1
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deBettencourt MF, Liu Y, Cotler SJ, Molvar CA, Abdelrahman T, Thomas TO. SBRT vs. Y90: HCC Treatment Outcomes and Costs. Am J Clin Oncol 2024; 47:99-104. [PMID: 37981697 DOI: 10.1097/coc.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Stereotactic Body Radiotherapy (SBRT) and Yttrium-90 (Y90) are among the ablative therapies used as treatment options for localized hepatocellular carcinoma (HCC). To date, direct comparisons of the 2 modalities' outcomes and costs are lacking. This study aimed to analyze demographic, treatment, and cost information for patients with HCC treated with SBRT and Y90. METHODS Patients with HCC treated with SBRT or Y90 radioembolization between January 2018 and January 2020 at one institution were retrospectively reviewed. Demographic and treatment data were compared utilizing χ 2 tests. Kaplan-Meier curves and log-rank tests were applied to compare overall survival and progression-free survival in different treatment groups. Cox proportional hazard models were applied to analyze the unadjusted and adjusted survival differences. Ten SBRT and 10 Y90 patients were randomly selected for Medicare cost analysis. RESULTS Sixty-three patients received Y90, and 21 received SBRT. On univariable and multivariable analysis, there was no significant difference in overall survival or progression-free survival between the Y90 and SBRT cohorts. SBRT patients had higher American Joint Committee on Cancer staging ( P =0.039), greater tumor size (4.07 vs. 2.96 cm, P =0.013), and greater rates of prior liver-directed therapy (71.4% SBRT vs. 12.7% Y90, P <0.001). The average cost for SBRT was $15,148, and Y90 was $41,360. CONCLUSIONS SBRT and Y90 are effective therapies in the treatment of HCC, specifically having similar overall survival and progression-free survival. Y90 was found to have a significantly higher cost than SBRT. This study demonstrates the need for prospective studies to assess these modalities in treating HCC.
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Affiliation(s)
| | - Yirong Liu
- Department of Radiation Oncology Northwestern Medical Group Northwestern Memorial Hospital Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital, Chicago, IL
| | | | | | | | - Tarita O Thomas
- Department of Radiation Oncology Northwestern Medical Group Northwestern Memorial Hospital Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital, Chicago, IL
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2
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Minto T, Abdelrahman T, Jones L, Wheat J, Key T, Shivakumar N, Ansell J, Seddon O, Cronin A, Tomkinson A, Theron A, Trickett RW, Sagua N, Sultana S, Clark A, McKay E, Johnson A, Behera K, Towler J, Kynaston H. Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board. Surg Open Sci 2022; 10:168-173. [PMID: 36211629 PMCID: PMC9531361 DOI: 10.1016/j.sopen.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P < .001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non–Protected Elective Surgical Unit (0.42% vs 3.2% P < .001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19–positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.
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Affiliation(s)
- T Minto
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - T Abdelrahman
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - L Jones
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - J Wheat
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - T Key
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - N Shivakumar
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - J Ansell
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - O Seddon
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Cronin
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Tomkinson
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Theron
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - RW Trickett
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - N Sagua
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - S Sultana
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - A Clark
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - E McKay
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - A Johnson
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - Karishma Behera
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - J Towler
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - H Kynaston
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW,School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN,Corresponding author at: School of Medicine, Cardiff University, Cardiff, United Kingdom CF14 4XN.
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3
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Minto T, Abdelrahman T, Jones L, Shivakumar N, Wheat J, Ansell J, Seddon O, Cronin A, Tomkinson A, Theron A, Trickett R, Kynaston H, Sagua N, Sultana S, Clark A, McKay E, Johnson A, Behera K, Towler J. 276 Safety of Maintaining Elective and Emergency Surgery During the COVID-19 Pandemic with the Introduction of an Innovative Protected Elective Surgical Unit (PESU): A Cross-Specialty Evaluation of 30-Day Outcomes in 9925 Patients Undergoing Surgery in a University Health Board. Br J Surg 2022. [DOI: 10.1093/bjs/znac040.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
High quality mobile health applications (mhealth apps) have the potential to enhance the prevention, diagnosis, and treatment of burns. The primary aim of this study was to evaluate whether the quality of mhealth apps for burns care is being adequately assessed. The secondary aim was to determine whether these apps meet UK regulatory standards.
Method
We searched AMED, BNI, CINAHL, Cochrane library, Embase, Emcare, Medline and PsychInfo to identify studies assessing mhealth app quality for burns. The PRISMA reporting guideline was adhered to. Two independent reviewers screened s to identify relevant studies. We analysed whether seven established domains of mhealth app quality were assessed: design, information/content, usability, functionality, ethical issues, security/privacy, and user-perceived value.
Results
Of the 28 included studies, none assessed all seven domains of quality. Design was assessed in 4/28 studies; information/content in 26/28 studies; usability in 12/28 studies; functionality in 10/28 studies; ethical issues were never assessed in any studies; security/privacy was not assessed; subjective assessment was made in 9/28 studies. 17/28 studies included apps that met the definition of ‘medical device’ according to MHRA guidance, yet only one app was appropriately certified with the UK Conformity Assessed (UKCA) mark.
Conclusions
The quality of mHealth apps for burns are not being adequately assessed. The majority of apps should be considered medical devices according to UK standards, but only one was appropriately certified. Regulatory bodies should support mhealth app developers, so as to improve quality control whilst simultaneously fostering innovation.
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Affiliation(s)
- T. Minto
- University Hospital Wales, Cardiff, United Kingdom
| | | | - L. Jones
- University Hospital Wales, Cardiff, United Kingdom
| | | | - J. Wheat
- University Hospital Wales, Cardiff, United Kingdom
| | - J. Ansell
- University Hospital Wales, Cardiff, United Kingdom
| | - O. Seddon
- University Hospital Wales, Cardiff, United Kingdom
| | - A. Cronin
- University Hospital Wales, Cardiff, United Kingdom
| | - A. Tomkinson
- University Hospital Wales, Cardiff, United Kingdom
| | - A. Theron
- University Hospital Wales, Cardiff, United Kingdom
| | - R. Trickett
- University Hospital Wales, Cardiff, United Kingdom
| | - H. Kynaston
- University Hospital Wales, Cardiff, United Kingdom
| | - N. Sagua
- Cardiff Medical School, Cardiff, United Kingdom
| | - S. Sultana
- Cardiff Medical School, Cardiff, United Kingdom
| | - A. Clark
- Cardiff Medical School, Cardiff, United Kingdom
| | - E. McKay
- Cardiff Medical School, Cardiff, United Kingdom
| | - A. Johnson
- Cardiff Medical School, Cardiff, United Kingdom
| | - K. Behera
- Cardiff Medical School, Cardiff, United Kingdom
| | - J. Towler
- Cardiff Medical School, Cardiff, United Kingdom
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Powell AGMT, Eley C, Abdelrahman T, Coxon AH, Chin C, Appadurai I, Davies R, Bailey DM, Lewis WG. Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery. BJS Open 2020; 4:840-846. [PMID: 32749071 PMCID: PMC7528531 DOI: 10.1002/bjs5.50328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The extent to which physiological factors influence outcome following oesophageal cancer surgery is poorly understood. This study aimed to evaluate the extent to which cardiorespiratory fitness and selected metabolic factors predicted complications after surgery for carcinoma. METHODS Two hundred and twenty-five consecutive patients underwent preoperative cardiopulmonary exercise testing to determine peak oxygen uptake ( V ˙ o2peak ), anaerobic threshold and the ventilatory equivalent for carbon dioxide ( V ˙ e/ V ˙ co2 ). Cephalic venous blood was assayed for serum C-reactive protein (CRP) and albumin levels, and a full blood count was done. The primary outcome measure was the Morbidity Severity Score (MSS). RESULTS One hundred and ninety-eight patients had anatomical resection. A high MSS (Clavien-Dindo grade III or above) was found in 48 patients (24·2 per cent) and was related to an increased CRP concentration (area under the receiver operating characteristic (ROC) curve (AUC) 0·62, P = 0·001) and lower V ˙ o2peak (AUC 0·36, P = 0·003). Dichotomization of CRP levels (above 10 mg/l) and V ˙ o2peak (below 18·6 ml per kg per min) yielded adjusted odds ratios (ORs) for a high MSS of 2·86 (P = 0·025) and 2·92 (P = 0·002) respectively. Compared with a cohort with a low Combined Inflammatory and Physiology Score (CIPS), the OR was 1·70 (95 per cent c.i. 0·85 to 3·39) for intermediate and 27·47 (3·12 to 241·69) for high CIPS (P < 0·001). CONCLUSION CRP and V ˙ o2peak were independently associated with major complications after potentially curative oesophagectomy for cancer. A composite risk score identified a group of patients with a high risk of developing complications.
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Affiliation(s)
- A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK.,Departments of Surgery, Cardiff, UK
| | - C Eley
- Departments of Surgery, Cardiff, UK
| | | | | | - C Chin
- Departments of Surgery, Cardiff, UK
| | - I Appadurai
- Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - R Davies
- Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - D M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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5
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Robinson DBT, Hopkins L, James OP, Brown C, Powell AGMT, Hemington-Gorse S, Abdelrahman T, Lewis WG, Egan RJ. Surgical training rotation design: effects of hospital type, rotation theme and duration. BJS Open 2020; 4:970-976. [PMID: 32706526 PMCID: PMC7528516 DOI: 10.1002/bjs5.50326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 06/17/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Entrants into UK surgical specialty training undertake a 2-year programme of core surgical training, rotating through specialties for varying lengths of time, at different hospitals, to gain breadth of experience. This study aimed to assess whether these variables influenced core surgical trainee (CST) work productivity. METHODS Intercollegiate Surgical Curriculum Programme portfolios of consecutive CSTs between 2016 and 2019 were examined. Primary outcome measures were workplace-based assessment (WBA) completion, operative experience and academic outputs (presentations to learned societies, publications and audits). RESULTS A total of 344 rotations by 111 CSTs were included. Incremental increases in attainment were observed related to the duration of core surgical training rotation. The median number of consultant-validated WBAs completed during core surgical training were 48 (range 0-189), 54 (10-120) and 75 (6-94) during rotations consisting of 4-, 6- and 12-month posts respectively (P < 0·001). Corresponding median operative caseloads (as primary surgeon) were 84 (range 3-357), 110 (44-394) and 134 (56-366) (P < 0·001) and presentations to learned societies 0 (0-12), 0 (0-14) and 1 (0-5) (P = 0·012) respectively. Hospital type and specialty training theme were unrelated to workplace productivity. Multivariable analysis identified length of hospital rotation as the only factor independently associated with total WBA count (P = 0·001), completion of audit (P = 0·015) and delivery of presentation (P = 0·001) targets. CONCLUSION Longer rotations with a single educational supervisor, in one training centre, are associated with better workplace productivity. Consideration should be given to this when reconfiguring training programmes within the arena of workforce planning.
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Affiliation(s)
- D B T Robinson
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - L Hopkins
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK.,Department of Surgery, Morriston Hospital, Swansea, UK
| | - O P James
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - C Brown
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, UK
| | - S Hemington-Gorse
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - T Abdelrahman
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - W G Lewis
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - R J Egan
- Department of Surgery, Morriston Hospital, Swansea, UK.,Swansea Medical School, Swansea University, Swansea, UK
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6
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Robinson DBT, Powell AGMT, Hopkins L, James OP, Abdelrahman T, Egan R, Lewis WG. Proof of surgical publication prowess: prospective observational study of factors associated with surrogate markers of academic reach. BJS Open 2020; 4:724-729. [PMID: 32490575 PMCID: PMC7397360 DOI: 10.1002/bjs5.50307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/05/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In the UK, general surgery higher surgical trainees (HSTs) must publish at least three peer-reviewed scientific articles (as first, second or corresponding author) to qualify for certification of completion of training (CCT). This study aimed to identify the factors associated with success in this arena. METHODS Deanery rosters supplemented with data from the Intercollegiate Surgical Curriculum Programme, PubMed and ResearchGate were used to identify the profiles of consecutive HSTs. Primary outcomes were publication numbers at defined points in higher training (speciality training year (ST) 3-8); secondary outcomes were the Hirsch index and ResearchGate scores. RESULTS Fifty-nine consecutive HSTs (24 women, 35 men) were studied. The median publication number was 3 (range 0-30). At least three published articles were obtained by 30 HSTs (51 per cent), with 19 (38 per cent) of 50 HSTs achieving this by ST4 (of whom 15 (79 per cent) had undertaken out of programme for research (OOPR) time) and 24 (80 per cent) by ST6. Thirteen HSTs (22 per cent) (ST3, 6; ST4, 4; ST5, 2; ST8, 1) had yet to publish at the time of writing. OOPR was associated with achieving three publications (24 of 35 (69 per cent) versus 6 of 24 (25 per cent) with no formal research time; P = 0·001), higher overall number of publications (median 6 versus 1 respectively; P < 0·001), higher ResearchGate score (median 23·37 versus 5·27; P < 0·001) and higher Hirsch index (median 3 versus 1; P < 0·001). In multivariable analysis, training grade (odds ratio (OR) 1·89, 95 per cent c.i. 0·01 to 3·52; P = 0·045) and OOPR (OR 6·55, 2·04 to 21·04; P = 0·002) were associated with achieving three publications. CONCLUSION If CCT credentials are to include publication profiles, HST programmes should incorporate research training in workforce planning.
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Affiliation(s)
- D B T Robinson
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - L Hopkins
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - O P James
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - T Abdelrahman
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - R Egan
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - W G Lewis
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
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7
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Wood S, James OP, Hopkins L, Harries R, Robinson DBT, Brown CM, Abdelrahman T, Egan RJ, Lewis WG. Variations in competencies needed to complete surgical training. BJS Open 2019; 3:852-856. [PMID: 31832592 PMCID: PMC6887895 DOI: 10.1002/bjs5.50200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 03/13/2019] [Accepted: 05/22/2019] [Indexed: 11/07/2022] Open
Abstract
Background This study aimed to analyse the degree of relative variation in specialty-specific competencies required for certification of completion of training (CCT) by the UK Joint Committee on Surgical Training. Methods Regulatory body guidance relating to operative and non-operative surgical skill competencies required for CCT were analysed and compared. Results Wide interspecialty variation was demonstrated in the required minimum number of logbook cases (median 1201 (range 60-2100)), indexed operations (13 (5-55)), procedure-based assessments (18 (7-60)), publications (2 (0-4)), communications to learned associations (0 (0-6)) and audits (4 (1-6)). Mandatory courses across multiple specialties included: Training the Trainers (10 of 10 specialties), Advanced Trauma Life Support (6 of 10), Good Clinical Practice (9 of 10) and Research Methodologies (8 of 10), although no common accord was evident. Discussion Certification guidelines for completion of surgical training were inconsistent, with metrics related to minimum operative caseload and academic reach having wide variation.
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Affiliation(s)
- S Wood
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - O P James
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - L Hopkins
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - R Harries
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - D B T Robinson
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - C M Brown
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - T Abdelrahman
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - R J Egan
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK.,Department of Surgery Morriston Hospital, Heol Maes Eglwys Swansea UK
| | - W G Lewis
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
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8
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Dewi F, Egan RJ, Abdelrahman T, Morris C, Stechman MJ, Lewis WG. Prognostic Significance of Acute Kidney Injury Following Emergency Laparotomy: A Prospective Observational Cohort Study. World J Surg 2018; 42:3575-3580. [PMID: 30097705 DOI: 10.1007/s00268-018-4744-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/28/2022]
Abstract
AIMS Post-operative acute kidney injury (AKI) is a common and independent mortality risk factor carrying high clinical and economic cost. This study aimed to establish the incidence of AKI in patients undergoing emergency laparotomy (EL), to determine patients' risk profile and consequent mortality. METHODS Consecutive 239 patients of median age 68 (IQR 51-76) years, undergoing EL in a UK tertiary hospital, were studied. Primary outcome measure was AKI and in-hospital operative mortality. RESULTS Ninety-five patients (39.7%) developed AKI, which was associated with in-hospital mortality in 32 patients (33.7%) compared with 7 patients (4.9%) without AKI. AKI occurred in 81.1% of all mortalities, but none occurred when AKI resolved within 48 h of EL. AKI was associated with chronic kidney disease, age, serum lactate, white cell count, pre-EL systolic blood pressure and tachycardia (p < 0.010). Median length of hospital stay in AKI survivors was 15 days compared with 11 days in the absence of AKI (p < 0.001). On multivariable analysis, only AKI at 48 h post-EL was significantly and independently associated with mortality [HR 10.895, 95% CI 3.152-37.659, p < 0.001]. CONCLUSION Peri-operative AKI after EL was common and associated with a more than sixfold significant greater mortality. Pre-operative risk profile assessment and prompt protocol-driven intervention should minimise AKI and reduce EL mortality.
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Affiliation(s)
- F Dewi
- Wales Postgraduate Medical and Dental Education Deanery, Cardiff, UK
| | - R J Egan
- Wales Postgraduate Medical and Dental Education Deanery, Cardiff, UK
| | - T Abdelrahman
- Wales Postgraduate Medical and Dental Education Deanery, Cardiff, UK
| | - C Morris
- Department of Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - M J Stechman
- Department of Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - W G Lewis
- Department of Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK.
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9
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Abdelrahman T, Latif A, Chan D, Jones H, Farag M, Lewis W, Havard T, Escofet X. Outcomes after laparoscopic anti-reflux surgery related to obesity: A systematic review and meta-analysis. Int J Surg 2018; 51:76-82. [DOI: 10.1016/j.ijsu.2018.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
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Brown C, Abdelrahman T, Patel N, Thomas C, Pollitt MJ, Lewis WG. Operative learning curve trajectory in a cohort of surgical trainees. Br J Surg 2017; 104:1405-1411. [DOI: 10.1002/bjs.10584] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/20/2017] [Accepted: 04/04/2017] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Certification of completion of training in general surgery in the UK requires demonstration of competence in index operations by means of three level 4 competence consultant-validated procedure-based assessments (PBAs). The aim of this study was to evaluate the trajectory of operative learning curves related to PBA performance levels for curriculum-defined indicative operations with respect to numbers performed and training time.
Methods
Logbook data from consecutive higher general surgical trainees were compared with PBA evaluations to determine the relationship between PBA performance level, operative experience, training time and indicative numbers. Learning curve gradients were calculated using the inverse trigonometric function of tan related to operative experience and training time.
Results
Eighty-four surgical trainees participated. Median caseload to achieve three level 4 competence assessments was 64 (range 18–110) for inguinal hernia, 83 (15–177) for emergency laparotomy, 87 (23–192) for laparoscopic cholecystectomy, 95 (22–209) for appendicectomy, 45 (17–111) for segmental colectomy and 16 (6–28) for Hartmann's procedure. Median learning curve gradients to achieve level 4 competence for emergency laparotomy were 15·3° and 33·7° by caseload and training time respectively, compared with 73·3° and 59·9° for Hartmann's procedure. Significant variance was observed in the gradients of all learning curves related to both the caseload between the first level 3 and the first level 4 PBA (P = 0·001), and between the first and third level 4 PBAs (P < 0·001).
Conclusion
Significant learning curve gradient variance was observed, with discrepancies between expected indicative operative numbers and the point at which competence was judged to have been achieved. Numbers of index operations to achieve certification of completion of training warrant further examination.
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Affiliation(s)
- C Brown
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - T Abdelrahman
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - N Patel
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - C Thomas
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - M J Pollitt
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - W G Lewis
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
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Egan RJ, Abdelrahman T, Tate S, Ansell J, Harries R, Davies L, Clark G, Lewis WG. Modular emergency general surgery training: A pilot study of a novel programme. Ann R Coll Surg Engl 2016; 98:475-8. [PMID: 27269241 PMCID: PMC5210010 DOI: 10.1308/rcsann.2016.0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Pan-speciality consensus guidance advocates mandatory emergency general surgery (EGS) training modules for specialist registrars (StRs). This pilot study evaluated the impact of EGS modules aimed at StRs over 1 year. Methods Eleven StRs were allocated a focused 4-week EGS module, in addition to the standard 1:12 on-call duty rota, in a tertiary surgical centre. Primary outcome measures included the number of indicative emergency operations and validated Procedure Based Assessments (PBAs) performed, both during the EGS module and over the training year. Results StRs performed a median of 11 (range 5-15) laparotomies during the EGS module versus 31 (range 9-49) over the whole training year. StRs attended 43.7% of available laparotomies during the module (range 24.1-63.7%). EGS modules provided more than one-third of the total emergency laparotomy experience, and a quarter of the emergency colectomy, appendicectomy and Hartmann's procedure experience. There were no differences in EGS module-related outcomes between junior and senior StRs. Significantly more PBAs related to laparotomy and segmental colectomy were completed during EGS modules than the on-call duty rota, at 32% versus 14% (p<0.001) and 48% versus 22% (p=0.019), respectively. Performance levels were maintained following module completion. Conclusions These findings provide an important baseline when considering future modular EGS training.
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Affiliation(s)
- R J Egan
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | | | - S Tate
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | - J Ansell
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | | | - L Davies
- University Hospital of Wales , Cardiff , UK
| | - Gwb Clark
- University Hospital of Wales , Cardiff , UK
| | - W G Lewis
- University Hospital of Wales , Cardiff , UK
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Bosanquet D, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey J, Frewer K, Frewer N, Russell D, Russell I, Torkington J. Systematic review and meta regression of factors affecting midline incisional hernia rates: An analysis of 14,618 patients. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.307] [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: 10/22/2022]
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13
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Abdelrahman T, Witkowska W, Al-Otaibi S, Vattipally S, Thomson E. Baseline majority and minority resistance mutations in HIV-infected MSM with acute HCV. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Shepherd SJ, Abdelrahman T, MacLean AR, Thomson EC, Aitken C, Gunson RN. Prevalence of HCV NS3 pre-treatment resistance associated amino acid variants within a Scottish cohort. J Clin Virol 2015; 65:50-3. [PMID: 25766988 PMCID: PMC4728298 DOI: 10.1016/j.jcv.2015.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Protease inhibitors (PI) including boceprevir, telaprevir and simeprevir have revolutionised HCV genotype 1 treatment since their introduction. A number of pre-treatment resistance associated amino acid variants (RAVs) and polymorphisms have been associated with reduced response to treatment. OBJECTIVES We measured the prevalence of RAVs/polymorphisms in a PI treatment-naïve HCV genotype 1 Scottish cohort using Sanger sequencing. STUDY DESIGN Chronically infected, treatment-naïve, HCV genotype 1 patients (n = 146) attending NHS Greater Glasgow and Clyde clinics were investigated for RAVs/polymorphisms to the PIs boceprevir, telaprevir and simeprevir. The NS3/4A region was amplified by nested polymerase chain reaction. The 1.4 kb amplified product was sequenced using an ABI 3710XL DNA sequencer. Sequence analysis was performed using web-based ReCall (beta 2.10). Amino acid positions 36, 41, 43, 54, 55, 80, 109, 122, 155, 156, 168 and 170 were analysed for RAVs/polymorphisms. RESULTS Overall, 23.29% (34/146) of patients had an RAV or polymorphism detected. Overall, 13.69% (20/146) of patients had HCV virus that contained the Q8 K polymorphism. Other RAVs detected were: V36 M 0.70% (1/146), V36L 0.70% (1/146), T54S 6.85% (10/146), V55A 3.42% (5/146) and V/I170A 0.68% (1/146). Four patients had dual combinations of mutations (T54S+V36L; T54S+V55A and 2 patients with T54S+Q80K). CONCLUSIONS Q80K was the most prevalent baseline polymorphism detected in the Scottish cohort. Simeprevir treatment is not recommended in patients infected with the Q80K genotype 1a variant. This highlights the need for baseline sequencing prior to administration of this drug in this population.
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Affiliation(s)
- Samantha J Shepherd
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom.
| | - Tamer Abdelrahman
- MRC-University of Glasgow Centre for Virus Research, Stoker Building, 464 Bearsden Road, Glasgow G61 1QH, United Kingdom
| | - Alasdair R MacLean
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Stoker Building, 464 Bearsden Road, Glasgow G61 1QH, United Kingdom
| | - Celia Aitken
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom
| | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom
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Abdelrahman T, Hughes J, Main J, McLauchlan J, Thursz M, Thomson E. Reply: To PMID 24797101. Hepatology 2015; 61:1438. [PMID: 25147121 PMCID: PMC4407921 DOI: 10.1002/hep.27393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | - Joseph Hughes
- MRC University of Glasgow Centre for Virus ResearchGlasgow, UK
| | - Janice Main
- Department of Medicine, Imperial College NHS TrustLondon, UK
| | - John McLauchlan
- MRC University of Glasgow Centre for Virus ResearchGlasgow, UK
| | - Mark Thursz
- Department of Medicine, Imperial College NHS TrustLondon, UK
| | - Emma Thomson
- MRC University of Glasgow Centre for Virus ResearchGlasgow, UK,Department of Medicine, Imperial College NHS TrustLondon, UK
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Abdelrahman T, Hughes J, Main J, McLauchlan J, Thursz M, Thomson E. Next-generation sequencing sheds light on the natural history of hepatitis C infection in patients who fail treatment. Hepatology 2015; 61:88-97. [PMID: 24797101 PMCID: PMC4303934 DOI: 10.1002/hep.27192] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/29/2014] [Indexed: 12/18/2022]
Abstract
UNLABELLED High rates of sexually transmitted infection and reinfection with hepatitis C virus (HCV) have recently been reported in human immunodeficiency virus (HIV)-infected men who have sex with men and reinfection has also been described in monoinfected injecting drug users. The diagnosis of reinfection has traditionally been based on direct Sanger sequencing of samples pre- and posttreatment, but not on more sensitive deep sequencing techniques. We studied viral quasispecies dynamics in patients who failed standard of care therapy in a high-risk HIV-infected cohort of patients with early HCV infection to determine whether treatment failure was associated with reinfection or recrudescence of preexisting infection. Paired sequences (pre- and posttreatment) were analyzed. The HCV E2 hypervariable region-1 was amplified using nested reverse-transcription polymerase chain reaction (RT-PCR) with indexed genotype-specific primers and the same products were sequenced using both Sanger and 454 pyrosequencing approaches. Of 99 HIV-infected patients with acute HCV treated with 24-48 weeks of pegylated interferon alpha and ribavirin, 15 failed to achieve a sustained virological response (six relapsed, six had a null response, and three had a partial response). Using direct sequencing, 10/15 patients (66%) had evidence of a previously undetected strain posttreatment; in many studies, this is interpreted as reinfection. However, pyrosequencing revealed that 15/15 (100%) of patients had evidence of persisting infection; 6/15 (40%) patients had evidence of a previously undetected variant present in the posttreatment sample in addition to a variant that was detected at baseline. This could represent superinfection or a limitation of the sensitivity of pyrosequencing. CONCLUSION In this high-risk group, the emergence of new viral strains following treatment failure is most commonly associated with emerging dominance of preexisting minority variants rather than reinfection. Superinfection may occur in this cohort but reinfection is overestimated by Sanger sequencing.
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Affiliation(s)
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus ResearchGlasgow, UK
| | - Janice Main
- Department of Medicine, Imperial College NHS TrustLondon, UK
| | - John McLauchlan
- MRC-University of Glasgow Centre for Virus ResearchGlasgow, UK
| | - Mark Thursz
- Department of Medicine, Imperial College NHS TrustLondon, UK
| | - Emma Thomson
- MRC-University of Glasgow Centre for Virus ResearchGlasgow, UK
- Department of Medicine, Imperial College NHS TrustLondon, UK
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Coulman KD, Abdelrahman T, Owen-Smith A, Andrews RC, Welbourn R, Blazeby JM. Patient-reported outcomes in bariatric surgery: a systematic review of standards of reporting. Obes Rev 2013; 14:707-20. [PMID: 23639053 DOI: 10.1111/obr.12041] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/20/2013] [Accepted: 04/01/2013] [Indexed: 12/01/2022]
Abstract
Bariatric surgery is increasingly being used to treat severe obesity, but little is known about its impact on patient-reported outcomes (PROs). For PRO data to influence practice, well-designed and reported studies are required. A systematic review identified prospective bariatric surgery studies that used validated PRO measures. Risk of bias in randomized controlled trials (RCTs) was assessed, and papers were examined for reporting of (i) who completed PRO measures; (ii) missing PRO data and (iii) clinical interpretation of PRO data. Studies meeting all criteria were classified as robust. Eighty-six studies were identified. Of the eight RCTs, risk of bias was high in one and unclear in seven. Sixty-eight different PRO measures were identified, with the Short Form (SF)-36 questionnaire most commonly used. Forty-one (48%) studies explicitly stated measures were completed by patients, 63 (73%) documented missing PRO data and 50 (58%) interpreted PRO data clinically. Twenty-six (30%) met all criteria. Although many bariatric surgery studies assess PROs, study design and reporting is often poor, limiting data interpretation and synthesis. Well-designed studies that include agreed PRO measures are needed with reporting to include integration with clinical outcomes to inform practice.
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Affiliation(s)
- K D Coulman
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK; Department of Bariatric and Upper GI Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
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Atchade PS, Doderer-Lang C, Chabi N, Perrotey S, Abdelrahman T, Akpovi CD, Anani L, Bigot A, Sanni A, Candolfi E. Is a Plasmodium lactate dehydrogenase (pLDH) enzyme-linked immunosorbent (ELISA)-based assay a valid tool for detecting risky malaria blood donations in Africa? Malar J 2013; 12:279. [PMID: 23927596 PMCID: PMC3750723 DOI: 10.1186/1475-2875-12-279] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 07/06/2013] [Indexed: 11/18/2022] Open
Abstract
Background Malaria is a leading cause of mortality in southern Benin. The main causative agent, Plasmodium falciparum, poses a threat on critical transfusions in pregnant women and children. This study’s objective was to compare the performance of different malaria screening methods in blood donors in southern Benin, a malaria-endemic country. Methods Blood from 2,515 voluntary blood donors in Benin was collected over a period of 10 months in ethylenediaminetetraacetic acid (EDTA) tubes, which were then classified according to extraction time: long rainy season, short dry season, short rainy season, and long dry season. Microscopic examination was used to count parasites. Parasite density (PD) was expressed as the number of parasites per μL of blood. Pan Plasmodium pLDH detection was assessed by an ELISA-malaria antigen test. Using crude soluble P. falciparum antigens, an ELISA-malaria antibody test detected anti-Plasmodium antibodies. Results Among the 2,515 blood donors (2,025 males and 488 females) screened, the rate of asymptomatic Plasmodium carriage was 295/2,515 (11.72%, 95% CI: 10.5-13.1%). Males had a higher infection rate (12.4%) than did females (8.8%). Parasite density was very low: between seven and100 parasites per μL of blood was reported in 80% of donors with parasitaemia. Three Plasmodium species were diagnosed: P. falciparum in 280/295 patients (95.0%), Plasmodium malariae in 14/295 (5.0%), and Plasmodium ovale in 1/295 (0.34%). Malaria prevalence in donors was higher during the rainy seasons (13.7%) compared with the dry seasons (9.9%). The use of a highly sensitive assay enabled pan Plasmodium pLDH detection in 966/2,515 (38.4%, 95% CI: 36.5%-40.3%). Malaria antibody prevalence was 1,859/2,515 (73.9%, 95% CI: 72.16-75.6%). Donors’ antigenaemia and antibody levels varied significantly (P <0.05) over the course of the four seasons. The highest antigenaemia rate 323/630 (51.3%), was observed during the short rainy season, while the highest antibody prevalence, 751/886 (84.7%), was recorded during the long dry season. Conclusion Blood donations infected with Plasmodium can transmit malaria to donation recipients. Malaria diagnostic methods are currently available, but the feasibility criteria for mass screening in endemic areas become preponderant. Detection of the pLDH antigen seems to be an adequate screening tool in endemic areas, for this antigen indicates parasite presence. Routine screening of all donated blood would prevent infected blood donations and reduce P. falciparum transmission in critical patients, such as children and pregnant women. This tool would also decrease medical prophylaxis in donation recipients and contribute to lower Plasmodium resistance.
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Affiliation(s)
- Pascal S Atchade
- Institut de Parasitologie et de Pathologie Tropicale (IPPTS) - Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
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Moore C, Galiano M, Lackenby A, Abdelrahman T, Barnes R, Evans MR, Fegan C, Froude S, Hastings M, Knapper S, Litt E, Price N, Salmon R, Temple M, Davies E. Evidence of person-to-person transmission of oseltamivir-resistant pandemic influenza A(H1N1) 2009 virus in a hematology unit. J Infect Dis 2011; 203:18-24. [PMID: 21148492 DOI: 10.1093/infdis/jiq007] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe the first confirmed person-to-person transmission of oseltamivir-resistant pandemic influenza A(H1N1) 2009 virus that occurred in a hematology unit in the United Kingdom. Eleven cases of (H1N1) 2009 virus infection were identified, of which, ten were related as shown by sequence analysis of the hemagglutinin and neuraminidase genes. H275Y analysis demonstrated that 8 of 10 case patients had oseltamivir-resistant virus, with 4 of 8 case patients infected by direct transmission of resistant virus. Zanamivir should be considered as first-line therapy for influenza in patients with lymphopenic hematological conditions and uptake of influenza vaccination encouraged to further reduce the number of susceptible individuals.
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Affiliation(s)
- Catherine Moore
- Public Health Wales Microbiology, Public Health Wales NHS Trust, Cardiff, UK
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20
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Holt RIG, Abdelrahman T, Hirsch M, Dhesi Z, George T, Blincoe T, Peveler RC. The prevalence of undiagnosed metabolic abnormalities in people with serious mental illness. J Psychopharmacol 2010; 24:867-73. [PMID: 19304868 DOI: 10.1177/0269881109102788] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of metabolic syndrome is increased 2-3-fold in people with serious mental illness (SMI). Monitoring of physical health in these individuals is poor, despite clear guidance from the National Institute of Health and Clinical Excellence. The aim of this study was to assess the proportion of people with SMI who had been screened for metabolic abnormalities within the previous year and in a further study to assess the prevalence of undiagnosed metabolic abnormalities in people who had not been screened. The notes and computer records of 100 patients with SMI from community and in-patient settings were evaluated. In a subsequent study, the prevalence of metabolic syndrome was assessed in 71 previously unscreened patients. The study was carried out at the psychiatric in-patient and out-patient units in Southampton and Winchester. The frequency of screening and prevalence of the metabolic syndrome as defined by the International Diabetes Federation (IDF) were assessed. There was documented evidence that the following cardiovascular risk factors had been measured in the previous year: blood pressure (32%), glucose (16%), lipids (9%) and weight (2%). In the metabolic abnormalities study, 41 of 71 (58%) patients were found to fulfil the IDF criteria for the metabolic syndrome. Two had previously undiagnosed diabetes. Twelve percent of patients had a greater than 20% risk of a cardiovascular event within the next 10 years. Despite clear guidance and a high prevalence of undiagnosed metabolic syndrome, screening rates for metabolic abnormalities in people with SMI remain low. Improved screening of metabolic complications should lead to better identification and treatment of this clinical problem.
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Affiliation(s)
- R I G Holt
- Endocrinology & Metabolism Sub-division, Developmental Origins of Adult Disease Division, University of Southampton, Southampton, UK.
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Lahmar I, Guinard M, Sauer A, Marcellin L, Abdelrahman T, Roux M, Mousli M, Moussa A, Babba H, Pfaff AW, Candolfi E. Murine neonatal infection provides an efficient model for congenital ocular toxoplasmosis. Exp Parasitol 2010; 124:190-6. [DOI: 10.1016/j.exppara.2009.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 09/03/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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Lahmar I, Abou-Bacar A, Abdelrahman T, Guinard M, Babba H, Ben Yahia S, Kairallah M, Speeg-Schatz C, Bourcier T, Sauer A, Villard O, Pfaff AW, Mousli M, Garweg JG, Candolfi E. Cytokine profiles in toxoplasmic and viral uveitis. J Infect Dis 2009; 199:1239-49. [PMID: 19302012 DOI: 10.1086/597478] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Uveitis is a major cause of visual impairment throughout the world. Analysis of cytokine profiles in aqueous humor specimens may provide insight into the physiopathological processes that underly retinal damage in this context. METHODS Using a multiplex assay, we determined the concentrations of 17 cytokines and chemokines in aqueous humor specimens obtained from patients with ocular toxoplasmosis or viral uveitis and compared these concentrations with those in specimens obtained from patients with noninfectious intermediate uveitis or cataract. RESULTS Five mediators (interleukin [IL]-8, monocyte chemoattractant protein-1, tumor necrosis factor-alpha, IL-4, and IL-10) were detected in >50% of patients in all groups. In contrast, IL-5 and IL-12 were specific for ocular toxoplasmosis, and granulocyte monocyte colony-stimulating factor and IL-1 were specific for viral uveitis; these mediators could present specific markers for diagnostic purposes. Interferon-gamma, IL-6, and macrophage inflammatory protein-1beta were common markers of ocular toxoplasmosis and viral uveitis. IL-17 was a common marker of ocular toxoplasmosis and intermediate uveitis. CONCLUSIONS We found specific cytokine profiles for each type of uveitis, with large interindividual variations and no etiological or clinical correlations. Ocular cytokine mapping contributes to a better understanding of the physiopathology of specific forms of uveitis and provides guidance for new targeted treatment.
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Affiliation(s)
- Ibtissem Lahmar
- Institut de Parasitologie et de Pathologie Tropicale, Université de Strasbourg, Strasbourg, France
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Mason AJ, Moussaoui W, Abdelrahman T, Boukhari A, Bertani P, Marquette A, Shooshtarizaheh P, Moulay G, Boehm N, Guerold B, Sawers RJH, Kichler A, Metz-Boutigue MH, Candolfi E, Právost G, Bechinger B. Structural determinants of antimicrobial and antiplasmodial activity and selectivity in histidine-rich amphipathic cationic peptides. J Biol Chem 2008; 284:119-133. [PMID: 18984589 DOI: 10.1074/jbc.m806201200] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Designed histidine-rich amphipathic cationic peptides, such as LAH4, have enhanced membrane disruption and antibiotic properties when the peptide adopts an alignment parallel to the membrane surface. Although this was previously achieved by lowering the pH, here we have designed a new generation of histidine-rich peptides that adopt a surface alignment at neutral pH. In vitro, this new generation of peptides are powerful antibiotics in terms of the concentrations required for antibiotic activity; the spectrum of target bacteria, fungi, and parasites; and the speed with which they kill. Further modifications to the peptides, including the addition of more hydrophobic residues at the N terminus, the inclusion of a helix-breaking proline residue or using D-amino acids as building blocks, modulated the biophysical properties of the peptides and led to substantial changes in toxicity to human and parasite cells but had only a minimal effect on the antibacterial and antifungal activity. Using a range of biophysical methods, in particular solid-state NMR, we show that the peptides are highly efficient at disrupting the anionic lipid component of model membranes. However, we also show that effective pore formation in such model membranes may be related to, but is not essential for, high antimicrobial activity by cationic amphipathic helical peptides. The information in this study comprises a new layer of detail in the understanding of the action of cationic helical antimicrobial peptides and shows that rational design is capable of producing potentially therapeutic membrane active peptides with properties tailored to their function.
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Affiliation(s)
- A James Mason
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland.
| | - Wardi Moussaoui
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Tamer Abdelrahman
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Alyae Boukhari
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Philippe Bertani
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Arnaud Marquette
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Peiman Shooshtarizaheh
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Gilles Moulay
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Nelly Boehm
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Bernard Guerold
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Ruairidh J H Sawers
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Antoine Kichler
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Marie-Háléne Metz-Boutigue
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Ermanno Candolfi
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Gilles Právost
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
| | - Burkhard Bechinger
- Universitá Louis Pasteur/CNRS, UMR7177, Institut de Chimie, 4 Rue Blaise Pascal, F-67070 Strasbourg, France, the UPRES EA-3432 Institut de Bactáriologie, Universitá Louis Pasteur-Hôpitaux Universitaires de Strasbourg, 3 Rue Koeberlá F-67000 Strasbourg, France, the UPRES EA-3950 Institut de Parasitologie et de Pathologie Tropicale de la FacultádeMádecine, Universitá Louis Pasteur, 3 Rue Koeberlá F-67000 Strasbourg, France, INSERM Unitá 575, Physiopathologie du Systéme Nerveux, 5 Rue Blaise Pascal, F-67084 Strasbourg, France, CNRS FRE 3087-Gánáthon, 1 Rue de l'Internationale, F-91002, Evry, France, INSERM Unitá 666 and Service Central de Microscopie Electronique, Universitá Louis Pasteur, 11 Rue Humann, F-67085 Strasbourg, France, and the Department of Plant Molecular Biology, University of Lausanne, Biophore Building, CH-1015 Lausanne, Switzerland
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Elghouzzi MH, Senegas A, Steinmetz T, Guntz P, Barlet V, Assal A, Gallian P, Volle P, Chuteau C, Beolet M, Berrebi S, Filisetti D, Doderer C, Abdelrahman T, Candolfi E. Multicentric evaluation of the DiaMed enzyme-linked immunosorbent assay malaria antibody test for screening of blood donors for malaria. Vox Sang 2007; 94:33-40. [PMID: 18021184 DOI: 10.1111/j.1423-0410.2007.00998.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk of malaria transmission by blood transfusion is critical due to extensive travel from endemic areas to non-endemic areas. An enzyme-linked immunosorbent assay (ELISA) malaria antibody test has been developed that is claimed to perform better than the immunofluorescence assay test (IFAT). The assay contains antigens to both Plasmodium falciparum and Plasmodium vivax. A multicentre study was performed to evaluate the appropriateness of replacing the IFAT by the new ELISA test. MATERIAL AND METHODS Nine French blood banks participated in this multicentre study. Two panels of samples were evaluated. The first included 4163 samples from healthy donors and was used to calculate clinical specificity of the assay. The second involved 10,995 samples, either collected retrospectively or prospectively from malaria-risk donors , was used to assess the comparative performance of the ELISA and IFAT. Discordant samples were further tested using an in-house IFAT and also tested for presence of Plasmodium DNA by polymerase chain reaction. RESULTS The ELISA showed a clinical specificity of 99.02%. In the malaria-risk blood donors groups, the retrospective group showed a concordance rate of 92.6% (k = 0.90), while the prospective group showed a concordance rate of 97% (k = 0.46). After confirming the discordant sample results by an in-house IFAT, the k index increased to 0.81. None of the discordant samples was shown to contain Plasmodium DNA. CONCLUSION The performance of the ELISA test in this study has confirmed its potential as a new screening test for use in blood banks, as an alternative to the IFAT in prevention of transfusion-transmitted malaria in non-endemic countries.
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Affiliation(s)
- M-H Elghouzzi
- Etablissement Français du Sang Ile de France, 94150 Rungis, France
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Abdelrahman T, Letscher Bru V, Waller J, Noacco G, Candolfi E. Dermatomycosis: comparison of the performance of calcofluor and potassium hydroxide 30% for the direct examination of skin scrapings and nails. J Mycol Med 2006. [DOI: 10.1016/j.mycmed.2006.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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