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Stanworth SJ, Killick S, McQuilten ZK, Karakantza M, Weinkove R, Smethurst H, Pankhurst LA, Hodge RL, Hopkins V, Thomas HL, Deary AJ, Callum J, Lin Y, Wood EM, Buckstein R, Bowen D, Wallis L, Rabbi T, Serrano M, Williams R, Chacko J, Darlow J, Watson L, Earley K, Haas N, Woods L, Dimitriu C, Croft J, Carvalhosa A, Clarke C, Hickish T, Penny C, Sternberg A, Owen T, Parajes C, Meyer C, Dodge J, Meakin S, Lake D, Culligan D, Fletcher H, Forbes H, Johannesson N, Taylor G, Tomlinson J, Shaw A, Ratcliffe M, Lamacchia M, Vickers M, Duncan C, Untiveros P, Olaiya A, Tighe J, Preston G, Zaidi M, Lawrie A, Robertson C, Saadi H, Onyeakazi U, Radia R, Father T, Stainthorp K, Mc Connell S, Booth T, Langton C, Howcroft C, Saddiq I, Gupta ED, Byrne J, Lindsey‐Hill J, Badder D, Jones M, Pol R, Vyas P, Mead A, Peniket A, Bancroft R, Springett S, Yoganayagam S, Gray L, Friesen H, Wardle K, Murthy V, Pratt G, Kishore B, Mayer G, Nikolousis E, Smith N, Lovell R, Kartsios C, Ewing J, Lumley M, Khawaja J, Ali M, Sutton D, Murray D, Milligan D, Dhani S, O'Sullivan M, Whitehouse J, Schumacher A, Enstone R, Hardy A, Kelly M, Wallis J, Boal L, Davies M, Latter R, Wincup J, Ellis S, Poolan S, Birt M, Watts E, Charlton A, Forsyth H, Waring L, Twohig J, Marr H, Lennard A, Jones G, Menne T, Redding N, Jones S, Robinson K, Grand E, Cullis J, Collins F, Gamble L, Brown J, Tudgay S, Salisbury S, Mathew S, Tipler N, Parker T, Stobie E, Tribbeck M, Hebballi S, Millar C, Allotey D, Lala J, McGee N, Chmeil J, Hufton L, Dawson S, Weincove R, Smyth D, Buyck H, Hayden J, George A, Baluwala I, Wheeler M, Daysh L, Williams O, Millmow S, Miles R, Geller S, Blakemore M, Hargreaves A, Hayden G, Mo A, Van Dam M, Uhe M, Indran T, Wong J, Coughlin L, MacWhannell A, Beardsmore C, Lunn L, Pearson S, Shaw S, Parker J, Bowen A, Jones A, Player M. Red cell transfusion in outpatients with myelodysplastic syndromes: a feasibility and exploratory randomised trial. Br J Haematol 2020; 189:279-290. [PMID: 31960409 DOI: 10.1111/bjh.16347] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Abstract
Optimal red cell transfusion support in myelodysplastic syndromes (MDS) has not been tested and established. The aim of this study was to demonstrate feasibility of recruitment and follow-up in an outpatient setting with an exploratory assessment of quality of life (QoL) outcomes (EORTC QLQ-C30 and EQ-5D-5L). We randomised MDS patients to standardised transfusion algorithms comparing current restrictive transfusion thresholds (80 g/l, to maintain haemoglobin 85-100 g/l) with liberal thresholds (105 g/l, maintaining 110-125 g/l). The primary outcomes were measures of compliance to transfusion thresholds. Altogether 38 patients were randomised (n = 20 restrictive; n = 18 liberal) from 12 participating sites in UK, Australia and New Zealand. The compliance proportion for the intention-to-treat population was 86% (95% confidence interval 75-94%) and 99% (95-100%) for restrictive and liberal arms respectively. Mean pre-transfusion haemoglobin concentrations for restrictive and liberal arms were 80 g/l (SD6) and 97 g/l (SD7). The total number of red cell units transfused on study was 82 in the restrictive and 192 in the liberal arm. In an exploratory analysis, the five main QoL domains were improved for participants in the liberal compared to restrictive arm. Our findings support the feasibility and need for a definitive trial to evaluate the effect of different red cell transfusion thresholds on patient-centred outcomes.
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Affiliation(s)
- Simon J. Stanworth
- Oxford University Oxford United Kingdom
- The John Radcliffe Hospital Oxford GBR
- NHSBT Oxford United Kingdom
| | - Sally Killick
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Bournemouth United Kingdom
| | | | - Marina Karakantza
- Department of HaematologyLeeds Teaching Hospitals Leeds United Kingdom
| | - Robert Weinkove
- Wellington Blood & Cancer CentreCapital & Coast District Health Board Wellington New Zealand
- Malaghan Institute of Medical Research Wellington New Zealand
| | - Heather Smethurst
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | | | - Renate L. Hodge
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Valerie Hopkins
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Helen L. Thomas
- NHS Blood and Transplant Clinical Trials Unit Bristol United Kingdom
| | - Alison J. Deary
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre Toronto ON Canada
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto Toronto ON Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre Toronto ON Canada
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto Toronto ON Canada
| | - Erica M. Wood
- Transfusion Research UnitMonash University Melbourne Australia
| | - Rena Buckstein
- Odette Cancer CentreSunnybrook Health Sciences Centre Toronto ON Canada
| | - David Bowen
- Department of HaematologyLeeds Teaching Hospitals Leeds United Kingdom
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Molyneux EM, Walsh AL, Forsyth H, Tembo M, Mwenechanya J, Kayira K, Bwanaisa L, Njobvu A, Malenga G. Causes and outcome of bacterial meningitis in Malawian children. Malawi Med J 2016; 15:43-6. [PMID: 27528955 DOI: 10.4314/mmj.v15i2.10775] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
598 children with bacterial meningitis were admitted to the paediatric wards of the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi from July 1997 - March 2001. Patients were followed up at 1 and 6 months after hospital discharge when physical, neurological, developmental and hearing assessments were made. The most common causes of pyogenic meningitis were Streptococcus pneumoniae (40%), Haemophilus influenzae type b (28%), Neisseria meningitidis (11%), Salmonella species (5%). There was no growth on culture in 13% of cases. The overall mortality was 31% and 38% were left with significant sequelae. Indicators for a poor prognosis were younger age, lower coma score on admission, bacterial cause, nutritional status and HIV positivity.
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Affiliation(s)
- E M Molyneux
- Department of Paediatrics, College of Medicine, Box 360, Blantyre; Wellcome Trust Research Laboratories, Box 30096, Blantyre
| | - A L Walsh
- Department of Paediatrics, College of Medicine, Box 360, Blantyre; Wellcome Trust Research Laboratories, Box 30096, Blantyre
| | - H Forsyth
- Audiology Department, Royal Liverpool Children's Hospital, Liverpool, Eaton Road, Liverpool, UK
| | - M Tembo
- Department of Paediatrics, College of Medicine, Box 360, Blantyre; Wellcome Trust Research Laboratories, Box 30096, Blantyre
| | - J Mwenechanya
- Department of Paediatrics, College of Medicine, Box 360, Blantyre; Wellcome Trust Research Laboratories, Box 30096, Blantyre
| | - K Kayira
- Department of Paediatrics, College of Medicine, Box 360, Blantyre; Wellcome Trust Research Laboratories, Box 30096, Blantyre
| | - L Bwanaisa
- Department of Paediatrics, College of Medicine, Box 360, Blantyre; Wellcome Trust Research Laboratories, Box 30096, Blantyre
| | - A Njobvu
- Department of Paediatrics, College of Medicine, Box 360, Blantyre; Wellcome Trust Research Laboratories, Box 30096, Blantyre
| | - G Malenga
- Department of Paediatrics, College of Medicine, Box 360, Blantyre
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Molyneux EM, Mankhambo LA, Phiri A, Graham SM, Forsyth H, Phiri A, Walsh AL, Wilson LK, Molyneux ME. The outcome of non-typhoidal salmonella meningitis in Malawian children, 1997-2006. ACTA ACUST UNITED AC 2009; 29:13-22. [PMID: 19222929 DOI: 10.1179/146532809x401980] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The clinical course and outcome of non-typhoidal salmonella (NTS) meningitis in Malawian children over a 10-year period (1997-2006) is described. METHODS Demographic, clinical and laboratory data were collected for all children over 2 months of age admitted with salmonella meningitis to Queen Elizabeth Central Hospital from 1997 to 2006. In the 1st year, salmonellae were susceptible to chloramphenicol, and children received 2 weeks of chloramphenicol treatment. When NTS resistance to chloramphenicol started to appear in 1998, treatment was changed to ceftriaxone. From 2002, the duration of antibiotic therapy was extended to 4-weeks which included 2 weeks of intravenous ceftriaxone and a further 2 weeks of oral ciprofloxacin. RESULTS The in-hospital case fatality rate (CFR) was 52.3% (48.2% until 2002 and 53.9% after prolonged antibiotic therapy was introduced). Of the survivors, one in 12 (8.3%) became completely well (sequelae-free) in the period 1997-2001 while 18 of 31 survivors (58.1%) made a complete recovery during 2002-2006 (p<0.01). After the 4-week course of antimicrobial therapy was introduced, the number of relapses or recurrences fell from nine in 15 (60%) survivors treated with chloramphenicol or ceftriaxone to three in 35 (8.7%) survivors who received 4 weeks of antibiotics (p<0.0001). CONCLUSION In Malawi, salmonella meningitis has a CFR of approximately 50%, which has remained constant over many years. Residual morbidity, however, has decreased over 10 years, despite rising numbers of multi-drug-resistant cases of NTS. This improvement might be owing to better treatment and management and/or reduced pathogenicity of the multi-drug-resistant bacteria.
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Affiliation(s)
- E M Molyneux
- Department of Paediatrics, College of Medicine, Blantyre, Malawi.
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Abstract
BACKGROUND Paediatric audiology services and screening programmes are currently under review. AIMS AND METHODS To investigate current practice and performance of the school hearing screening programme (SHSP) by means of a questionnaire. RESULTS SHSP was found to detect previously unrecognised hearing loss at low cost. Wide variation in practice was shown, and the majority of services had no computerised system for data collection. CONCLUSION There is a need for nationally agreed protocols and quality assurance procedures.
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Affiliation(s)
- S Fonseca
- Clare House, St George's Hospital, London SW17 0QT, UK.
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Molyneux EM, Tembo M, Kayira K, Bwanaisa L, Mweneychanya J, Njobvu A, Forsyth H, Rogerson S, Walsh AL, Molyneux ME. The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi. Arch Dis Child 2003; 88:1112-8. [PMID: 14670782 PMCID: PMC1719398 DOI: 10.1136/adc.88.12.1112] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To compare presentation, progress, and outcome of acute bacterial meningitis in HIV seropositive and seronegative children. METHODS A double blind randomised placebo controlled study of the use of dexamethasone as adjuvant therapy in acute bacterial meningitis, in children aged 2 months to 13 years, was carried out from July 1997 to March 2001. A total of 598 children were enrolled, of whom 459 were tested for HIV serostatus. RESULTS Of the 459 children, 34% were HIV seropositive. Their presentation was similar to HIV seronegative children but more were shocked on arrival at hospital (33/157 v 12/302), and more had a focus of infection (85/157 v 57/302). HIV positive children had a higher incidence of Streptococcus pneumoniae infections (52% v 32%). Sixty four cases relapsed; 67% were in HIV positive patients. The mortality in HIV positive children was 65% compared with 36% in HIV negative children. The number of survivors in each group was similar. Hearing loss was more common in HIV negative than HIV positive children (66.3% v 47.2%). Steroid therapy had no influence on meningitis in HIV positive children, but the mortality in HIV negative children was 61% in children given steroids, and 39% in those who did not receive steroids. CONCLUSION HIV seropositive children who develop bacterial meningitis have a high mortality and are prone to recurrent disease. There is an urgent need to prevent both primary and recurrent infections.
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Affiliation(s)
- E M Molyneux
- Paediatric Department College of Medicine, Box 360, Blantyre, Malawi.
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Molyneux EM, Walsh AL, Forsyth H, Tembo M, Mwenechanya J, Kayira K, Bwanaisa L, Njobvu A, Rogerson S, Malenga G. Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. Lancet 2002; 360:211-8. [PMID: 12133656 DOI: 10.1016/s0140-6736(02)09458-8] [Citation(s) in RCA: 239] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Steroids are used as adjuvant treatment in childhood pyogenic meningitis to attenuate host inflammatory responses to bacterial invasion. We aimed to assess the effectiveness of dexamethasone in management of acute bacterial meningitis in a developing country. METHODS In a double-blind, placebo controlled trial, we included 598 children with pyogenic meningitis who had been admitted to the children's wards of the Queen Elizabeth Central Hospital, Blantyre, Malawi. We did physical, neurological, developmental, and hearing assessments at 1 and 6 months after discharge. The primary outcome was overall death. Secondary outcomes included sequelae, in-hospital deaths, and death after discharge. Analysis was done by intention to treat. FINDINGS Of the 598 included children, 307 (51%) were assigned to dexamethasone and 295 (49%) to placebo. 338 (40%) of 598 patients had Streptococcus pneumoniae, 170 (28%) Haemophilus influenzae type b, 66 (11%) Neisseria meningitidis, and 29 (5%) Salmonella spp. 78 (13%) patients had no growth on culture. The number of overall deaths was the same in the two treatment groups (relative risk 1.00 [95% CI 0.8-1.25], p=0.93). At final outcome, sequelae were identified in 84 (28%) of children on steroids and in 81 (28%) on placebo (relative risk 0.99 [95% CI 0.78-1.27], p=0.97). The number of children dying in hospital did not differ between groups. INTERPRETATION Steroids are not an effective adjuvant treatment in children with acute bacterial meningitis in developing countries.
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Affiliation(s)
- E M Molyneux
- Paediatric Department, College of Medicine, Blantyre, Malawi.
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Brook L, Trussell J, Hilton K, Forsyth H, Pizer B. Normal values for distortion product otoacoustic emissions in children: a study using primary levels previously demonstrated to be optimum for identification of hearing loss. Scand Audiol Suppl 2002:37-43. [PMID: 11409776 DOI: 10.1080/010503901750166628] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
No published data exist for normal values of distortion product otoacoustic emissions (DPOAE) in children at primary levels f1 = 65 dB and f2 = 55 dB SPL. These primary levels have been previously demonstrated to be optimal for identification of hearing impaired ears in adults. A total of 102 normal children underwent audiological assessment, including exclusion of middle ear disease, pure tone audiometry and DPOAE DP-grams (primaries L1/L2 = 65/55 dB SPL, f1:f2 = 1.22). There was a statistically significant decrease in DPOAE amplitude with increasing age. DPOAE amplitude was also dependent on the frequency of f2. However, there was wide inter- and intra-individual variation in DPOAE amplitude at different frequencies of f2. There was also a large overlap between the range of values of DPOAE amplitude between the adjacent age groups. Detailed assessment of DPOAE in children is feasible in the clinical setting. These normal values should prove invaluable in future studies; however, the large range of normal values means that cross-sectional studies may not be able to detect small variations in cochlear function.
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Affiliation(s)
- L Brook
- Department of Paediatric Oncology, Royal Liverpool Children's Hospital (Alder Hey), United Kingdom.
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Fonseca S, Forsyth H, Grigor J, Lowe J, MacKinnon M, Price E, Rose S, Scanlon P, Umapathy D. Identification of permanent hearing loss in children: are the targets for outcome measures attainable? Br J Audiol 1999; 33:135-43. [PMID: 10439140 DOI: 10.3109/03005369909090093] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A collaborative nine-centre study was designed to follow the routes to identification of all children up to the age of seven years newly diagnosed with permanent hearing impairment (> or = 50 dB HL) during the period 1993-1994. Ages of identification were compared with the standards set by the National Deaf Children's Society (NDCS), ascertaining whether these targets could be achieved with current service provision. Of the 126 children identified, 104 had congenital sensorineural hearing loss: 19% were identified by the age of six months and 39% by their first year. These results fall short of the NDCS targets of 40% and 80%, respectively, and point to the need for modifications of current practice, such as the introduction of universal neonatal screening.
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Forsyth H. Gladys Sandes FRCS England 1897-1968. Ann R Coll Surg Engl 1980; 62:65. [PMID: 19310703 PMCID: PMC2492270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Forsyth H. Treating parasitic tracheobronchitis in the dog. Vet Rec 1976; 99:425. [PMID: 1006969 DOI: 10.1136/vr.99.21.425-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Forsyth H. Letter: Ulceration of the sole in cattle. Vet Rec 1975; 96:457-8. [PMID: 1146173 DOI: 10.1136/vr.96.20.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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