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Izulla P, Wagai JN, Akelo V, Ombeva A, Okeri E, Onyango D, Omore R, Fuller S, Khagayi S, Were J, Anderson SA, Wong HL, Tippett Barr BA. Vaccine safety surveillance in Kenya using GAIA standards: A feasibility assessment of existing national and subnational research and program systems. Vaccine 2023; 41:5722-5729. [PMID: 37550143 DOI: 10.1016/j.vaccine.2023.07.063] [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: 07/08/2022] [Revised: 04/17/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Active surveillance systems for monitoring vaccine safety among pregnant women address some of the limitations of a current passive surveillance approach utilized in low- and middle-income countries (LMIC). However, few active surveillance systems in LMIC exist. Our study assessed the feasibility of utilizing three existing data collection systems in Kenya for active surveillance of maternal immunization and to assess the applicability of Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) case definitions that were initially developed for clinical trials within these systems. METHODS We assessed applicability of GAIA case definition for maternal Tetanus Toxoid exposure, stillbirth, low birth weight, small for gestational age, Neonatal Invasive Blood Stream Infection (NIBSI), prematurity and neonatal death in two routine web-based health information systems (Kenya EMR and DHIS-2), and a web-based population-based pregnancy research platform (ANCOV1) in Kenya. RESULTS All three HIS were capable of reporting selected outcomes to varying degrees of GAIA certainty. The ANCOV platform was the most robust in collecting and collating clinical data for effective maternal pharmacovigilance. The utilization of facility- and district-aggregated data limits the usefulness of DHIS-2 in pharmacovigilance as currently operationalized. While the Kenya EMR contained individual level data and meets the key considerations for effective pharmacovigilance, it was used primarily for HIV care and treatment records in a small proportion of health facilities and would require additional resources to expand to all antenatal care facilities and to link maternal and infant records. DISCUSSION Population-based research studies may offer a responsive short-term option for implementing maternal vaccine pharmacovigilance in LMICs. However, the foundation exists for long-term capacity building within the national health electronic data systems to provide this critical service as well as ensure participation of the country in international studies on maternal vaccine safety.
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Affiliation(s)
- P Izulla
- Adroitz Consultants, Nairobi, Kenya.
| | | | - V Akelo
- US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - A Ombeva
- Adroitz Consultants, Nairobi, Kenya
| | - E Okeri
- Adroitz Consultants, Nairobi, Kenya
| | - D Onyango
- Kisumu County Department of Health, Kisumu, Kenya
| | - R Omore
- Kenya Medical Research Institute Center for Global Health Research, Kisumu, Kenya
| | - S Fuller
- US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - S Khagayi
- Kenya Medical Research Institute Center for Global Health Research, Kisumu, Kenya
| | - J Were
- Kenya Medical Research Institute Center for Global Health Research, Kisumu, Kenya
| | - S A Anderson
- US Food and Drug Administration, Silver Spring, USA
| | - H L Wong
- US Food and Drug Administration, Silver Spring, USA
| | - B A Tippett Barr
- US Centers for Disease Control and Prevention, Kisumu, Kenya; Nyanja Health Research Institute, Salima, Malawi
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Garland GD, Harvey RF, Mulroney TE, Monti M, Fuller S, Haigh R, Gerber PP, Barer MR, Matheson NJ, Willis AE. Development of a colorimetric assay for the detection of SARS-CoV-2 3CLpro activity. Biochem J 2022; 479:901-920. [PMID: 35380004 PMCID: PMC9162461 DOI: 10.1042/bcj20220105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 12/15/2022]
Abstract
Diagnostic testing continues to be an integral component of the strategy to contain the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) global pandemic, the causative agent of Coronavirus Disease 2019 (COVID-19). The SARS-CoV-2 genome encodes the 3C-like protease (3CLpro) which is essential for coronavirus replication. This study adapts an in vitro colorimetric gold nanoparticle (AuNP) based protease assay to specifically detect the activity of SARS-CoV-2 3CLpro as a purified recombinant protein and as a cellular protein exogenously expressed in HEK293T human cells. We also demonstrate that the specific sensitivity of the assay for SARS-CoV-2 3CLpro can be improved by use of an optimised peptide substrate and through hybrid dimerisation with inactive 3CLpro mutant monomers. These findings highlight the potential for further development of the AuNP protease assay to detect SARS-CoV-2 3CLpro activity as a novel, accessible and cost-effective diagnostic test for SARS-CoV-2 infection at the point-of-care. Importantly, this versatile assay could also be easily adapted to detect specific protease activity associated with other viruses or diseases conditions.
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Affiliation(s)
- Gavin D. Garland
- MRC Toxicology Unit, Gleeson Building, Tennis Court Rd, Cambridge, U.K
- Correspondence: Gavin D. Garland () or Anne E. Willis ()
| | - Robert F. Harvey
- MRC Toxicology Unit, Gleeson Building, Tennis Court Rd, Cambridge, U.K
| | | | - Mie Monti
- MRC Toxicology Unit, Gleeson Building, Tennis Court Rd, Cambridge, U.K
| | - Stewart Fuller
- Department of Medicine, University of Cambridge, Cambridge, U.K
| | - Richard Haigh
- Department of Respiratory Sciences, Maurice Shock Medical Sciences Building, University Road, Leicester, U.K
| | - Pehuén Pereyra Gerber
- Department of Medicine, University of Cambridge, Cambridge, U.K
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge, Cambridge, U.K
| | - Michael R. Barer
- Department of Respiratory Sciences, Maurice Shock Medical Sciences Building, University Road, Leicester, U.K
| | - Nicholas J. Matheson
- Department of Medicine, University of Cambridge, Cambridge, U.K
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge, Cambridge, U.K
- NHS Blood and Transplant, Cambridge, U.K
| | - Anne E. Willis
- MRC Toxicology Unit, Gleeson Building, Tennis Court Rd, Cambridge, U.K
- Correspondence: Gavin D. Garland () or Anne E. Willis ()
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Middleton RM, Craig EM, Rodgers WJ, Tuite-Dalton K, Garjani A, Evangelou N, das Nair R, Hunter R, Tallantyre EC, Cauchi M, Cairn C, Paling D, Fuller S, McDonnell G, Petheram K, Liu B, Nock U, Ingram G, Brownlee W, Taylor J, Nicholas R. COVID-19 in Multiple Sclerosis: Clinically reported outcomes from the UK Multiple Sclerosis Register. Mult Scler Relat Disord 2021; 56:103317. [PMID: 34653949 DOI: 10.1016/j.msard.2021.103317] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In March 2020, the United Kingdom Multiple Sclerosis Register (UKMSR) established an electronic case return form, designed collaboratively by MS neurologists, to record data about COVID-19 infections in people with MS (pwMS). OBJECTIVES Examine how hospital admission and mortality are affected by disability, age and disease modifying treatments (DMTs) in people with Multiple Sclerosis with COVID-19. METHODS Anonymised data were submitted by clinical teams. Regression models were tested for predictors of hospitalisation and mortality outcomes. Separate analyzes compared the first and second 'waves' of the pandemic. RESULTS Univariable analysis found hospitalisation and mortality were associated with increasing age, male gender, comorbidities, severe disability, and progressive MS; severe disability showed the highest magnitude of association. Being on a DMT was associated with a small, lower risk. Multivariable analysis found only age and male gender were significant. Post hoc analysis demonstrated that factors were significant for hospitalisation but not mortality. In the second wave, hospitalisation and mortality were lower. Separate models of the first and second wave using age and gender found they had a more important role in the second wave. CONCLUSIONS Features associated with poor outcome in COVID-19 are similar to other populations and being on a DMT was not found to be associated with adverse outcomes, consistent with smaller studies. Once in hospital, no factors were predictive of mortality. Reassuringly, mortality appears lower in the second wave.
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Affiliation(s)
- R M Middleton
- Population Data Science, School of Medicine, Singleton Park, Swansea University, SA2 8PP, United Kingdom.
| | - E M Craig
- Population Data Science, School of Medicine, Singleton Park, Swansea University, SA2 8PP, United Kingdom
| | - W J Rodgers
- Population Data Science, School of Medicine, Singleton Park, Swansea University, SA2 8PP, United Kingdom
| | - K Tuite-Dalton
- Population Data Science, School of Medicine, Singleton Park, Swansea University, SA2 8PP, United Kingdom
| | - A Garjani
- School of Medicine, University of Nottingham, United Kingdom
| | - N Evangelou
- School of Medicine, University of Nottingham, United Kingdom
| | - R das Nair
- School of Medicine, University of Nottingham, United Kingdom
| | - R Hunter
- Psychology Department, Swansea University, United Kingdom
| | - E C Tallantyre
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University, United Kingdom
| | - M Cauchi
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University, United Kingdom
| | - C Cairn
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - D Paling
- Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - S Fuller
- Barking Havering and Redbridge Hospitals NHS Trust, Romford, United Kingdom
| | - G McDonnell
- Belfast City Hospital, Belfas, United Kingdom
| | - K Petheram
- South Tyneside and Sunderland NHS Foundation Trust, Tyne and Wear, United Kingdom
| | - B Liu
- School of Medicine, University of Nottingham, United Kingdom
| | - U Nock
- Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, United Kingdom
| | - G Ingram
- Swansea Bay University Health Board, Swansea, United Kingdom
| | - W Brownlee
- University College London, Queen Square MS Centre, London, United Kingdom
| | - J Taylor
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - R Nicholas
- Imperial College London, London, United Kingdom
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Jones NK, Rivett L, Sparkes D, Forrest S, Sridhar S, Young J, Pereira-Dias J, Cormie C, Gill H, Reynolds N, Wantoch M, Routledge M, Warne B, Levy J, Córdova Jiménez WD, Samad FNB, McNicholas C, Ferris M, Gray J, Gill M, Curran MD, Fuller S, Chaudhry A, Shaw A, Bradley JR, Hannon GJ, Goodfellow IG, Dougan G, Smith KGC, Lehner PJ, Wright G, Matheson NJ, Baker S, Weekes MP. Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19. eLife 2020; 9:e59391. [PMID: 32558644 PMCID: PMC7326489 DOI: 10.7554/elife.59391] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022] Open
Abstract
Previously, we showed that 3% (31/1032)of asymptomatic healthcare workers (HCWs) from a large teaching hospital in Cambridge, UK, tested positive for SARS-CoV-2 in April 2020. About 15% (26/169) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive for SARS-CoV-2 (Rivett et al., 2020). Here, we show that the proportion of both asymptomatic and symptomatic HCWs testing positive for SARS-CoV-2 rapidly declined to near-zero between 25th April and 24th May 2020, corresponding to a decline in patient admissions with COVID-19 during the ongoing UK 'lockdown'. These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent 'hubs' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organizations in other sectors may be able to resume on-site work safely.
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MESH Headings
- Adult
- Asymptomatic Diseases
- Betacoronavirus/genetics
- Betacoronavirus/isolation & purification
- COVID-19
- COVID-19 Testing
- Clinical Laboratory Techniques/statistics & numerical data
- Community-Acquired Infections/transmission
- Contact Tracing
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Disease Transmission, Infectious/prevention & control
- England/epidemiology
- Family Characteristics
- Female
- Health Personnel
- Hospital Units
- Hospitals, Teaching/organization & administration
- Hospitals, Teaching/statistics & numerical data
- Hospitals, University/organization & administration
- Hospitals, University/statistics & numerical data
- Humans
- Infection Control
- Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data
- Male
- Mass Screening/organization & administration
- Mass Screening/statistics & numerical data
- Middle Aged
- Nasopharynx/virology
- Occupational Diseases/epidemiology
- Occupational Diseases/prevention & control
- Pandemics/prevention & control
- Patient Admission/statistics & numerical data
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- Prevalence
- Program Evaluation
- Real-Time Polymerase Chain Reaction
- SARS-CoV-2
- Symptom Assessment
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Affiliation(s)
- Nick K Jones
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Lucy Rivett
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Dominic Sparkes
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Sally Forrest
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Sushmita Sridhar
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
- Wellcome Sanger InstituteHinxtonUnited Kingdom
| | - Jamie Young
- Academic Department of Medical Genetics, University of CambridgeCambridgeUnited Kingdom
| | - Joana Pereira-Dias
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Claire Cormie
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Harmeet Gill
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Nicola Reynolds
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Michelle Wantoch
- Wellcome - MRC Cambridge Stem Cell Institute, University of CambridgeCambridgeUnited Kingdom
- Department of Haematology, School of Clinical Medicine, University of CambridgeCambridgeUnited Kingdom
| | - Matthew Routledge
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Ben Warne
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Jack Levy
- Institute for Manufacturing, Department of Engineering, University of CambridgeCambridgeUnited Kingdom
| | | | - Fathima Nisha Begum Samad
- Institute for Manufacturing, Department of Engineering, University of CambridgeCambridgeUnited Kingdom
| | - Chris McNicholas
- Improvement and Transformation Team, Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Mark Ferris
- Occupational Health and Wellbeing, Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Jane Gray
- Cancer Research United Kingdom Cambridge Institute, University of CambridgeCambridgeUnited Kingdom
| | - Michael Gill
- Cancer Research United Kingdom Cambridge Institute, University of CambridgeCambridgeUnited Kingdom
| | - Martin D Curran
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Stewart Fuller
- National Institutes for Health Research Cambridge Biomedical Research CentreCambridgeUnited Kingdom
| | - Afzal Chaudhry
- Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Ashley Shaw
- Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - John R Bradley
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- National Institutes for Health Research Cambridge, Clinical Research FacilityCambridgeUnited Kingdom
| | - Gregory J Hannon
- Cancer Research United Kingdom Cambridge Institute, University of CambridgeCambridgeUnited Kingdom
| | - Ian G Goodfellow
- Division of Virology, Department of Pathology, University of CambridgeCambridgeUnited Kingdom
| | - Gordon Dougan
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Kenneth GC Smith
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Paul J Lehner
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Giles Wright
- Occupational Health and Wellbeing, Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Nicholas J Matheson
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
- NHS Blood and TransplantCambridgeUnited Kingdom
| | - Stephen Baker
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Michael P Weekes
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
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Rivett L, Sridhar S, Sparkes D, Routledge M, Jones NK, Forrest S, Young J, Pereira-Dias J, Hamilton WL, Ferris M, Torok ME, Meredith L, Curran MD, Fuller S, Chaudhry A, Shaw A, Samworth RJ, Bradley JR, Dougan G, Smith KGC, Lehner PJ, Matheson NJ, Wright G, Goodfellow IG, Baker S, Weekes MP. Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission. eLife 2020; 9:e58728. [PMID: 32392129 PMCID: PMC7314537 DOI: 10.7554/elife.58728] [Citation(s) in RCA: 346] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/30/2022] Open
Abstract
Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.
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Affiliation(s)
- Lucy Rivett
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology and Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Sushmita Sridhar
- Wellcome Sanger InstituteHinxtonUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Dominic Sparkes
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology and Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Matthew Routledge
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology and Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Nick K Jones
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology and Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Sally Forrest
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Jamie Young
- Academic Department of Medical Genetics, University of CambridgeCambridgeUnited Kingdom
| | - Joana Pereira-Dias
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - William L Hamilton
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology and Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Mark Ferris
- Occupational Health and Wellbeing, Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - M Estee Torok
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
- Department of Microbiology, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
| | - Luke Meredith
- Division of Virology, Department of Pathology, University of CambridgeCambridgeUnited Kingdom
| | - Martin D Curran
- Clinical Microbiology and Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Stewart Fuller
- National Institutes for Health Research Cambridge, Clinical Research FacilityCambridgeUnited Kingdom
| | - Afzal Chaudhry
- Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Ashley Shaw
- National Institutes for Health Research Cambridge, Clinical Research FacilityCambridgeUnited Kingdom
| | - Richard J Samworth
- Statistical Laboratory, Centre for Mathematical SciencesCambridgeUnited Kingdom
| | - John R Bradley
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- National Institutes for Health Research Cambridge Biomedical Research CentreCambridgeUnited Kingdom
| | - Gordon Dougan
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Kenneth GC Smith
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Paul J Lehner
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Nicholas J Matheson
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
- NHS Blood and TransplantCambridgeUnited Kingdom
| | - Giles Wright
- Occupational Health and Wellbeing, Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Ian G Goodfellow
- Division of Virology, Department of Pathology, University of CambridgeCambridgeUnited Kingdom
| | - Stephen Baker
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Michael P Weekes
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
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Nordquist L, Ghanbari H, Elist J, Oliver J, Gannon W, Shahlaee A, Fuller S, Shore N. Final results from a phase i clinical trial evaluating the safety, immunogenicity, and anti-tumor activity of SNS-301 in men with biochemically relapsed prostate cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy279.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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O'Connor M, Glatz A, Rossano J, Shaddy R, Ryan R, Ravishankar C, Fuller S, Spray T, Mascio C, Gaynor J, Lin K. Preoperative Recipient Factors Predict Outcome in Pediatric Heart Transplant Recipients Using a Novel Risk Factor Score. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.734] [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: 10/19/2022] Open
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8
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Green BB, Anderson ML, Chubak J, Fuller S, Meenan RT, Vernon SW. Long-term Adherence to Colorectal Cancer Screening; 5-Year Results from the Systems of Support to Increase Colorectal Cancer Screening Trial. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1055-9965.epi-17-0033] [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: 11/16/2022] Open
Abstract
Abstract
Colorectal cancer (CRC) is the second-leading cause of cancer deaths. Mortality could be rapidly reduced through higher uptake and adherence to CRC screening. Information on long-term screening adherence comes from organized programs that lack a comparison group. Objective: Systems of Support to Increase Colorectal Cancer Screening is an ongoing trial testing a centralized mailed and phone-based program to increase long-term CRC screening adherence. We hypothesized that compared to usual care (UC) intervention-arm patients would have more time in compliance with CRC screening guidelines over 5 years. Methods: The setting was an integrated healthcare organization in Washington State. UC included patient-centered medical home with clinic-based strategies to increase screening. Participants included 4675 individuals initially aged 50–74, not current for CRC screening. Intervention arms combined were compared to UC. The primary outcome was the percent of time covered for CRC screening over 5 years of follow-up. Screening tests contributed covered time based on national guidelines for screening intervals. All participants contributed data, but were censored at disenrollment, death, age 76, or CRC diagnosis. Interventions: Patients were randomly assigned to receive UC, or one of three stepped care interventions: 1. Mailings including mailed fecal tests, a call-in number if colonoscopy or sigmoidoscopy was preferred; 2. Mailings plus brief telephone assistance; 3. Mailings and telephone assistance plus nurse navigation. In year 3, intervention group participants still CRC screening-eligible were randomized to stopped or continued mailed interventions only. Results: Compared to UC, intervention participants had 31% more time not in need of CRC testing (adjusted rate ratio, weighted for exposure time 1.31 [1.25–1.37], 47.2% vs. 62.0% covered time) over 5 years. Fecal testing was responsible for almost all additional covered time. Compared to intervention participants, UC individuals were more likely never to have completed any CRC testing over 5 years (17.4% vs. 10.3%, net difference 7.2%, P < 0.001) Conclusions: An organized mail and phone program led to increased CRC screening adherence over 5 years, mainly because of regular fecal testing uptake.
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Castro C, Fuller S, Navarro M, Palou R, Roura E. Development of non-invasive methods to monitor the transfer of dietary volatile compounds in pigs. Anim Prod Sci 2017. [DOI: 10.1071/anv57n12ab072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Palou R, Fuller S, Roura E. Dietary essential oil volatiles are transferred to milk and amniotic fluid in sows. Anim Prod Sci 2017. [DOI: 10.1071/anv57n12ab068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fuller S, Hamandi K, Jones DK, Gray WP. PREDICTING VISUAL FIELD DEFECTS FOLLOWING SELECTIVE TRANSSYLVIAN AMYGDALOHIPPOCAMPECTOMY. J Neurol Neurosurg Psychiatry 2015. [DOI: 10.1136/jnnp-2015-312379.57] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionSurgery for refractory temporal lobe epilepsy can cause postoperative visual field defects (VFD). This study aimed to predict personalised risk of VFDs for patients undergoing selective transsylvian amygdalohippocampectomy.MethodsPreoperative reconstruction of the optic radiations (OR) using diffusion tensor-based tractography was completed on two patients. The ‘average resection model’ uses a template from postoperative structural scans of five patient scans to predict an average resection in the patient. The OR tractography was compared with the resection margins to determine fibre involvement. The ‘multiple individual comparison model’ compared individual postoperative scans with the preoperative tractography to determine risk of VFD.ResultsIn Patient 1 the average resection overlapped the OR, so an average resection would be expected to produce a VFD. In 3/5 postoperative scans the resection intersected with the OR, indicating that 60% of prior resections would have caused a defect. In Patient 2 no overlap between resection and OR was found in either model. Perimetry confirmed VFD in patient 1 but not in patient 2.DiscussionThis pilot study demonstrates that the risk of postoperative VFDs can be predicted. The two models provide qualitatively different form of quantitative risk which could inform the discussion between patient and clinician.
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D’Souza B, Fuller S, Hornsby N, Wald J, Krok K, Shaked A, Goldberg L, Pochettino A, Olthoff K, Kim Y. Single Center Outcomes of Combined Heart and Liver Transplantation in the Failing Fontan. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zhang B, Edwards O, Kang L, Fuller S. A multi-genome analysis approach enables tracking of the invasion of a single Russian wheat aphid (Diuraphis noxia) clone throughout the New World. Mol Ecol 2014; 23:1940-51. [DOI: 10.1111/mec.12714] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 11/30/2022]
Affiliation(s)
- B. Zhang
- Science & Engineering Faculty; Queensland University of Technology; GPO Box 2434 Brisbane Qld 4001 Australia
- State Key Laboratory of Integrated Management of Pest Insects and Rodents; Institute of Zoology; Chinese Academy of Sciences; Beijing 100101 China
- State Key Laboratory for Biology of Plant Diseases and Insect Pests; Institute of Plant Protection; Chinese Academy of Agricultural Sciences; Beijing 100193 China
- Cooperative Research Centre for National Plant Biosecurity; LPO Box 5012 Bruce ACT 2617 Australia
| | - O. Edwards
- Cooperative Research Centre for National Plant Biosecurity; LPO Box 5012 Bruce ACT 2617 Australia
- CSIRO Ecosystem Sciences; Centre for Environment and Life Sciences; Underwood Avenue Floreat WA 6014 Australia
| | - L. Kang
- State Key Laboratory of Integrated Management of Pest Insects and Rodents; Institute of Zoology; Chinese Academy of Sciences; Beijing 100101 China
| | - S. Fuller
- Science & Engineering Faculty; Queensland University of Technology; GPO Box 2434 Brisbane Qld 4001 Australia
- Cooperative Research Centre for National Plant Biosecurity; LPO Box 5012 Bruce ACT 2617 Australia
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Gaballah M, Rhee E, Hurst R, Pukenas B, Ichord R, Rossano J, Fuller S, Lin K, Krishnamurthy G, Cahill A. Mechanical embolectomy using the Solitaire FR revascularization device for acute arterial ischemic stroke in a pediatric ventricular assist device patient: a case report. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Murphy MO, Glatz AC, Goldberg DJ, Rogers LS, Ravishankar C, Nicolson SC, Steven JM, Fuller S, Spray TL, Gaynor JW. Management of early Fontan failure: a single-institution experience. Eur J Cardiothorac Surg 2014; 46:458-64; discussion 464. [DOI: 10.1093/ejcts/ezu022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Murphy MO, Glatz AC, Goldberg DJ, Rogers LS, Ravishankar C, Nicolson SC, Steven J, Fuller S, Spray TL, Gaynor JW. 135 * MANAGEMENT OF EARLY FONTAN FAILURE: A SINGLE-INSTITUTION EXPERIENCE. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clerk A, Sugden PH, Fuller S, Osborne S. 227 IDENTIFYING THE PROTEIN KINASES IN THE CARDIAC MYOCYTE KINOME. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Reed SD, Lampe JW, Qu C, Gundersen G, Fuller S, Copeland WK, Newton KM. Self-reported menopausal symptoms in a racially diverse population and soy food consumption. Maturitas 2013; 75:152-8. [PMID: 23562010 DOI: 10.1016/j.maturitas.2013.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Evaluate the association of self-reported vasomotor symptom (VMS) frequency with race/ethnicity among a diverse midlife US population and explore menopause symptom differences by dietary soy isoflavone (genistein+daidzein) consumption. STUDY DESIGN Cross-sectional population-based study of peri- and postmenopausal women, ages 45-58. OUTCOMES Recent VMS frequency, VMS ever; recent symptom bother (hot flashes, night sweats, headache and joint-ache). RESULTS Of 18,500 potentially eligible women, 9325 returned questionnaires (50.4% response); 3691 were excluded (premenopausal, missing data, taking hormones). Of 5634 remaining women, 82.1% reported hot flashes ever, 73.1% reported night sweats ever; 48.8% and 38.6% reported recent hot flashes or night sweats, respectively. Compared with White women, Chinese, Japanese, Vietnamese, other Asian (each p<0.001) and Filipino (p<0.01) women less commonly reported ever having hot flashes; Asian women less commonly reported recent VMS bother (p<0.001). Black women more commonly reported hot flashes ever (p<0.05) and recent VMS bother (p<0.05). Compared with non-Hispanic White women, Hispanic women were less likely to report hot flashes (p<0.05) or night sweats (p<0.001) ever. Women were classified by isoflavone consumption: (1) none (n=1819), (2) 0.01-4.30 mg/day (n=1931), (3) 4.31-24.99 mg/day (n=1347) and (4) ≥ 25 mg/day (n=537). There were no group differences in recent VMS number/day: (1) 7.0 (95% CI 6.5, 7.5); (2) 6.4 (95% CI 6.0, 7.1); (3) 7.0 (95% CI 6.3, 8.2); and (4) 6.8 (95% CI 6.1, 7.7). CONCLUSIONS Menopausal symptoms, independent of isoflavone intake, varied considerably by race/ethnicity and were least common among Asian races.
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Fuller S, Backus B, Dam LV, Ernst M. Short-term dynamics of perceptual bias for bistable stimuli. J Vis 2010. [DOI: 10.1167/9.8.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fuller S, Carrasco M. Perceptual consequences of visual performance fields: The case of the line motion illusion. J Vis 2010. [DOI: 10.1167/8.6.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Park Y, Fuller S, Carrasco M. Cue salience modulates the effects of exogenous attention on apparent contrast. J Vis 2010. [DOI: 10.1167/8.6.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Rodriguez RZ, Gobell J, Fuller S, Carrasco M. Apparent contrast differs across the vertical meridian of the visual field: Visual and attentional factors. J Vis 2010. [DOI: 10.1167/6.6.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Most cases of acute leukemia can be assigned to the myeloid, B or T lineage. In a few cases, definitive assignment cannot be achieved because blasts express antigens of more than one lineage. A subset of these, referred to as acute bilineal leukemias (aBLLs), is characterized by the presence of more than one population of blasts, each comprising a single lineage. We identified 19 cases of aBLL, including 10 mixed T and myeloid (T-My) and nine mixed B and myeloid (B-My); no mixed B and T cases were identified. Cytogenetic data were available for 16 patients. Three of seven patients with B-My had a t(9;22)(q34q11.2), two had 11q23 translocations and one had del(9). Two of nine patients with T-My had 2p13 translocations; five had other unrelated abnormalities. Of 16 patients with outcome data, only six achieved complete remission and only two remain free of disease 2.5 and 4.5 years after chemotherapy or stem cell transplantation. aBLL is a rare disease that combines B or T and myeloid blasts. Cytogenetic abnormalities of t(9;22) and 11q23 are common in, and may be restricted to, B-My cases, while T-My cases have frequent but generally non-recurring abnormalities. Both types of aBLL are associated with poor outcome.
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Affiliation(s)
- E G Weir
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA
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Keyler DE, Roiko SA, Benlhabib E, LeSage MG, St Peter JV, Stewart S, Fuller S, Le CT, Pentel PR. Monoclonal nicotine-specific antibodies reduce nicotine distribution to brain in rats: dose- and affinity-response relationships. Drug Metab Dispos 2005; 33:1056-61. [PMID: 15843487 DOI: 10.1124/dmd.105.004234] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vaccination against nicotine is being studied as a potential treatment for nicotine dependence. Some of the limitations of vaccination, such as variability in antibody titer and affinity, might be overcome by instead using passive immunization with nicotine-specific monoclonal antibodies. The effects of antibodies on nicotine distribution to brain were studied using nicotine-specific monoclonal antibodies (NICmAbs) with K(d) values ranging from 60 to 250 nM and a high-affinity polyclonal rabbit antiserum (K(d) = 1.6 nM). Pretreatment with NICmAbs substantially increased the binding of nicotine in serum after a single nicotine dose, reduced the unbound nicotine concentration in serum, and reduced the distribution of nicotine to brain. Efficacy was directly related to antibody affinity for nicotine. Efficacy of the highest affinity NICmAb, NICmAb311, was dose-related, with the highest dose reducing nicotine distribution to brain by 78%. NICmAb311 decreased nicotine clearance by 90% and prolonged the terminal half-life of nicotine by 120%. At equivalent doses, NICmAb311 was less effective than the higher affinity rabbit antiserum but comparable efficacy could be achieved by increasing the NICmAb311 dose. These data suggest that passive immunization with nicotine-specific monoclonal antibodies substantially alters nicotine pharmacokinetics in a manner similar to that previously reported for vaccination against nicotine. Antibody efficacy is a function of both dose and affinity for nicotine.
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Affiliation(s)
- D E Keyler
- Minneapolis Medical Research Foundation, Minnesota, USA
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Carrasco M, Ling S, Gobel J, Fuller S, Read S. Attention alters appearance in early vision: Contrast sensitivity, spatial resolution, and color saturation. J Vis 2004. [DOI: 10.1167/4.8.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gaffan J, Holden L, Newlands ES, Short D, Fuller S, Begent RHJ, Rustin GJS, Seckl MJ. Infertility rates following POMB/ACE chemotherapy for male and female germ cell tumours - a retrospective long-term follow-up study. Br J Cancer 2004; 89:1849-54. [PMID: 14612891 PMCID: PMC2394462 DOI: 10.1038/sj.bjc.6601383] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The risk of chemotherapy-induced infertility in male and female germ cell tumour (GCT) survivors is unclear, but may correlate with cisplatin dose. Here, we examine a large series of GCT patients for the effect of chemotherapy on those attempting to have children. Our GCT database was screened for nonseminomatous GCT patients who had (1) received POMB/ACE chemotherapy (cisplatin, vincristine, methotrexate, bleomycin alternating with actinomycin D, cyclophosphamide and etoposide) and (2) stage I male GCT patients who were untreated between 1977 and 1996. Fertility was assessed by questionnaire and medical records. A total of 64 of 153 treated and 35 of 115 untreated men attempted to have children. In all, 28% (18 out of 64) receiving POMB/ACE were unsuccessful. Radiotherapy (six), atrophic remaining testis (one) or prior infertility (three) were implicated in 10 cases, so chemotherapy-induced infertility may have occurred in only 11% (eight out of 64). Strikingly, 26% (nine out of 35) of untreated stage I patients also failed to have children (three had radiotherapy, three prior infertility). Moreover, in treated men, no association was seen between cisplatin dose and infertility. In contrast, radiotherapy significantly increased male infertility (P=0.001). Of 28 treated women who attempted to have children, 25% (seven out of 28) were unsuccessful. One previously had infertility and one subsequently had successful IVF so chemotherapy-induced infertility potentially occurred in only 18% (five out of 28) and was not related to cisplatin dose. In conclusion, the risk of chemotherapy-induced infertility is low in both male and female GCT patients and does not clearly correlate with the cumulative cisplatin dose.
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Affiliation(s)
- J Gaffan
- Department of Medical Oncology, Charing Cross Campus of Imperial College London, Fulham Palace Rd, London W6 8RF, UK
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Tammer AH, Coia G, Cappai R, Fuller S, Masters CL, Hudson P, Underwood JR. Generation of a recombinant Fab antibody reactive with the Alzheimer's disease-related Abeta peptide. Clin Exp Immunol 2002; 129:453-63. [PMID: 12197886 PMCID: PMC1906481 DOI: 10.1046/j.1365-2249.2002.01905.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [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] [Accepted: 04/10/2002] [Indexed: 12/31/2022] Open
Abstract
A recombinant Fab antibody, designated 1E8-4b, which reacts with the Alzheimer's disease (AD)-related Abeta peptides, Abeta[1-40], Abeta[1-42] and Abeta[1-43] has been developed. The 1E8-4b Fab was constructed by cloning the V(H)C(H1) and V(L)C(L) domains from the parent hybridoma 1E8 antibody, reported previously to recognize these Abeta peptides. Briefly, a C-terminal Flag tag sequence was incorporated into this construct, which was ligated into the vector pHFA2 and expressed in Escherichia coli. Following purification on an M2 anti-Flag affinity column, the 1E8-4b recombinant Fab antibody was shown to bind plaques within sections of brain tissue from CERAD-defined AD patients by immunohistochemistry. ELISA, epitope mapping and immunoblotting confirmed the recognition of the Abeta1-40/42/43] peptides by the 1E8-4b Fab. The 1E8-4b Fab did not recognize APP695 or APP770 which contain the Abeta sequence. The Abeta specificity of the recombinant 1E8-4b Fab antibody was identical to the parent 1E8 monoclonal antibody.
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Affiliation(s)
- A H Tammer
- Department of Pathology, Melbourne University, Parkville, Victoria, Australia
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Karras BT, Kimball AM, Gonzales V, Pautler NA, Alarcón J, Garcia PJ, Fuller S. Informatics for Peru in the new millennium. Stud Health Technol Inform 2002; 84:1033-7. [PMID: 11604888] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
INTRODUCTION As efforts continue to narrow the digital divide between the North and South, a new biomedical and health informatics training effort has been launched in Peru. This report describes the first year of work on this collaborative effort between the University of Washington (Seattle) Universidad Peruana Cayetano Heredia and Universidad Nacional de San Marcos (Peru) OBJECTIVES To describe activities in the first year of a new International Research and Training Program in Biomedical and Health Informatics. METHODS Descriptive analysis of key activities including an assessment of electronic environment through observation and survey, an in country short course with quantitative evaluation, and first round of recruitment of Peruvian scholars for long-term training in Seattle. RESULTS A two-week short course on informatics was held in the country. Participants' success in learning was demonstrated through pretest/posttest. A systematic assessment of electronic environment in Peru was carried out and two scholars for long-term training were enrolled at the University of Washington, Seattle. DISCUSSION Initial activity in the collaborative training effort has been high. Of particular importance in this environment is orchestration of efforts among interested parties with similar goals in Peru, and integration of informatics skills into ongoing large-scale research projects in country.
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Affiliation(s)
- B T Karras
- University of Washington, Seattle, Washington 98195-7230, USA.
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Blagden SP, Foskett MA, Fisher RA, Short D, Fuller S, Newlands ES, Seckl MJ. The effect of early pregnancy following chemotherapy on disease relapse and foetal outcome in women treated for gestational trophoblastic tumours. Br J Cancer 2002; 86:26-30. [PMID: 11857007 PMCID: PMC2746538 DOI: 10.1038/sj.bjc.6600041] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2001] [Revised: 07/23/2001] [Accepted: 10/31/2001] [Indexed: 11/17/2022] Open
Abstract
Little literature exists on the safety of early pregnancy following chemotherapy. Here we assess the rate of relapse and foetal outcome in women who have completed single and multi-agent chemotherapy for gestational trophoblastic tumours. The records of 1532 patients treated for persistent gestational trophoblastic tumours at Charing Cross Hospital between 1969 and 1998 were reviewed. Patients were defined as receiving single agent or multi-agent treatment. Relapse rates and foetal outcome were reviewed in the 230 patients who became pregnant within 12 months of completing chemotherapy. In the single agent group 153 (22%) of 691 patients conceived early. Three subsequently relapsed. In the multi-agent group, 77 (10%) of 779 patients conceived early, two then relapsed. Relapse rates were 2% (3 out of 153) and 2.5% (2 out of 77) for each group compared to 5% and 5.6% in the comparative non-pregnant groups. Outcomes of 230 early pregnancies: 164 (71%) delivered at full term, 35 (15%) terminations, 26 (11%) spontaneous abortions, three (1.3%) new hydatidiform moles and two (1%) stillbirths. Early pregnancies were more common in the single agent group (P<0.001), but spontaneous miscarriages and terminations were more likely to occur in the multi-agent group (P=0.04 and 0.03, respectively). Of the full-term pregnancies, three (1.8%) babies were born with congenital abnormalities. Patients in either group who conceive within 12 months of completing chemotherapy are not at increased risk of relapse. Though, we still advise avoiding pregnancy within 12 months of completing chemotherapy, those that do conceive can be reassured of a likely favourable outcome. DOI: 10.1038/sj/bjc/6600041 www.bjcancer.comCopyright 2002 The Cancer Research Campaign
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Affiliation(s)
- S P Blagden
- Department of Medical Oncology, Charing Cross Hospital, London W6 8RF, UK
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Abstract
Increasing emphasis is now being placed upon the evaluation of health service interventions to demonstrate their effects. A series of effectiveness reviews of the oral health education and promotion literature has demonstrated that many of these interventions are poorly and inadequately evaluated. It is therefore difficult to determine the effectiveness of many interventions. Based upon developments from the field of health promotion research this paper explores options for improving the quality of oral health promotion evaluation. It is essential that the methods and measures used in the evaluation of oral health promotion are appropriate to the intervention. For many oral health promotion interventions clinical measures and methods of evaluation may not be appropriate. This paper outlines an evaluation framework which can be used to assess the range of effects of oral health promotion programmes. Improving the quality of oral health promotion evaluation is a shared responsibility between researchers and those involved in the provision of programmes. The provision of adequate resources and training are essential requirements for this to be successfully achieved.
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Affiliation(s)
- R Watt
- Department of Epidemiology and Public Health, University College London, UK.
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Fuller S. Measuring HIPAA's impact. J AHIMA 2001; 72:16A-16D. [PMID: 11216040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Attard GS, Fuller S, Tiddy GJT. Influence of Added Electrolytes on the Lyotropic Phase Behavior of Triethylammoniodecyloxycyanobiphenyl Bromide (OCB-C10NEt3Br). J Phys Chem B 2000. [DOI: 10.1021/jp0013513] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G. S. Attard
- Department of Chemistry, University of Southampton, Southampton, U.K., Department of Pure and Applied Chemistry, University of Salford, Salford, U.K., and Department of Chemical Engineering, UMIST, PO Box 88, Manchester M60 1QD, U.K
| | - S. Fuller
- Department of Chemistry, University of Southampton, Southampton, U.K., Department of Pure and Applied Chemistry, University of Salford, Salford, U.K., and Department of Chemical Engineering, UMIST, PO Box 88, Manchester M60 1QD, U.K
| | - G. J. T. Tiddy
- Department of Chemistry, University of Southampton, Southampton, U.K., Department of Pure and Applied Chemistry, University of Salford, Salford, U.K., and Department of Chemical Engineering, UMIST, PO Box 88, Manchester M60 1QD, U.K
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Fuller S, Kalet I, Tarczy-Hornoch P. Biomedical and Health Informatics Research and Education at the University of Washington. Yearb Med Inform 2000. [DOI: 10.1055/s-0038-1637949] [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: 10/17/2022] Open
Abstract
AbstractAlthough an extensive medical informatics research program as well as courses and training experiences in biomedical informatics have existed at the University of Washington (UW) for many years, a formal home did not exist until 1997 when the Division of Biomedical Informatics was created in the Department of Medical Education, School of Medicine. Since that time the expansion of the research, service and teaching programs has been rapid with a key milestone being a university commitment to provide funding, space and faculty to support the development of a new graduate program in Biomedical and Health Informatics.Hallmarks of the biomedical and health informatics program at the University of Washington include:- Strong shared belief that informatics research can contribute to the improvement of healthcare and health;- Large, multidisciplinary faculty including faculty from computer science, library and information science as well as the health sciences schools (dentistry, medicine, nursing, pharmacy, and public health and community medicine);- Comprehensive research and development partnership with the University of Washington Medical Centers information systems group and the UW Primary Care Network to move research from the laboratory to operational clinical systems;- Extensive and diverse regional setting in which to study information needs and develop informatics solutions in primary care settings;- Lack of barriers to interdisciplinary research and teaching.
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Fuller S. To "e" or not to "e": HIM and the dawn of e-health. J AHIMA 2000; 71:50-3. [PMID: 11009686] [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: 04/15/2023]
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Maertens G, Priem S, Ducatteeuw A, Verschoorl E, Verstrepen B, Roskams T, Desmet V, Fuller S, Van Hoek K, Vandeponseele P, Bosman F, Buyse MA, van Doorn LJ, Heeney J, Kos A, Depla E. Improvement of chronic active hepatitis C in chronically infected chimpanzees after therapeutic vaccination with the HCV E1 protein. Acta Gastroenterol Belg 2000; 63:203. [PMID: 11023431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- G Maertens
- Hepatitis Program, Innogenetics, Gent, Belgium
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Abstract
Electron microscopy of negatively stained human foamy virus particles provides direct evidence for the trimeric nature of intact Env surface glycoproteins. Three-dimensional image reconstruction reveals that the Env trimer is a tapering spike 14 nm in length. The spikes were often arranged in hexagonal rings which shared adjacent Env trimers.
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Affiliation(s)
- T Wilk
- Structural Biology Programme, European Molecular Biology Laboratory, Heidelberg, Germany
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Abstract
Assembly of infectious human immunodeficiency virus type 1 (HIV-1) proceeds in two steps. Initially, an immature virus with a spherical capsid shell consisting of uncleaved Gag polyproteins is formed. Extracellular proteolytic maturation causes rearrangement of the inner virion structure, leading to the conical capsid of the infectious virus. Using an in vitro assembly system, we show that the same HIV-1 Gag-derived protein can form spherical particles, virtually indistinguishable from immature HIV-1 capsids, as well as tubular or conical particles, resembling the mature core. The assembly phenotype could be correlated with differential binding of the protein to monoclonal antibodies recognizing epitopes in the HIV-1 capsid protein (CA), suggesting distinct conformations of this domain. Only tubular and conical particles were observed when the protein lacked spacer peptide SP1 at the C-terminus of CA, indicating that SP1 may act as a molecular switch, whose presence determines spherical capsid formation, while its cleavage leads to maturation.
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Affiliation(s)
- I Gross
- Heinrich-Pette-Institut für experimentelle Virologie und Immunologie an der Universität Hamburg, Martinistrasse 52, D-20251 Hamburg, Germany
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Fuller S, Kalet I, Tarczy-Hornoch P. Biomdecial and Health Informatics Research and Education at the University of Washington. Yearb Med Inform 2000:107-113. [PMID: 27699353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Although an extensive medical informatics research program as well as courses and training experiences in biomedical informatics have existed at the University of Washington (UW) for many years, a formal home did not exist until 1997 when the Division of Biomedical Informatics was created in the Department of Medical Education, School of Medicine. Since that time the expansion of the research, service and teaching programs has been rapid with a key milestone being a university commitment to provide funding, space and faculty to support the development of a new graduate program in Biomedical and Health Informatics. Hallmarks of the biomedical and health informatics program at the University of Washington include: - Strong shared belief that informatics research can contribute to the improvement of healthcare and health; - Large, multidisciplinary faculty including faculty from computer science, library and information science as well as the health sciences schools (dentistry, medicine, nursing, pharmacy, and public health and community medicine); - Comprehensive research and development partnership with the University of Washington Medical Centers information systems group and the UW Primary Care Network to move research from the laboratory to operational clinical systems; - Extensive and diverse regional setting in which to study information needs and develop informatics solutions in primary care settings; - Lack of barriers to interdisciplinary research and teaching.
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Fuller S. Using scenario planning. J AHIMA 2000; 71:68-9. [PMID: 11009655] [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: 02/17/2023]
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Fuller S. Implementing HIPAA security standards--are you ready? J AHIMA 1999; 70:36-40, 42-4, quiz 47-8. [PMID: 10977404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Seckl M, Blagden S, Foskett M, Fuller S, Short D, Newlands E. Outcome in patients who become pregnant within 12 months after completing single and multiple agent chemotherapy for gestational trophoblastic disease (gtd). Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81326-4] [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: 10/27/2022]
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Abstract
Hypersensitivity reactions to 6-mercaptopurine (6-MP) or azathioprine occur during the treatment of inflammatory bowel disease (IBD), raising significant diagnostic and therapeutic challenges. Charts of 591 patient with IBD treated with 6-MP in a single center were retrospectively reviewed. All allergic reactions were recorded along with results of rechallenge, desensitization, and subsequent course of IBD. Sixteen (2.7%) allergic reactions to 6-MP were noted, with fever being the most common (14 cases). Nine of these were rechallenged with 6-MP with recurrence of the same symptoms. Azathioprine was tried in six patients and in five the same symptoms recurred. Four patients underwent successful desensitization to either 6-MP or azathioprine; all four plus another patient who tolerated direct switch to azathioprine entered long-term remission. Among the remaining 11, 5 required surgery, 2 are well on methotrexate, and 4 have chronic symptoms while being treated with other medications. If an allergic reaction to 6-MP occurs during the treatment of IBD, direct switching to azathioprine is probably not justified. Instead, desensitization to either 6-MP or azathioprine should be attempted. Patients who can tolerate these medications after previous allergic reactions have improved outcomes compared with patients who resort to other forms of treatment.
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Affiliation(s)
- B I Korelitz
- Department of Medicine, Lenox Hill Hospital, New York University School of Medicine, NY, USA
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Fuller S. Leading change: a piano lesson. J AHIMA 1999; 70:54, 56-8. [PMID: 10344965] [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: 02/12/2023]
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Fattom A, Cho YH, Chu C, Fuller S, Fries L, Naso R. Epitopic overload at the site of injection may result in suppression of the immune response to combined capsular polysaccharide conjugate vaccines. Vaccine 1999; 17:126-33. [PMID: 9987146 DOI: 10.1016/s0264-410x(98)00162-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [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: 11/26/2022]
Abstract
Capsular polysaccharide (CP) conjugate vaccines targeting a variety of bacterial infections are currently under development and clinical evaluation. The inclusion of multiple CP serotypes combined in a single injection is an important maneuver being evaluated. The combination of CP conjugate vaccines into a single multivalent injection may result in competition among the different components and adversely affect the immunogenicity of any individual conjugate. We observed a reduction of 30-90% in antibody responses to several serotypes in mice when immunogenicity of a 12-valent Escherichia coli (E. coli) lipopolysaccharide (LPS) conjugate vaccine was compared to the immunogenicity of each monovalent vaccine evaluated separately. A reduction of 30% was observed in the Staphylococcus aureus (S. aureus) type 8 CP antibodies when a type 8-rEPA conjugate was combined with a type 5-rEPA conjugate. S. aureus types 5 and 8-rEPA conjugates were combined with 100 micrograms of either rEPA (homologous) or diphtheria toxoid (DT) (heterologous) carrier proteins, and evaluated in rEPA or DT primed mice. The addition of the homologous protein resulted in a 64% reduction in type 5 CP antibodies. The heterologous protein did not affect the immunogenicity of the type 5. We postulate that the free protein competed with the conjugate and recruited most of the rEPA primed T cells. In the case of the DT conjugates, the DT targeted different populations of the T cells, thus interference was not observed. These data suggested that the epitopic load rather than the antigenic load at the site of injection caused reduced immunogenicity of the conjugates. We theorize that individual components of multivalent CP vaccines conjugated to the same carrier proteins would compete for a limited number of specific carrier protein primed T cells. This would result in one or more components being unavailable in eliciting a sufficient immune response. The use of multiple carrier proteins should be considered as an approach to reduce interference when multivalent conjugate vaccines are to be formulated into a single injection.
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Affiliation(s)
- A Fattom
- Walter Karakawa Microbial Pathogenesis Laboratory, NABI, Rockville, MD 20852, USA.
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Martin T, Fuller S. Components of the CPR: an overview. J AHIMA 1998; 69:58-60, 62-4; quiz 65-6. [PMID: 10187472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- T Martin
- University of Washington Medical Centers Information Systems, USA
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Abstract
This project aims to clarify the phylogenetic relationships among the extant species of Varanus in order to elucidate the origins of Varanidae, using DNA sequences. Results obtained for a minimum of 662 nucleotides of 12S rRNA sequence data from each of 21 extant species of Varanus indicate that the Australian varanids form a single monophyletic clade and also suggest that within the Australian varanids, members of the subgenus Odatria (pygmy monitors) may from a clade separate from those in the subgenus Varanus (large monitors). The Asian species appear to be sister taxa to the Australian species, while the two African species investigated were most divergent, suggesting that the Varanidae are not Gondwanic in origin. Hypothesis testing analyses were performed and involved constraining the 12S sequence data according to previously described topologies and testing the difference using parametric and nonparametric statistics. The phylogeny generated using 12S sequence data was statistically different from previously described morphological trees, while there was some support for topologies based on chomosomal and immunological datasets. Overall, our results suggest that the Australian species may be derived from an Asian source and are, therefore, in agreement with the hypothesis based on the fossil record suggesting that Varanidae may be Asian in origin.
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Affiliation(s)
- S Fuller
- School of Applied Science, Southern Cross University, Lismore, New South Wales, Australia
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