1
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Trovao NS, Pan V, Goel C, Gallego-García P, Liu Y, Barbara C, Borg R, Briffa M, Cilia C, Grech L, Vassallo M, Treangen TJ, Posada D, Beheshti A, Borg J, Zahra G. Evolutionary and spatiotemporal analyses reveal multiple introductions and cryptic transmission of SARS-CoV-2 VOC/VOI in Malta. Microbiol Spectr 2023; 11:e0153923. [PMID: 37800925 PMCID: PMC10714767 DOI: 10.1128/spectrum.01539-23] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/13/2023] [Indexed: 10/07/2023] Open
Abstract
IMPORTANCE Our study provides insights into the evolution of the coronavirus disease 2019 (COVID-19) pandemic in Malta, a highly connected and understudied country. We combined epidemiological and phylodynamic analyses to analyze trends in the number of new cases, deaths, tests, positivity rates, and evolutionary and dispersal patterns from August 2020 to January 2022. Our reconstructions inferred 173 independent severe acute respiratory syndrome coronavirus 2 introductions into Malta from various global regions. Our study demonstrates that characterizing epidemiological trends coupled with phylodynamic modeling can inform the implementation of public health interventions to help control COVID-19 transmission in the community.
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Affiliation(s)
- Nidia S. Trovao
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
- COVID-19 International Research Team, Medford, Massachusetts, USA
| | - Vincent Pan
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
- Harvard University, Cambridge, Massachusetts, USA
| | - Chirag Goel
- COVID-19 International Research Team, Medford, Massachusetts, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pilar Gallego-García
- CINBIO, Universidade de Vigo, Vigo, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Yunxi Liu
- Department of Computer Science, Rice University, Houston, Texas, USA
| | - Christopher Barbara
- Molecular Diagnostics-Infectious Diseases, Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - Rebecca Borg
- Molecular Diagnostics-Infectious Diseases, Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - Mark Briffa
- Molecular Diagnostics-Infectious Diseases, Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - Chanelle Cilia
- Molecular Diagnostics-Infectious Diseases, Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - Laura Grech
- Molecular Diagnostics-Infectious Diseases, Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - Mario Vassallo
- Department of Sociology, Faculty of Arts, University of Malta, Msida, Malta
| | - Todd J. Treangen
- Department of Computer Science, Rice University, Houston, Texas, USA
| | - David Posada
- CINBIO, Universidade de Vigo, Vigo, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Biochemistry, Genetics, and Immunology, Universidade de Vigo, Vigo, Spain
| | - Afshin Beheshti
- COVID-19 International Research Team, Medford, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, California, USA
| | - Joseph Borg
- COVID-19 International Research Team, Medford, Massachusetts, USA
- Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Graziella Zahra
- Molecular Diagnostics-Infectious Diseases, Department of Pathology, Mater Dei Hospital, Msida, Malta
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2
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Borg R, Herrera P, Purkiss A, Cacciottolo R, Cauchi RJ. Reduced levels of ALS gene DCTN1 induce motor defects in Drosophila. Front Neurosci 2023; 17:1164251. [PMID: 37360176 PMCID: PMC10289029 DOI: 10.3389/fnins.2023.1164251] [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: 02/12/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neuromuscular disease that has a strong genetic component. Deleterious variants in the DCTN1 gene are known to be a cause of ALS in diverse populations. DCTN1 encodes the p150 subunit of the molecular motor dynactin which is a key player in the bidirectional transport of cargos within cells. Whether DCTN1 mutations lead to the disease through either a gain or loss of function mechanism remains unresolved. Moreover, the contribution of non-neuronal cell types, especially muscle tissue, to ALS phenotypes in DCTN1 carriers is unknown. Here we show that gene silencing of Dctn1, the Drosophila main orthologue of DCTN1, either in neurons or muscles is sufficient to cause climbing and flight defects in adult flies. We also identify Dred, a protein with high homology to Drosophila Dctn1 and human DCTN1, that on loss of function also leads to motoric impairments. A global reduction of Dctn1 induced a significant reduction in the mobility of larvae and neuromuscular junction (NMJ) deficits prior to death at the pupal stage. RNA-seq and transcriptome profiling revealed splicing alterations in genes required for synapse organisation and function, which may explain the observed motor dysfunction and synaptic defects downstream of Dctn1 ablation. Our findings support the possibility that loss of DCTN1 function can lead to ALS and underscore an important requirement for DCTN1 in muscle in addition to neurons.
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Affiliation(s)
- Rebecca Borg
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Paul Herrera
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Angie Purkiss
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Rebecca Cacciottolo
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Ruben J. Cauchi
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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3
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Borg R, Purkiss A, Cacciottolo R, Herrera P, Cauchi RJ. Loss of amyotrophic lateral sclerosis risk factor SCFD1 causes motor dysfunction in Drosophila. Neurobiol Aging 2023; 126:67-76. [PMID: 36944290 DOI: 10.1016/j.neurobiolaging.2023.02.005] [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: 09/21/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease mostly resulting from a complex interplay between genetic, environmental and lifestyle factors. Common genetic variants in the Sec1 Family Domain Containing 1 (SCFD1) gene have been associated with increased ALS risk in the most extensive genome-wide association study (GWAS). SCFD1 was also identified as a top-most significant expression Quantitative Trait Locus (eQTL) for ALS. Whether loss of SCFD1 function directly contributes to motor system dysfunction remains unresolved. Here we show that moderate gene silencing of Slh, the Drosophila orthologue of SCFD1, is sufficient to cause climbing and flight defects in adult flies. A more severe knockdown induced a significant reduction in larval mobility and profound neuromuscular junction (NMJ) deficits prior to death before metamorphosis. RNA-seq revealed downregulation of genes encoding chaperones that mediate protein folding downstream of Slh ablation. Our findings support the notion that loss of SCFD1 function is a meaningful contributor to ALS and disease predisposition may result from erosion of the mechanisms protecting against misfolding and protein aggregation.
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Affiliation(s)
- Rebecca Borg
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta; Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Angie Purkiss
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta; Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Rebecca Cacciottolo
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta; Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Paul Herrera
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta; Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Ruben J Cauchi
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta; Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
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4
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Farrugia Wismayer M, Borg R, Farrugia Wismayer A, Bonavia K, Vella M, Pace A, Vassallo N, Cauchi RJ. Occupation and amyotrophic lateral sclerosis risk: a case-control study in the isolated island population of Malta. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:528-534. [PMID: 33821701 DOI: 10.1080/21678421.2021.1905847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) is a mostly sporadic neurodegenerative disease. The role of environmental factors has been extensively investigated but associations remain controversial. Considering that a substantial proportion of adult life is spent at work, identifying occupations and work-related exposures is considered an effective way to detect factors that increase ALS risk. This process may be further facilitated in population isolates due to environmental and genetic homogeneity. Our study investigated occupations and occupational exposures potentially associated with ALS risk in the isolated island population of Malta, using a case-control study design. Methods: Patients with ALS and randomly identified matched controls (1:1) were recruited throughout a four-year window, from 2017 through 2020. Data on educational level, residence, main occupation, smoking, and alcohol history were collected. Results: We found that compared to controls (44.4%), a higher percentage (73.7%) of ALS patients reported a blue-collar job as their main occupation (OR 2.04, 95% CI 1.2-3.72; p = 0.0072). Through regression analysis, craft and related trades occupations such as carpentry and construction (ISCO-08 major group 7), were found to be positively associated with ALS, with patients in this occupational category found to be more prone to develop bulbar-onset ALS (p = 0.0297). Overall, patients with ALS reported a significantly higher exposure to work-related strenuous physical activity (OR 2.35, 95% CI 1.53-3.59; p = 0.0002). Conclusion: Our findings suggest that manual workers particularly those working in the carpentry and construction industries have an increased ALS risk, possibly due to a history of intense or sustained physical activity.
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Affiliation(s)
- Maia Farrugia Wismayer
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Rebecca Borg
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Andrew Farrugia Wismayer
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
| | - Karl Bonavia
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
| | - Malcolm Vella
- Department of Neuroscience, Mater Dei Hospital, Msida, Malta
| | - Adrian Pace
- Department of Neurology, Gozo General Hospital, Victoria, Gozo, Malta
| | - Neville Vassallo
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Ruben J Cauchi
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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5
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Borg R, Pace D. MRSA colonisation rates on a neonatal and paediatric intensive care unit. J Infect Prev 2021; 21:68-71. [PMID: 33425019 DOI: 10.1177/1757177419885009] [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: 05/01/2019] [Accepted: 10/06/2019] [Indexed: 11/15/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) colonisation is a challenge in healthcare institutions worldwide. In this retrospective nation-wide study, the rates of MRSA colonisation and infection from 2012 to 2015, on the only neonatal and paediatric intensive care unit (NPICU) in the country, were determined. Mean local rates were compared to rates of MRSA colonisation reported in units in North America, Asia and Europe between 2001 and 2010. The average rate of MRSA colonisation on admission to NPICU from 2012 to 2015 was 3.71% (95% confidence interval [CI] 2.17-5.25), while the mean rate of acquired colonisation was 14.60% (95% CI 6.16-23.04). Both were significantly higher than in units abroad: 1.9% and 4.1%, respectively (P = 0.04 and P < 0.001). There were no cases of invasive MRSA infection, while the mean rate of non-invasive infection was 0.77% (95% CI 0.54-1.01). Improved adherence to infection control measures and newer molecular diagnostic techniques are needed to further decrease the acquisition of MRSA.
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Affiliation(s)
- Rebecca Borg
- Department of Paediatrics, Mater Dei Hospital, Msida, Malta
| | - David Pace
- Department of Paediatrics, Mater Dei Hospital, Msida, Malta
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6
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Borg R, Farrugia Wismayer M, Bonavia K, Farrugia Wismayer A, Vella M, van Vugt JJFA, Kenna BJ, Kenna KP, Vassallo N, Veldink JH, Cauchi RJ. Genetic analysis of ALS cases in the isolated island population of Malta. Eur J Hum Genet 2021; 29:604-614. [PMID: 33414559 PMCID: PMC8115635 DOI: 10.1038/s41431-020-00767-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 05/06/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
Genetic isolates are compelling tools for mapping genes of inherited disorders. The archipelago of Malta, a sovereign microstate in the south of Europe is home to a geographically and culturally isolated population. Here, we investigate the epidemiology and genetic profile of Maltese patients with amyotrophic lateral sclerosis (ALS), identified throughout a 2-year window. Cases were largely male (66.7%) with a predominant spinal onset of symptoms (70.8%). Disease onset occurred around mid-age (median age: 64 years, men; 59.5 years, female); 12.5% had familial ALS (fALS). Annual incidence rate was 2.48 (95% CI 1.59–3.68) per 100,000 person-years. Male-to-female incidence ratio was 1.93:1. Prevalence was 3.44 (95% CI 2.01–5.52) cases per 100,000 inhabitants on 31st December 2018. Whole-genome sequencing allowed us to determine rare DNA variants that change the protein-coding sequence of ALS-associated genes. Interestingly, the Maltese ALS patient cohort was found to be negative for deleterious variants in C9orf72, SOD1, TARDBP or FUS genes, which are the most commonly mutated ALS genes globally. Nonetheless, ALS-associated repeat expansions were identified in ATXN2 and NIPA1. Variants predicted to be damaging were also detected in ALS2, DAO, DCTN1, ERBB4, SETX, SCFD1 and SPG11. A total of 40% of patients with sporadic ALS had a rare and deleterious variant or repeat expansion in an ALS-associated gene, whilst the genetic cause of two thirds of fALS cases could not be pinpointed to known ALS genes or risk loci. This warrants further studies to elucidate novel genes that cause ALS in this unique population isolate.
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Affiliation(s)
- Rebecca Borg
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Maia Farrugia Wismayer
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Karl Bonavia
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
| | - Andrew Farrugia Wismayer
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
| | - Malcolm Vella
- Department of Neuroscience, Mater Dei Hospital, Msida, Malta
| | - Joke J F A van Vugt
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brendan J Kenna
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kevin P Kenna
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Neville Vassallo
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Jan H Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruben J Cauchi
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta. .,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
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7
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Ngoga G, Park PH, Borg R, Bukhman G, Ali E, Munyaneza F, Tapela N, Rusingiza E, Edwards JK, Hedt-Gauthier B. Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013-2014. Public Health Action 2019; 9:142-147. [PMID: 32042605 DOI: 10.5588/pha.19.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/28/2019] [Accepted: 07/26/2019] [Indexed: 02/08/2023] Open
Abstract
Setting Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda. Objective To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home. Design A retrospective descriptive cohort study using routinely collected data involving adult patients aged ⩾18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014. Results Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs. Conclusion By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.
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Affiliation(s)
- G Ngoga
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - P H Park
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - R Borg
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - G Bukhman
- Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Partners In Health, Boston, MA, USA
| | - E Ali
- Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - F Munyaneza
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - N Tapela
- Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E Rusingiza
- Ministry of Health, Kigali, Rwanda.,School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - J K Edwards
- Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - B Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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8
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Borg R, Persson F, Siersma V, Lind B, de Fine Olivarius N, Andersen CL. Interpretation of HbA 1c in primary care and potential influence of anaemia and chronic kidney disease: an analysis from the Copenhagen Primary Care Laboratory (CopLab) Database. Diabet Med 2018; 35:1700-1706. [PMID: 29985535 DOI: 10.1111/dme.13776] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Accepted: 07/04/2018] [Indexed: 12/28/2022]
Abstract
AIMS To investigate, in a large population in primary care, the relationship between fasting plasma glucose and HbA1c measurements, as well as the clinical implications of anaemia or chronic kidney disease for the interpretation of HbA1c values. METHODS From a primary care resource, we examined HbA1c and fasting plasma glucose as well as haemoglobin and estimated GFR. We stratified observations by chronic kidney disease stage and anaemia level. The estimation of the mean fasting plasma glucose level from HbA1c alone, and from HbA1c , haemoglobin and estimated GFR, respectively, was evaluated. RESULTS In 198 346 individuals, the fasting plasma glucose-HbA1c relationship mimicked the regression described in the A1c-Derived Average Glucose (ADAG) study, which was based on average capillary and interstitial glucose. The fasting plasma glucose-HbA1c relationship was unaffected in mild to moderate chronic kidney disease and in mild to moderate anaemia. The correlation changed only in severe hyperglycaemia and concurrent severe anaemia or when estimated GFR was <45 ml/min/1.73m², so that glucose concentration was underestimated by HbA1c in anaemia and overestimated in chronic kidney disease. The prevalence of estimated GFR <30 ml/min/1.73m² was 0.82%, while the prevalence of haemoglobin <81 g/l (5.0 mmol/l) was 0.11%. CONCLUSIONS The relationship between fasting plasma glucose and HbA1c mimics that of the people with diabetes included in the ADAG study. Mild to moderate anaemia and CKD do not have a significant impact on the interpretation of HbA1c as a marker of retrograde glycaemia. Hence, it seems justified to use HbA1c without adjustment in primary care.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anemia/blood
- Anemia/complications
- Anemia/epidemiology
- Blood Glucose/analysis
- Data Interpretation, Statistical
- Databases as Topic
- Denmark/epidemiology
- Diabetes Complications/blood
- Diabetes Complications/epidemiology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diagnostic Errors/statistics & numerical data
- Female
- General Practitioners/statistics & numerical data
- Glycated Hemoglobin/analysis
- Humans
- Laboratories/statistics & numerical data
- Male
- Middle Aged
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/statistics & numerical data
- Primary Health Care/statistics & numerical data
- Renal Insufficiency, Chronic/blood
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/epidemiology
- Young Adult
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Affiliation(s)
- R Borg
- Department of Nephrology, Zealand University Hospital, Roskilde, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F Persson
- Steno Diabetes Centre, Copenhagen, Denmark
| | - V Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B Lind
- Department of Clinical Biochemistry, Hvidovre Hospital, Copenhagen, Denmark
| | - N de Fine Olivarius
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C L Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Departments of Haematology, Zealand University Hospital, Roskilde, Denmark
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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9
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Affiliation(s)
- P Pullicino
- Department of Medicine, St Luke's Hospital, Gwardamangia, Malta
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10
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Nyirandagijimana B, Edwards JK, Venables E, Ali E, Rusangwa C, Mukasakindi H, Borg R, Fabien M, Tharcisse M, Nshimyiryo A, Park PH, Raviola GJ, Smith SL. Closing the gap: decentralising mental health care to primary care centres in one rural district of Rwanda. Public Health Action 2017; 7:231-236. [PMID: 29201658 DOI: 10.5588/pha.16.0130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 12/31/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Programmes that integrate mental health care into primary care settings could reduce the global burden of mental disorders by increasing treatment availability in resource-limited settings, including Rwanda. Objective: We describe patient demographics, service use and retention of patients in care at health centres (HC) participating in an innovative primary care integration programme, compared to patients using existing district hospital-based specialised out-patient care. Design: This was a retrospective cohort study using routinely collected data from six health centres and one district hospital from October 2014 to March 2015. Results: Of 709 patients, 607 were cared for at HCs; HCs accounted for 88% of the total visits for mental disorders. Patients with psychosis used HC services more frequently, while patients with affective disorders were seen more frequently at the district hospital. Of the 68% of patients who returned to care within 90 days of their first visit, 76% had a third visit within a further 90 days. There were no significant differences in follow-up rates between clinical settings. Conclusion: This study suggests that a programme of mentorship for primary care nurses can facilitate the decentralisation of out-patient mental health care from specialised district hospital mental health services to HCs in rural Rwanda.
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Affiliation(s)
| | - J K Edwards
- Médecins Sans Frontières, Luxembourg Operational Research Unit (LuxOR), Brussels Operational Centre, Luxembourg City, Luxembourg.,School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - E Venables
- Médecins Sans Frontières, Luxembourg Operational Research Unit (LuxOR), Brussels Operational Centre, Luxembourg City, Luxembourg.,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - E Ali
- Médecins Sans Frontières, Luxembourg Operational Research Unit (LuxOR), Brussels Operational Centre, Luxembourg City, Luxembourg
| | - C Rusangwa
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - H Mukasakindi
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - R Borg
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - M Fabien
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - A Nshimyiryo
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - P H Park
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - G J Raviola
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - S L Smith
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
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11
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Habineza H, Mutumbira C, Hedt-Gauthier BL, Borg R, Gupta N, Tapela N, Dusabeyezu S, Ngoga G, Harerimana E, Mpanumusingo E, Ngabireyimana E, Rusingiza E, Bukhman G. Treating persistent asthma in rural Rwanda: characteristics, management and 24-month outcomes. Int J Tuberc Lung Dis 2017; 21:1176-1182. [PMID: 28766486 DOI: 10.5588/ijtld.17.0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING In 2007, the Rwandan Ministry of Health, with support from Partners In Health, introduced a district-level non-communicable disease programme that included asthma care. OBJECTIVE To describe the demographics, management and 24-month outcomes of asthma patients treated at three rural district hospitals in Rwanda. DESIGN We retrospectively reviewed electronic medical records of asthma patients enrolled from January 2007 to December 2012, and extracted information on demographics, clinical variables and 24-month outcomes. RESULTS Of the 354 patients, 66.7% were female and 41.5% were aged between 41 and 60 years. Most patients (53.1%) were enrolled with moderate persistent asthma, 40.1% had mild persistent asthma and 6.8% had severe persistent asthma. Nearly all patients (95.7%) received some type of medication, most commonly a bronchodilator. After 24 months, 272 (76.8%) patients were still alive and in care, 21.1% were lost to follow-up, 1.7% had died and 0.3% had transferred out. Of the 121 patients with an updated asthma classification at 24 months, the severity of their asthma had decreased: 17.4% had moderate and 0.8% had severe persistent asthma. CONCLUSION Our findings show improvements in asthma severity after 24 months and reasonable rates of loss to follow-up, demonstrating that asthma can be managed effectively in rural, resource-limited settings.
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Affiliation(s)
- H Habineza
- Partners In Health/Inshuti Mu Buzima, Kigali
| | | | - B L Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - R Borg
- Partners In Health/Inshuti Mu Buzima, Kigali
| | - N Gupta
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - N Tapela
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, Massachusetts, USA
| | | | - G Ngoga
- Partners In Health/Inshuti Mu Buzima, Kigali
| | | | | | | | - E Rusingiza
- Ministry of Health, Kigali, University of Rwanda, Kigali, Rwanda
| | - G Bukhman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, Brigham and Women's Hospital, Division of Global Health Equity, Boston, Massachusetts, USA, Partners in Health, Boston, Massachusetts, USA
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12
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Abstract
The motor neuron degenerative disease spinal muscular atrophy (SMA) remains one of the most frequently inherited causes of infant mortality. Afflicted patients loose the survival motor neuron 1 (SMN1) gene but retain one or more copies of SMN2, a homolog that is incorrectly spliced. Primary treatment strategies for SMA aim at boosting SMN protein levels, which are insufficient in patients. SMN is known to partner with a set of diverse proteins collectively known as GEMINs to form a macromolecular complex. The SMN-GEMINs complex is indispensible for chaperoning the assembly of small nuclear ribonucleoproteins (snRNPs), which are key for pre-mRNA splicing. Pharmaceutics that alleviate the neuromuscular phenotype by restoring the fundamental function of SMN without augmenting its levels are also crucial in the development of an effective treatment. Their use as an adjunct therapy is predicted to enhance benefit to patients. Inspired by the surprising discovery revealing a premier role for GEMINs in snRNP biogenesis together with in vivo studies documenting their requirement for the correct function of the motor system, this review speculates on whether GEMINs constitute valid targets for SMA therapeutic development.
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Affiliation(s)
- Rebecca Borg
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta Msida, Malta
| | - Ruben J Cauchi
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta Msida, Malta
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13
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Borg R, Kuenen JC, Carstensen B, Zheng H, Nathan DM, Heine RJ, Nerup J, Borch-Johnsen K, Witte DR. HbA₁(c) and mean blood glucose show stronger associations with cardiovascular disease risk factors than do postprandial glycaemia or glucose variability in persons with diabetes: the A1C-Derived Average Glucose (ADAG) study. Diabetologia 2011; 54:69-72. [PMID: 20886203 PMCID: PMC2995856 DOI: 10.1007/s00125-010-1918-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 08/16/2010] [Indexed: 01/17/2023]
Abstract
AIMS Increased glucose excursions and postprandial hyperglycaemia have been suggested as unique risk factors for cardiovascular disease (CVD) and mortality in patients with diabetes mellitus. Much of the evidence is based on a single 2 h glucose value after oral glucose tolerance testing in epidemiological studies. We examined the association between various indices of glycaemia measured during everyday activities and metabolic CVD risk factors in the A1C-Derived Average Glucose (ADAG) study. METHODS Participants (268 with type 1 diabetes, 159 with type 2 diabetes) completed 16 weeks of intensive continuous glucose monitoring (CGM) and self-monitoring of blood glucose (SMBG). From these data, common indices of postprandial glycaemia, overall hyperglycaemia, glucose variability and HbA₁(c) were derived. The associations between glycaemic indices and known CVD risk factors (lipids, high-sensitivity C-reactive protein and blood pressure) were explored in linear regression models. RESULTS For both diabetes types, the overall strongest associations with CVD risk factors were seen for the measures of average glycaemia (mean blood glucose and HbA₁(c)). Associations between self-monitored postprandial and fasting glucose and CVD risk factors were weaker, but significant. Measurements of blood glucose variability showed non-significant associations. Overall, calculations based on CGM were not more informative than those based on frequent SMBG. CONCLUSIONS/INTERPRETATION Mean glycaemia and HbA₁(c) show consistent and stronger associations with CVD risk factors than fasting glucose or postprandial glucose levels or measures of glucose variability in patients with diabetes.
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Affiliation(s)
- R Borg
- Steno Diabetes Center A/S, Gentofte, Denmark.
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14
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Borg R, Kuenen JC, Carstensen B, Zheng H, Nathan DM, Heine RJ, Nerup J, Borch-Johnsen K, Witte DR. Real-life glycaemic profiles in non-diabetic individuals with low fasting glucose and normal HbA1c: the A1C-Derived Average Glucose (ADAG) study. Diabetologia 2010; 53:1608-11. [PMID: 20396998 PMCID: PMC2892065 DOI: 10.1007/s00125-010-1741-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 03/09/2010] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS Real-life glycaemic profiles of healthy individuals are poorly studied. Our aim was to analyse to what extent individuals without diabetes exceed OGTT thresholds for impaired glucose tolerance (IGT) and diabetes. METHODS In the A1C-Derived Average Glucose (ADAG) study, 80 participants without diabetes completed an intensive glucose monitoring period of 12 weeks. From these data, we calculated the average 24 h glucose exposure as time spent above different plasma glucose thresholds. We also derived indices of postprandial glucose levels, glucose variability and HbA(1c). RESULTS We found that 93% of participants reached glucose concentrations above the IGT threshold of 7.8 mmol/l and spent a median of 26 min/day above this level during continuous glucose monitoring. Eight individuals (10%) spent more than 2 h in the IGT range. They had higher HbA(1c), fasting plasma glucose (FPG), age and BMI than those who did not. Seven participants (9%) reached glucose concentrations above 11.1 mmol/l during monitoring. CONCLUSIONS/INTERPRETATION Even though the non-diabetic individuals monitored in the ADAG study were selected on the basis of a very low level of baseline FPG, 10% of these spent a considerable amount of time at glucose levels considered to be 'prediabetic' or indicating IGT. This highlights the fact that exposure to moderately elevated glucose levels remains under-appreciated when individuals are classified on the basis of isolated glucose measurements.
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Affiliation(s)
- R Borg
- Steno Diabetes Center, Niels Steensens Vej 2-4, DK-2820 Gentofte, Denmark.
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15
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Abstract
AIMS Glycated haemoglobin (HbA(1c)) has been proposed as an alternative to the oral glucose tolerance test for diagnosing diabetes. We compared the cardiovascular risk profile of individuals identified by these two alternative methods. METHODS We assessed the prevalence of cardiovascular risk factors in individuals with undiagnosed diabetes according to the World Health Organization classification or by the newly proposed HbA(1c) level >or= 6.5% among 6258 participants of the Danish Inter99 study. Receiver operating curve analysis assessed the ability of fasting: 2-h plasma glucose and HbA(1c) to distinguish between individuals at high and low risk of ischemic heart disease, predicted by the PRECARD program. RESULTS Prevalence of undiagnosed diabetes was 4.1% [95% confidence interval (CI) 3.7-4.7%] by the current oral glucose tolerance test definition, whereas 6.6% (95% CI 6.0-7.2%) had diabetes by HbA(1c) levels. HbA(1c)-defined individuals were relatively older with higher proportions of men, smokers, lipid abnormalities and macro-albuminuria, but they were leaner and had lower blood pressure. HbA(1c) was better than fasting- and 2-h plasma glucose at distinguishing between individuals of high and low predicted risk of ischaemic heart disease; however, the difference between HbA(1c) and fasting- and 2-h plasma glucose was not statistically significant. CONCLUSIONS Compared with the current oral glucose tolerance test definition, more individuals were classified as having diabetes based on the HbA(1c) criteria. This group had as unfavourable a risk profile as those identified by the oral glucose tolerance test.
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Affiliation(s)
- R Borg
- Steno Diabetes Center, Gentofte, Denmark
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16
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Borg R, Dotevall L, Hagberg L, Maraspin V, Lotric-Furlan S, Cimperman J, Strle F. Intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme neuroborreliosis. ACTA ACUST UNITED AC 2009; 37:449-54. [PMID: 16012005 DOI: 10.1080/00365540510027228] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This prospective, open-label, non-randomized trial at the University Departments of Infectious Diseases in Ljubljana, Slovenia, and Göteborg, Sweden, was conducted to compare the kinetics of the cerebrospinal fluid (CSF) mononuclear cell count after 10-14 d of ceftriaxone or doxycycline for treatment of Lyme neuroborreliosis. 29 patients were treated with intravenous ceftriaxone 2 g daily in Ljubljana and 36 patients with oral doxycycline 400 mg daily in Göteborg. The study protocol included lumbar puncture before and 6-8 weeks after treatment initiation. There was a marked decrease (1.2 log10 x 10(6)/l) of the median CSF mononuclear cell count following treatment. With the assumption of a linear regression of the logarithmic mononuclear cell counts between the 2 lumbar punctures, no significant difference between the 2 antibiotic treatments could be found. All patients were clinically much improved after treatment. At 6 months follow-up 23 (79%) of the ceftriaxone- and 26 (72%) of the doxycycline-treated patients were completely recovered. Intravenous ceftriaxone or oral doxycycline was found to be effective, safe, and convenient for treatment of Lyme neuroborreliosis.
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Affiliation(s)
- Rebecca Borg
- Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden.
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17
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Le Gall G, Le Gall F, Clement C, Borg R. [The physician facing legal procedures: points of view of the physician and the lawyer]. Ann Fr Anesth Reanim 2006; 25:1090-5. [PMID: 17008046 DOI: 10.1016/j.annfar.2006.08.006] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- G Le Gall
- Service d'anesthésie-réanimation, centre hospitalier des Pays-de-Morlaix, Kersaint-Gilly, BP 97237, 29672 Morlaix cedex, France.
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18
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Gueret G, Rossignol B, Borg R, Kiss G, Chahir N, Bezon E, Arvieux CC. Rupture de l'auricule droite après traumatisme fermé abdominal. ACTA ACUST UNITED AC 2006; 25:1000-2. [PMID: 16891086 DOI: 10.1016/j.annfar.2006.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Accepted: 05/16/2006] [Indexed: 11/20/2022]
Abstract
If the cardiac injuries are frequent after closed chest traumatism, the cardiac injuries after abdominal closed traumatism are unusual but serious. We report the case of a right auricular rupture associated with a liver injury after a closed abdominal traumatism. The diagnosis was suspected on the TDM and confirmed by echocardiography. An emergency sternotomy was performed due to sudden haemodynamic instability. The initial clinical signs are often misleading. However the diagnosis must be made quickly and the treatment begun without delay.
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Affiliation(s)
- G Gueret
- Département d'anesthésie-réanimation chirurgicale, CHU la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
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19
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Stevenson PC, Franke AA, Borg R, Nervik W. THE SEPARATION OF THE FOUR PLATINUM GROUP METALS PALLADIUM, RHODIUM, IRIDIUM AND PLATINUM. J Am Chem Soc 2002. [DOI: 10.1021/ja01115a549] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Hunt GB, Bellenger CR, Borg R, Youmans KR, Tisdall PL, Malik R. Congenital interruption of the portal vein and caudal vena cava in dogs: six case reports and a review of the literature. Vet Surg 1998; 27:203-15. [PMID: 9605232 DOI: 10.1111/j.1532-950x.1998.tb00119.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe six dogs with congenital abnormalities involving the portal vein, caudal vena cava, or both. ANIMALS Six client-owned dogs with congenital interruption of the portal vein or the caudal vena cava, or both. METHODS Portal vein and caudal vena cava anatomy was evaluated by contrast radiography and visualization at surgery. Vascular casts or plastinated specimens were obtained in three animals. RESULTS Portal blood shunted into the caudal vena cava in four dogs and the left hepatic vein in one. Two of these five dogs also had interruption of the caudal vena cava with continuation as azygous vein, as did an additional dog, in which the portal vein was normally formed. Portal vein interruption was present in 5 of 74 (6.8%) dogs with congenital portosystemic shunts evaluated at the Veterinary Teaching Hospital during the study period. CONCLUSIONS Serious malformations of the abdominal veins were present in more than 1 in 20 dogs with single congenital portosystemic shunts. CLINICAL RELEVANCE Veterinarians involved in diagnosis and surgery for portosystemic shunts should be aware of these potential malformations, and portal vein continuity should be evaluated in all dogs before attempting shunt attenuation.
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Affiliation(s)
- G B Hunt
- Department of Veterinary Anatomy, University of Sydney, NSW, Australia
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21
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Pullicino P, Borg R, Agius-Muscat H, Nadassy V. The Authors’ Reply. Med Chir Trans 1990. [DOI: 10.1177/014107689008300430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P Pullicino
- Department of Neurology Eric County Medical Center Buffalo, New York, USA
| | - R Borg
- Department of Neurology Eric County Medical Center Buffalo, New York, USA
| | - H Agius-Muscat
- Department of Neurology Eric County Medical Center Buffalo, New York, USA
| | - V Nadassy
- Department of Neurology Eric County Medical Center Buffalo, New York, USA
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22
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Ferrito V, Borg R, Eagles J, Fenwick GR. Gas chromatographic and mass spectrometric characteristics of 2-trifluoromethyl-3-oxazol-5-ones. A potentially useful derivative for α-amino acids. ACTA ACUST UNITED AC 1979. [DOI: 10.1002/bms.1200061108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Traissac FJ, Borg R. [A new therapy of hepatic insufficiency. Experiments with (+)-3--cyanidanol. Its importance in the treatment of alcoholic hepatitis]. Minerva Dietol Gastroenterol 1977; 23:237-42. [PMID: 372845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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