Wald DS, Kelly P. 'Medical consent; striking the right balance between shared decision-making and shared responsibility': A win-win scenario if done well. QJM 2023; 116:146. [PMID: 35262707 DOI: 10.1093/qjmed/hcac053] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- D S Wald
- From the Population Health Research Institute, St George's Hospital Medical School, London, UK
| | - P Kelly
- Formerly, Legal Department, Barts Health NHS Trust, London, UK
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Niazi T, McBride SM, Williams S, Davis ID, Stockler MR, Martin AJ, Chung HT, Roncolato F, Ebacher A, Khoo E, Martin J, Lim TS, Hughes S, Pryor D, Catto JW, Kelly P, Gholam Rezaei L, Morgan SC, Rendon RA, Sweeney C. DASL-HiCaP: A randomized, phase 3, double-blind trial of darolutamide with androgen-deprivation therapy and definitive or salvage radiation for localized very high-risk prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.tps396] [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: 03/16/2023] Open
Abstract
TPS396 Background: Radiation therapy (RT), plus androgen deprivation therapy (ADT) with a luteinizing hormone releasing hormone analogue (LHRHA), is a standard of care for patients with very high-risk localized prostate cancer (PC), or with very high-risk features and persistent PSA after radical prostatectomy (RP). Despite this, incurable distant metastases develop within 5 years in 15% of patients with very high-risk features. Darolutamide is a structurally distinct oral androgen receptor antagonist with low blood-brain-barrier penetration, a demonstrated favorable safety profile, and low potential for drug-drug interactions. Our aim is to determine the efficacy of adding darolutamide to ADT and RT used either as primary definitive therapy, or as salvage therapy, for very high-risk PC. Methods: This study is a randomized (1:1), phase 3, placebo-controlled, double-blind, international trial for patients planned for RT who have very high-risk localized PC on conventional imaging; or very high-risk features with PSA persistence or rise within one year following RP. The trial is stratified by previous RP; planned use of adjuvant docetaxel; clinical or pathological pelvic nodal involvement. 1100 participants will be randomized to receive darolutamide 600 mg or placebo twice daily for 96 weeks in combination with SOC (LHRHA for 96 weeks, plus RT starting week 8-24 from randomization). Participants are allowed nonsteroidal antiandrogen in addition to LHRHA for up to 90 days prior to randomization. Early treatment with up to 6 cycles of docetaxel completed at least 4 weeks prior to RT is permitted. The primary endpoint is metastasis-free survival, with secondary endpoints of overall survival, PC-specific survival, PSA-progression free survival, time to subsequent hormonal therapy, time to castration-resistance, frequency and severity of adverse events, health related quality of life, fear of recurrence. Tertiary endpoints include incremental cost-effectiveness, and identification of prognostic and/or predictive biomarkers of treatment response, safety, and resistance to study treatment. Clinical trial information: NCT04136353 .
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Affiliation(s)
- Tamim Niazi
- Jewish General Hospital, McGill University, Montréal, QC, Canada
| | | | | | - Ian D. Davis
- Monash University Eastern Health Clinical School, Box Hill, VIC, Australia
| | | | | | - Hans T. Chung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Felicia Roncolato
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Annie Ebacher
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Eric Khoo
- Icon Cancer Centre - Gold Coast University Hospital, Gold Coast, Australia
| | | | | | - Simon Hughes
- Guy's and St. Thomas' Hospital NHS Trust & School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - David Pryor
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - James W.F. Catto
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Paul Kelly
- Bon Secours Radiotherapy Cork, in partnership with UPMC Hillman Cancer Centre, Cork, Ireland
| | | | | | - Ricardo A. Rendon
- Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada
| | - Christopher Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
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Hack J, Crabb S, Costin M, Kelly P, Makaroff L, Douglas J. A Survey of the Real-world Patient-reported Experience of Follow-up Practices Following Radical Surgery or Radiotherapy for Muscle-invasive Bladder Cancer (MIBC). Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.029] [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: 01/13/2023]
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Niven A, Ainge JA, Allison M, Gorely T, Kelly P, Ozakinci G, Ryde GC, Tomaz SA, Warne S, Whiteford V, Greenwood C. Building partnerships: A case study of physical activity researchers and practitioners collaborating to build evidence to inform the delivery of a workplace step count challenge. Front Sports Act Living 2023; 4:1067127. [PMID: 36685059 PMCID: PMC9845875 DOI: 10.3389/fspor.2022.1067127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
Background Walking is an integral part of Scotland's National Physical Activity Strategy, and the charity Paths for All's Workplace Step Count Challenge is a flagship programme within this strategy to promote physical activity. Effectively promoting physical activity requires collaborative engagement between stakeholders. However, there is limited guidance on how to do this. The aim of this case study is to share an example of a partnership between Paths for All and researchers to inform the development and delivery of the Workplace Step Count Challenge. Method An overview of the partnership, example activities, reflections on opportunities and challenges, and suggestions for future partnership working are considered. Results The partnership has evolved and strengthened over time through building trust. Many of the research activities provide an evidence base for the intervention. This work is mutually beneficial providing support for the work of the organisation, and opportunities for researchers to undertake "real world" research, leading to formal outputs and funding. The "real world" nature is challenging to integrate the most robust research designs. Recommendations for developing future partnerships were identified. Conclusion Promoting physical activity effectively requires partnership working, and this paper provides insight into how such partnerships can work to inform future collaborations.
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Affiliation(s)
- Ailsa Niven
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom,Correspondence: Ailsa Niven
| | - James A. Ainge
- School of Psychology & Neuroscience, University of St Andrews, St Andrews, United Kingdom
| | - Mary Allison
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Gozde Ozakinci
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | - Gemma C. Ryde
- BHF Glasgow Cardiovascular Research Centre, University of Kings College, Glasgow, United Kingdom
| | - Simone A. Tomaz
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Samuel Warne
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Victoria Whiteford
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
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Khan S, Fawaz S, Simpson R, Robertson C, Kelly P, Mohdnazri S, Tang K, Cook CM, Gallagher S, O’Kane P, Spratt J, Brilakis ES, Karamasis GV, Al-Lamee R, Keeble TR, Davies JR. The challenges of a randomised placebo-controlled trial of CTO PCI vs. placebo with optimal medical therapy: The ORBITA-CTO pilot study design and protocol. Front Cardiovasc Med 2023; 10:1172763. [PMID: 37206100 PMCID: PMC10188975 DOI: 10.3389/fcvm.2023.1172763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/13/2023] [Indexed: 05/21/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) has been performed for the improvement of symptoms and quality of life in patients with stable angina. The ORBITA study demonstrated the role of the placebo effect in contemporary PCI in non-CTO chronic coronary syndromes. However, the benefit of CTO PCI beyond that of a placebo has not been demonstrated. Aims The ORBITA-CTO pilot study will be a double-blind, placebo-controlled study of CTO PCI randomising patients who have: (1) been accepted by a CTO operator for PCI; (2) experienced symptoms due to a CTO; (3) evidence of ischaemia; (4) evidence of viability within the CTO territory; and (5) a J-CTO score ≤3. Methods Patients will undergo medication optimisation that will ensure they are on at least a minimum amount of anti-anginals and complete questionnaires. Patients will record their symptoms on an app daily throughout the study. Patients will undergo randomisation procedures, including an overnight stay, and be discharged the following day. All anti-anginals will be stopped after randomisation and re-initiated on a patient-led basis during the 6-month follow-up period. At follow-up, patients will undergo repeat questionnaires and unblinding, with a further 2-week unblinded follow-up. Results The co-primary outcomes are feasibility (blinding) in this cohort and angina symptom score using an ordinal clinical outcome scale for angina. Secondary outcomes include changes in quality-of-life measures, Seattle Angina Questionnaire (SAQ), peak VO2, and anaerobic threshold on the cardiopulmonary exercise test. Conclusion The feasibility of a placebo-controlled CTO PCI study will lead to future studies assessing efficacy. The impact of CTO PCI on angina measured using a novel daily symptom app may provide improved fidelity in assessing symptoms in patients with CTO's.
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Affiliation(s)
- Sarosh Khan
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
- Department of Interventional Cardiology, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Samer Fawaz
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
- Department of Interventional Cardiology, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Rupert Simpson
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
- Department of Interventional Cardiology, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Craig Robertson
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
- Department of Interventional Cardiology, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Paul Kelly
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Shah Mohdnazri
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Kare Tang
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Christopher M. Cook
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
- Department of Interventional Cardiology, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Sean Gallagher
- Department of Interventional Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Peter O’Kane
- Department of Interventional Cardiology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - James Spratt
- Department of Interventional Cardiology, St. George's Hospital, London, United Kingdom
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, United States
| | - Grigoris V. Karamasis
- School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Thomas R. Keeble
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
- Department of Interventional Cardiology, Anglia Ruskin University, Chelmsford, United Kingdom
| | - John R. Davies
- Department of Interventional Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
- Department of Interventional Cardiology, Anglia Ruskin University, Chelmsford, United Kingdom
- Correspondence: John R. Davies
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Smith LE, Chagwena DT, Bourke C, Robertson R, Fernando S, Tavengwa NV, Cairns J, Ndhlela T, Matumbu E, Brown T, Datta K, Mutasa B, Tengende A, Chidhanguro D, Langhaug L, Makanza M, Chasekwa B, Mutasa K, Swann J, Kelly P, Ntozini R, Prendergast A. Child Health, Agriculture and Integrated Nutrition (CHAIN): protocol for a randomised controlled trial of improved infant and young child feeding in rural Zimbabwe. BMJ Open 2022; 12:e056435. [PMID: 36585147 PMCID: PMC9809274 DOI: 10.1136/bmjopen-2021-056435] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Over one-quarter of children in sub-Saharan Africa are stunted; however, commercial supplements only partially meet child nutrient requirements, cannot be sustainably produced, and do not resolve physiological barriers to adequate nutrition (eg, inflammation, microbiome dysbiosis and metabolic dysfunction). Redesigning current infant and young child feeding (IYCF) interventions using locally available foods to improve intake, uptake and utilisation of nutrients could ameliorate underlying pathogenic pathways and improve infant growth during the critical period of complementary feeding, to reduce the global burden of stunting. METHODS AND ANALYSIS Child Health Agriculture Integrated Nutrition is an open-label, individual household randomised trial comparing the effects of IYCF versus 'IYCF-plus' on nutrient intake during infancy. The IYCF intervention comprises behaviour change modules to promote infant nutrition delivered by community health workers, plus small-quantity lipid-based nutrient supplements from 6 to 12 months of age which previously reduced stunting at 18 months of age by ~20% in rural Zimbabwe. The 'IYCF-plus' intervention provides these components plus powdered NUA-45 biofortified sugar beans, whole egg powder, moringa leaf powder and provitamin A maize. The trial will enrol 192 infants between 5 and 6 months of age in Shurugwi district, Zimbabwe. Research nurses will collect data plus blood, urine and stool samples at baseline (5-6 months of age) and endline (9-11 months of age). The primary outcome is energy intake, measured by multipass 24-hour dietary recall at 9-11 months of age. Secondary outcomes include nutrient intake, anthropometry and haemoglobin concentration. Nested laboratory substudies will evaluate the gut microbiome, environmental enteric dysfunction, metabolic phenotypes and innate immune function. Qualitative substudies will explore the acceptability and feasibility of the IYCF-plus intervention among participants and community stakeholders, and the effects of migration on food production and consumption. ETHICS AND DISSEMINATION This trial is registered at ClinicalTrials.gov (NCT04874688) and was approved by the Medical Research Council of Zimbabwe (MRCZ/A/2679) with the final version 1.4 approved on 20 August 2021, following additional amendments. Dissemination of trial results will be conducted through the Community Engagement Advisory Board in the study district and through national-level platforms. TRIAL REGISTRATION NUMBER NCT04874688.
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Affiliation(s)
- Laura E Smith
- Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
| | - Dexter T Chagwena
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Nutrition, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Claire Bourke
- Blizard Institute, Queen Mary University, London, UK
| | | | - Shamiso Fernando
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V Tavengwa
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | - Exhibit Matumbu
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | - Batsirai Mutasa
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Alice Tengende
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Dzivaidzo Chidhanguro
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lisa Langhaug
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Maggie Makanza
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Nutrition, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jonathan Swann
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Paul Kelly
- Barts and The London School of Medicine, London, UK
| | - Robert Ntozini
- Biostatistics & IT, Zvitambo Institute, Harare, Zimbabwe
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Hall Dykgraaf S, Desborough J, Parkinson A, Sturgiss EA, Kelly P, Kidd M. Implementing mandatory COVID-19 vaccination for Australian aged care workers. Med J Aust 2022; 217:570-574. [PMID: 36403195 PMCID: PMC10099713 DOI: 10.5694/mja2.51770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Sally Hall Dykgraaf
- Rural Clinical School, Australian National University, Canberra, ACT.,Academic Unit of General Practice, Australian National University, Canberra, ACT
| | - Jane Desborough
- College of Medicine, Biology and the Environment, Australian National University, Canberra, ACT
| | - Anne Parkinson
- Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | | | - Paul Kelly
- Australian Government Department of Health and Aged Care, Canberra, ACT
| | - Michael Kidd
- Australian Government Department of Health and Aged Care, Canberra, ACT
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English A, McKibben E, Sivaramakrishnan D, Hart N, Richards J, Kelly P. A Rapid Review Exploring the Role of Yoga in Healing Psychological Trauma. Int J Environ Res Public Health 2022; 19:16180. [PMID: 36498254 PMCID: PMC9741324 DOI: 10.3390/ijerph192316180] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
The evidence regarding the benefits of yoga for treating psychological trauma is well-established; however, there is a paucity of qualitative reviews exploring this topic. The purpose of this rapid review is to gain a deeper understanding of the impact that yoga can have on people with a history of psychological trauma and to reveal barriers and facilitators to the uptake of yoga in this cohort, from a qualitative perspective. The Ovid(EMBASE), Ovid(MEDLINE), PsycINFO, PubMed, and SPORTDiscus databases were searched using key terms. The systematic search generated 148 records, and 11 peer-reviewed articles met the inclusion criteria. The following main impacts of yoga on participants were identified: feeling an increased sense of self-compassion; feeling more centred; developing their coping skills; having a better mind-body relationship; and improving their relationships with others. The main barriers were also identified: concerns initiating yoga; time and motivational issues; and the costs and location of classes. The main facilitator was the feeling of safety generated in the trauma-informed yoga classes. This review suggests that yoga offers great potential in the field of trauma recovery. Despite this, more high-quality research with rigorous methodologies is called for to allow this field to advance.
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Affiliation(s)
- Arabella English
- Edinburgh Medical School, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Elizabeth McKibben
- Faculty of Health, Victoria University of Wellington, Wellington 6140, New Zealand
| | - Divya Sivaramakrishnan
- Physical Activity for Health Research Centre (PAHRC), The University of Edinburgh, Edinburgh EH8 8AQ, UK
| | - Niamh Hart
- Physical Activity for Health Research Centre (PAHRC), The University of Edinburgh, Edinburgh EH8 8AQ, UK
| | - Justin Richards
- Faculty of Health, Victoria University of Wellington, Wellington 6140, New Zealand
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), The University of Edinburgh, Edinburgh EH8 8AQ, UK
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Kidd M, de Toca L, Kelly P. Editorial: The invaluable contributions of general practice to Australia’s COVID-19 pandemic response. Aust J Gen Pract 2022; 51:917-918. [DOI: 10.31128/ajgp-11-22-6604] [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: 12/03/2022]
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Parikh P, Lee P, Low D, Kim J, Mittauer K, Bassetti M, Glide-Hurst C, Raldow A, Yang Y, Portelance L, Zaki B, Kim H, Mancias J, Ng J, Pfeffer R, Mueller A, Kelly P, Boldrini L, Fuss M, Chuong M. Stereotactic MR-Guided On-Table Adaptive Radiation Therapy (SMART) for Patients with Borderline or Locally Advanced Pancreatic Cancer: Primary Endpoint Outcomes of a Prospective Phase II Multi-Center International Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hunter RF, Cleland CL, Busby J, Nightingale G, Kee F, Williams AJ, Kelly P, Kelly MP, Milton K, Kokka K, Jepson R. Investigating the impact of a 20 miles per hour speed limit intervention on road traffic collisions, casualties, speed and volume in Belfast, UK: 3 year follow-up outcomes of a natural experiment. J Epidemiol Community Health 2022; 77:jech-2022-219729. [PMID: 36379715 PMCID: PMC9763225 DOI: 10.1136/jech-2022-219729] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence regarding the effectiveness of 20 miles per hour (mph) speed limit interventions is limited, and rarely have long-term outcomes been assessed. We investigate the effect of a 20 mph speed limit intervention on road traffic collisions, casualties, speed and volume at 1 and 3 years post-implementation. METHODS An observational, repeated cross-sectional design was implemented, using routinely collected data for road traffic collisions, casualties, speed and volume. We evaluated difference-in-differences in collisions and casualties (intervention vs control) across three different time series and traffic speed and volume pre-implementation, at 1 and 3 years post-implementation. RESULTS Small reductions in road traffic collisions were observed at year 1 (3%; p=0.82) and year 3 post-implementation (15%; p=0.31) at the intervention site. Difference-in-differences analyses showed no statistically significant differences between the intervention and control sites over time for road traffic collisions. There were 16% (p=0.18) and 22% (p=0.06) reductions in casualty rates at years 1 and 3 post-implementation, respectively, at the intervention site. Results showed little change in mean traffic speed at year 1 (0.2 mph, 95% CI -0.3 to 2.4, p=0.14) and year 3 post-implementation (0.8, 95% CI -1.5 to 2.5, p=0.17). For traffic volume, a decrease in 57 vehicles per week was observed at year 1 (95% CI -162 to -14, p<0.00) and 71 vehicles at year 3 (95% CI -213 to 1, p=0.05) post-implementation. CONCLUSION A 20 mph speed limit intervention implemented at city centre scale had little impact on long-term outcomes including road traffic collisions, casualties and speed, except for a reduction in traffic volume. Policymakers considering implementing 20 mph speed limit interventions should consider the fidelity, context and scale of implementation.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Claire L Cleland
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Glenna Nightingale
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, Scotland, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Paul Kelly
- Physical Activity for Health Research Centre (PHARC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, England, UK
| | - Kelly Kokka
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, Scotland, UK
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Ricci J, Kelly P, Shah A, Manon R, Hobeika G, Mercado C, Rineer J. Clinical Outcomes of Stereotactic Body Radiation Therapy across Treatment Platforms Employing Varied Approaches to Respiratory Management at a Single Institution. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1540] [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: 10/31/2022]
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Connell H, Logan G, Somers C, Baker G, Broadfield S, Bunn C, Harper LD, Kelly P, McIntosh E, Pell JP, Puttnam J, Robson S, Gill JMR, Gray CM. Development and optimisation of a multi-component workplace intervention to increase cycling for the Cycle Nation Project. Front Sports Act Living 2022; 4:857554. [PMID: 36385778 PMCID: PMC9643150 DOI: 10.3389/fspor.2022.857554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
The Cycle Nation Project (CNP) aimed to develop, test the feasibility of and optimize a multi-component individual-/social-level workplace-based intervention to increase cycling among office staff at a multinational bank (HSBC UK). To do this, we first explored barriers to cycling in a nationally-representative survey of UK adults, then undertook focus groups with bank employees to understand any context-specific barriers and ways in which these might be overcome. These activities led to identification of 10 individual-level, two social-level, and five organizational-level modifiable factors, which were mapped to candidate intervention components previously identified in a scoping review of cycling initiatives. Interviews with HSBC UK managers then explored the practicality of implementing the candidate intervention components in bank offices. The resultant pilot CNP intervention included 32 core components across six intervention functions (education, persuasion, incentivisation, training, environmental restructuring, enablement). Participants received a loan bike for 12-weeks (or their own bike serviced), and a 9-week cycle training course (condensed to 6 weeks for those already confident in basic cycling skills), including interactive information sharing activities, behavior change techniques (e.g., weekly goal setting), bike maintenance training, practical off-road cycling skill games and on-road group rides. Sessions were delivered by trained bank staff members who were experienced cyclists. The CNP pilot intervention was delivered across three sites with 68 participants. It was completed in two sites (the third site was stopped due to COVID-19) and was feasible and acceptable to both women and men and across different ethnicities. In addition, the CNP intervention was successful (at least in the short term) in increasing cycling by 3 rides/week on average, and improving perceptions of safety, vitality, confidence, and motivation to cycle. Following minor modifications, the long-term effectiveness and cost-effectiveness of the CNP intervention should be tested in a full-scale randomized controlled trial.
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Affiliation(s)
- Hayley Connell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Greig Logan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Camilla Somers
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Graham Baker
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Christopher Bunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Emma McIntosh
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Jason M. R. Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- *Correspondence: Jason M. R. Gill
| | - Cindy M. Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Cindy M. Gray
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Hearne S, Costelloe R, Murphy S, Kelly P, McGorrian C, Marnane M. 25 EVALUATION OF PATIENTS PRESENTING WITH TIA IN THE AMAU AND TIA FAST ASSESSMENT CLINICS - ARE WE MEETING ESO GUIDELINES? Age Ageing 2022. [DOI: 10.1093/ageing/afac218.020] [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
The European Stroke Organisation published guidelines on the management of Transient Ischaemic Attack (TIA) in 2021. Specialist review of suspected TIA is recommended within 24-hours of symptom onset in a TIA clinic. They suggest using CT or MR angiogram for additional confirmation of large artery stenosis of >50%. They advise against the use of prediction tools alone e.g. ABCD2 score when identifying high-risk patients. Dual antiplatelet therapy is recommended short-term in high risk, non cardio-embolic TIA patients. This audit evaluates if these guidelines are being followed in our institution.
Methods
We evaluated all patients attending the TIA clinic and the Acute Medical Assessment Unit (AMAU) with suspected TIA over a three-week period in 2021 in a single tertiary referral centre. Retrospective data was collected based on chart review.
Results
Twenty patients underwent review in the TIA clinic and eight in the AMAU with suspected TIA in the chosen time period. One patient (3.5%) was seen within 24 hours from symptom onset, 2 were seen within 24-36 hours (7.1%), 4 patients (14.2%) were seen within 36-72 hours, 21 patients (75%) were seen >72 hours after symptom onset. In all patients who had a doppler US showing >50% carotid stenosis, a CT angiogram was performed. ABCD2 scores were recorded but used in combination with clinical judgment. All patients with high-risk, non-cardioembolic TIA received early, short-term dual antiplatelet therapy.
Conclusion
The diagnostic methods and treatment strategies in place for patients attending the TIA clinic or AMAU with TIA were in keeping with the recently published ESO guidelines. However, there was a time delay from symptom onset to time of review in many patients. Further studies are indicated to identify the potential mechanisms behind these delays. Interventions to ensure that we are meeting this ‘time-to-review’ target in patients could be implemented, ensuring high quality, evidence-based care.
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Affiliation(s)
- S Hearne
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - R Costelloe
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - S Murphy
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - P Kelly
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - C McGorrian
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - M Marnane
- Mater Misericordiae University Hospital , Dublin, Ireland
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Ahmed S, PrayGod G, R. Lee N, Kelly P, Trilok-Kumar G, Chisenga M, Kweka B, Faurholt-Jepsen D, Krogh-Madsen R, AM Shaw J, M. Paglinawan-Modoc D, Solon J, Frahm Olsen M, Stefanovski D, Cox S, Nitsch D, Keogh R, Filteau S. Long-term health after Severe Acute Malnutrition in children and adults- the role of the Pancreas (SAMPA): Protocol. F1000Res 2022; 11:777. [PMID: 36300035 PMCID: PMC9577280 DOI: 10.12688/f1000research.123389.2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 01/13/2023] Open
Abstract
Background: Prenatal growth retardation may increase the risk of later chronic non-communicable diseases (NCDs), including diabetes; however, long-term effects of wasting malnutrition in childhood or adulthood are less studied. Pancreatic exocrine and endocrine functions, both critical for nutrition and NCD aetiology, may not fully recover following malnutrition. However, the evidence and mechanistic information is piecemeal. We hypothesise that wasting malnutrition at any age has long-term detrimental effects on endocrine and exocrine pancreatic structure and function. Methods: The SAMPA international research programme will assess pancreatic structure and function in 3700 participants from ongoing observational nutrition cohorts, two adolescent and four adult, in Zambia, Tanzania, Philippines, and India. Pancreas size, structure, and calcification will be assessed by ultrasound and computed tomography (CT) scan; exocrine function by faecal elastase and serum lipase; and endocrine function by haemoglobin A1c (HbA1c) and blood glucose, insulin and C-peptide concentrations during an oral glucose tolerance test (OGTT). In-depth hormonal analyses of incretins, glucagon, proinsulin and trypsinogen during OGTT and intravenous glucose tolerance tests will be done in subsets of adult participants. Pancreatic size and function outcomes will be compared between people with and without prior wasting malnutrition. Analyses will investigate effect modification by sex, current age, time since malnutrition, current body mass index and dietary patterns. Mathematical modelling of OGTT data will be used to estimate the relative contribution to glucose dysregulation of decreased insulin production, changes in insulin clearance and increased insulin resistance. Proinsulin/insulin ratio will be analysed in archived samples from the Tanzanian cohort using a nested case-control design to investigate whether abnormal values precede diabetes. Conclusions: SAMPA, a large-scale multi-centre research programme using data from people with or without prior wasting malnutrition to assess several aspects of pancreatic phenotype, will provide coherent evidence for future policies and programmes for malnutrition and diabetes.
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Affiliation(s)
- Sana Ahmed
- Institute of Home Economics, University of Delhi, Delhi, 110016, India,
| | - George PrayGod
- National Institute for Medical Research, Mwanza, Tanzania
| | - Nanette R. Lee
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Populations Studies Foundation, Cebu City, 6000, Philippines
| | - Paul Kelly
- University Teaching Hospital, Lusaka, Zambia,Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Geeta Trilok-Kumar
- Institute of Home Economics, University of Delhi, Delhi, 110016, India,Delhi School of Public Health, Institution of Eminence, University of Delhi, Delhi, 110007, India
| | | | - Belinda Kweka
- National Institute for Medical Research, Mwanza, Tanzania
| | | | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - James AM Shaw
- Translational and Clinical Research Institute, Newcastle University, The Medical School, Framlington Place, Newcastle-upon-Tyne, UK
| | | | - Juan Solon
- Nutrition Center of the Philippines, Muntinlupa City, Manila, Philippines
| | - Mette Frahm Olsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, 2100, Denmark,Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, 1017, Denmark
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Philadelphia, USA
| | - Sharon Cox
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Ruth Keogh
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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Sah S, Borkar PV, Wight C, Kelly P, Park KJ, McCluggage WG. Low-grade Neuroendocrine Tumor of the Cervix: Report of 3 Cases of a Rare Neoplasm With Review of the Literature. Int J Gynecol Pathol 2022; 41:437-446. [PMID: 35075048 PMCID: PMC9309179 DOI: 10.1097/pgp.0000000000000851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/25/2022]
Abstract
Neuroendocrine neoplasms are uncommon in the cervix with almost all representing neuroendocrine carcinomas (NECs), either small cell or large cell type. Cervical low-grade neuroendocrine tumors (NETs) are extremely rare with few recent reports using contemporary modern diagnostic criteria. We report 3 cases of cervical NET in patients aged 32 to 57 yr and undertake a review of the literature. The first case was a pure grade 2 NET with pelvic lymph node metastasis (FIGO stage IIIC1). In the second case, a grade 1 NET was associated with high-grade squamous intraepithelial lesion, adenocarcinoma in situ and human papillomavirus (HPV)-associated adenocarcinoma and was FIGO stage IA1. The third patient underwent chemoradiotherapy following a biopsy diagnosis of a high-grade NEC which was radiologically FIGO stage IIIC1 and salvage hysterectomy revealed residual tumor with features of a grade 1 NET. In all cases, the NET was diffusely positive with at least 2 of the neuroendocrine markers chromogranin, synaptophysin, and CD56. The first tumor was p16 negative and the third exhibited block-type immunoreactivity. Molecular tests revealed high risk HPV types 18 and 51 in the third case but no HPV in the first case. p16 immunohistochemistry and HPV molecular testing was not available in the second case. The patients remain disease free with follow-up ranging from 2 to 8 yr. Since a combination of NET and NEC is extremely rare at all sites due to a different pathogenesis, we speculate that in the third case, the NET developed out of the NEC as a "maturation" phenomenon secondary to chemoradiotherapy.
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Affiliation(s)
- Shatrughan Sah
- Department of Histopathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Pallavi Vijay Borkar
- Department of Histopathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Catherine Wight
- Department of Histopathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Paul Kelly
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Khan S, Alsanjari O, Keulards D, Vlaar PJ, Zhang J, Konstantinou K, Fawaz S, Simpson R, Clesham G, Kelly P, Tang K, Cook C, Cockburn J, Pijls N, Hildick-Smith D, Teeuwen K, Keeble T, Karamasis G, Davies J. TCT-129 Symptom and Physiological Changes After Successful Chronic Total Occlusion Percutaneous Coronary Intervention. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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