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Konyana SPP, Teixeira NF, Pirjol L, Thwala B, Nkoyane W, Porter M, Gxolo F, Phillips E, Lehloenya R, Mankahla A, Peter J. Spectrum of offending drugs and cutaneous adverse drug reactions requiring hospitalisation in a tertiary South African hospital in TB/HIV endemic setting. FRONTIERS IN ALLERGY 2024; 5:1481281. [PMID: 39668949 PMCID: PMC11634803 DOI: 10.3389/falgy.2024.1481281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 10/23/2024] [Indexed: 12/14/2024] Open
Abstract
Introduction Cutaneous immune-mediated adverse drug reactions are more prevalent in people with human immunodeficiency virus (PWH). Severe cutaneous adverse drug reactions (SCAR) are a life-threatening subset of cutaneous adverse drug reactions (CADRs) and a significant public health issue in settings endemic for human immunodeficiency virus and tuberculosis. However, limited data are available on CADR requiring hospitalisation in African settings. The aim of this study is to describe the epidemiology, offending drugs and outcomes of CADRs requiring admission to a South African tertiary dermatology service. Methods Retrospective folder review was conducted on all CADRs requiring hospitalisation at Nelson Mandela Academic Hospital in Mthatha, Eastern Cape, South Africa between 30 July 2015 and 15 December 2022. This data was compared to prospective inclusion of CADR admissions between 03 March 2021 and 09 April 2024 as part of the Immune-Mediated Adverse Drug Reactions (IMARI) Registry and Biorepository and AFRISCAR consortium. Where possible, phenotype and drug causality assessment was performed through RegiSCAR, or Naranjo and/or ALDEN scoring respectively. Results CADR admissions included 122 cases: 89 and 33 in the retrospective and prospective cohorts respectively. The commonest SCAR phenotype was Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) at 59.8% (73/122), although other validated SCAR phenotypes included drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP) and generalized fixed bullous drug eruption (GBFDE). Cutaneous presentations included typical and atypical SCAR features against a background Fitzpatrick skin tones of type IV and above. Amongst the retrospective cohort 16.9% (15/89) of phenotypes were unclassifiable due to lack of photographs. The overall median (IQR) age was 38 (25-50) years, 50.8% (62/122) were male and 60.7% (74/122) were PWH [median (IQR) CD4T-cell count of 267 (76-470) cells/mm3]. The commonest offending drugs included cotrimoxazole in 24.6% (30/122); and anti-retroviral therapy (ART) in 13.9% (17/122). No offending drug could be identified in 24.7% (22/89) of the retrospective cohort. The median (IQR) length of hospital stay for validated SCAR was 13 (8-21) days for the retrospective cohort and 19 (13-28) days for the prospective cohort (p = 0.03). The median (IQR) length of hospital stay for non-SCAR was 9 (5-13) days for the retrospective cohort and 11 (9-16) days for the prospective cohort. Conclusion Typical and atypical presentations of SCAR were represented in this vulnerable South African cohort of predominantly PWH. SJS/TEN was the commonest phenotype, and cotrimoxazole the most frequent offending drug. This data emphasises the need for prospective data collection across a diverse African population for valid SCAR phenotyping and drug causality assessment.
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Peter J, Takalani A, Meyer JC, Semete-Makokotlela B, Collie S, Seocharan I, Goga A, Garrett N, Gail-Bekker L, Gray G. Vaccine pharmacovigilance in South Africa: successes and limitations of current approaches. Expert Opin Drug Saf 2024; 23:1215-1225. [PMID: 39115010 DOI: 10.1080/14740338.2024.2387322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/10/2024] [Accepted: 07/26/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION Despite the public health success of vaccination, there is an ongoing need to build public confidence in vaccines and improve systems to monitor safety while maintaining data security and patient privacy. African countries face multiple challenges in establishing systems for vaccine pharmacovigilance as was demonstrated during COVID-19 mass vaccination. We provide a framework for the development of pharmacovigilance using the COVID-19 vaccination rollout as an exemplar. AREAS COVERED We describe the pre-COVID-19 vaccine pharmacovigilance systems in Southern Africa and propose improvements based on our experience of COVID-19 vaccine rollout in South Africa where we implemented systems to evaluate real-world safety and effectiveness of COVID-19 vaccinations. By conducting a PubMed review of the literature on pharmacovigilance with a focus on Africa and from guidance emanating from the World Health Organization (WHO), we evaluate challenges and opportunities to improve pharmacovigilance in our setting. EXPERT OPINION There are ongoing efforts to improve pharmacovigilance on the African continent with improved coordination at a national level with the support of the WHO, the national regulatory authorities, and national departments of health. COVID-19 vaccine rollout provided an opportunity to improve pharmacovigilance by integrating national vaccine platforms with active and passive surveillance including hospital and death registries.
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Buttgereit T, Aulenbacher F, Gutsche A, Kolkhir P, Weller K, Vera Ayala C, Magerl M, Farkas H, Grumach AS, Aygören-Pürsün E, Bara N, Ben-Shoshan M, Bernstein J, Betschel S, Bouillet L, Caballero T, Cancian M, Castaldo AJ, Cimbollek S, Cohn DM, Craig T, Fomina D, Gelincik A, Grivcheva-Panovska V, Jindal A, Katelaris C, Kessel A, Kinaciyan T, Longhurst HJ, Martinez-Saguer I, Riedl M, Schöffl C, Staubach P, Zanichelli A, Zhi Y, Balle Boysen H, Fok JS, Li PH, Hakl R, Hide M, Peter J, Maurer M. The Chronic Angioedema Registry (CARE): Rationale, Methods and Implementation. Clin Exp Allergy 2024; 54:712-716. [PMID: 38924594 DOI: 10.1111/cea.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/28/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
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Berger B, Lavaf A, DeRose PM, Whitley A, Ballo MT, Peter J, Abdullah H, Abraham Y, Bakalo O, Lipson A, Mooney C, Naveh A, Shamir R, Shapira N, Stepovoy K, Swaim J, Urman N, Zigelman G, Shi W. Patient-Specific Segmentation-Based Treatment Planning vs. NovoTAL for TTFields Therapy in Glioblastoma. Int J Radiat Oncol Biol Phys 2023; 117:e87. [PMID: 37786202 DOI: 10.1016/j.ijrobp.2023.06.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients treated with Tumor Treating Fields (TTFields) therapy for glioblastoma (GBM) have array layouts planned by NovoTAL. NovoTAL requires morphometric inputs and maximizes field intensity at the tumor. Patient-specific segmentation-based treatment planning (SBTP) software uses segmentation-based plans to maximize power density at defined regions of interest (ROIs). This technical analysis compared expected local minimum power density (LMiPD; mW/cm3) and local minimum field intensity (LMiFI; V/cm) delivered to ROIs with array layouts planned with SBTP vs NovoTAL. We hypothesized that SBTP has the potential to increase LMiPD and LMiFI to ROIs vs NovoTal. MATERIALS/METHODS 37 patients from 5 sites who received TTFields therapy for GBM using NovoTAL were included. Treatment plans using the prescribed/treated NovoTAL layouts were created with SBTP. De novo SBTP layouts were also created. Three ROIs representing the original treated GBM (CTV), high risk margin around the GBM (CTV-2), and recurrent GBM (CTV-R) were created. Plans were optimized to CTV. SBTP vs NovoTAL LMiPD and LMiFI volumetrics to ROIs were evaluated. LMiPD and LMiFI were normalized with the delivered current from the treated NovoTAL layout. Layout rankings based on LMiPD and LMiFI, average LMiPD and LMiFI, D95, D5, DVHs, and voxel-by-voxel LMiPD and LMiFI for SBTP derived from NovoTAL layouts were compared to de novo SBTP layouts (paired t-tests). RESULTS Average LMiPD (1.551 vs 1.194) and LMiFI (1.115 vs 0.978) to CTV were significantly higher with SBTP vs NovoTAL (P < 0.0001 for each). Average LMiPD (1.445 vs 1.164) and LMiFI (1.197 vs 1.077) to CTV-2 were also higher (P < 0.0001 for each). There was a positive trend to higher average LMiPD (1.203 vs 1.157; P = 0.212) and LMiFI (1.103 vs 1.090; P = 0.311) to CTV-R. Top ranked overall layouts by LMiPD to CTV were SBTP layouts (97%; n = 36). Percent ratio ([SBTP-NovoTAL]/NovoTAL*100) D95 for LMiPD was 34% (to CTV), 24% (to CTV-2), and 5% (to CTV-R) and for LMiFI was 16%, 12%, and 2% respectively. Percent ratio D5 for LMiPD was 31%, 24%, and 3% and for LMiFI was 14%, 9%, and 0%, respectively. For a given percent CTV volume, minimum LMiPD and LMiFI were higher with SBTP (95%, n = 35; DVH curves shifted to right). SBTP yielded higher LMiPD and LMiFI to the majority of voxels within the CTV (95%, n = 35). With SBTP, LMiPD to CTV was significantly higher than to CTV-R (P < 0.001). CONCLUSION Overall, these data demonstrate that SBTP compared to NovoTAL yielded higher expected average LMiPD and LMiFI, D95, D5, and percent voxel LMiPD and LMiFI to defined ROIs. Higher LMiPD and LMiFI delivered to CTV vs CTV-R with SBTP suggests a benefit to re-planning if the GBM recurs. Given previous reports showing that higher LMiPD and LMiFI are positively correlated with improved overall and progression free survival, patient-specific SBTP may lead to improved clinical outcomes for GBM patients vs NovoTAL.
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Day C, Van der Walt J, Crombie K, Hendrikse C, Peter J. Acute angioedema in Cape Town emergency centres and a suggested algorithm to simplify and improve management. S Afr Med J 2023; 113:51-57. [PMID: 37882115 DOI: 10.7196/samj.2023.v113i8.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Angioedema is the most common acute allergic presentation to emergency centres (EC), with hospitalisation rates increasing in high-income countries. Angioedema can complicate with life-threatening laryngeal obstruction. There are no local data; therefore, we aimed to characterise acute angioedema cases presenting to ECs and develop a simple management algorithm. OBJECTIVE To characterise the clinical presentation, management and outcomes of acute angioedema cases presenting to ECs. Based on these findings, we developed a management algorithm for acute angioedema to improve the care of acute angioedema in South Africa (SA). METHODS We conducted a retrospective folder review of all patients admitted to Groote Schuur Hospital (tertiary) and Mitchells Plain District Hospital (secondary) ECs from 1 June 2018 to 31 June 2020. Using ICD-10 coding, folders of adults ≥18 years with possible angioedema presenting to the ECs were screened. An allergist extracted demographics, medical history, management and outcome data for each angioedema event. RESULTS A total of 142 acute angioedema episodes were included, with a median (interquartile range) age of 42 (28 - 58) years, and 62% of patients were female. The majority (124/142, 87%) of acute angioedema EC presentations involved swelling above the shoulders, with airway involvement in 20 (14%) patients, with two patients requiring intubation. Nineteen (13%) patients required admission, with five (26%) admitted to high care/intensive care. Drug-induced angioedema was the most common cause, with 64/142 (45%) linked to a known offending drug, 42/64 (65.6%) being angiotensin-converting enzyme inhibitor (ACE-I). Critical information to guide angioedema management, including past personal/family allergy history, and duration of angioedema prior to EC visit, was not recorded in 64.7% and 37.8% of EC records, respectively. Unnecessary treatment with corticosteroids or antihistamines occurred in 19/53 (36%) and 16/53 (30%) cases with bradykinin-mediated angioedema ACE-I angioedema and hereditary angioedema). Overall, only 36/142 (25%) of angioedema patients were connected to allergy care. CONCLUSION Angioedema is the most common allergy presentation to two ECs in Cape Town, SA. Bradykinin-mediated angioedema secondary to ACE-I therapy is the single most common offender, and was not appropriately managed in more than a third of cases. Based on these findings, we have developed a management algorithm that easily stratifies patients into bradykinin or mast cell-mediated angioedema with a step-by-step management approach that is applicable to the SA context. Ongoing awareness and education on allergy emergencies are required to ensure accurate diagnosis of less common causes of angioedema (particularly bradykinin-mediated angioedema) and linkage to allergy specialist care.
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Veenstra S, Porter M, Thwala B, Pillay N, Panieri M, van der Westhuizen J, Phillips E, Meintjes G, Dlamini S, Lehloenya R, Peter J. Long-term HIV and tuberculosis outcomes in patients hospitalised with severe cutaneous adverse reactions. J Clin Tuberc Other Mycobact Dis 2023; 32:100374. [PMID: 37214159 PMCID: PMC10196841 DOI: 10.1016/j.jctube.2023.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background Treatment-limiting severe cutaneous adverse reactions (SCAR) occur more commonly amongst persons with HIV-associated tuberculosis (TB). The impact of SCAR on long-term HIV/TB outcomes is unknown. Methods Patients with TB and/or HIV admitted to Groote Schuur Hospital, Cape Town, South Africa with SCAR between 1/10/2018 and 30/09/2021 were eligible. Follow-up data was collected for 6- and 12-month outcomes: mortality, TB and antiretroviral therapy (ART) regimen changes, TB treatment completion, and CD4 count recovery. Results Forty-eight SCAR admissions included: 34, 11, and 3 HIV-associated TB, HIV-only and TB-only patients with 32, 13 and 3 cases of drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome/toxic epidermal necrolysis and generalised bullous fixed-drug eruption respectively. Nine (19%), all HIV-positive (eight co-infected with TB), were deceased at 12-months, and 12(25%) were lost to follow-up. Amongst TB-SCAR patients, seven (21%) were discharged on all four first-line anti-TB drugs (FLTD), while 12(33%) had regimens with no FLTDs; 24/37(65%) completed TB treatment. Amongst HIV-SCAR patients, 10/31(32%) changed ART regimen. If retained in care (24/36), median (IQR) CD4 counts increased at 12-months post-SCAR (115(62-175) vs. 319(134-439) cells/uL). Conclusion SCAR admission amongst patients with HIV-associated TB results in substantial mortality, and considerable treatment complexity. However, if retained in care, TB regimens are successfully completed, and immune recovery is good despite SCAR.
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McNair M, Porter M, Isaacs T, Pillay K, Williams G, Roberts R, Peter J, Lehloenya RJ. Lichenoid drug eruption in patients on anti-TB therapy in a high HIV prevalence setting. Int J Tuberc Lung Dis 2023; 27:643-645. [PMID: 37491745 PMCID: PMC10365564 DOI: 10.5588/ijtld.23.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 07/27/2023] Open
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Meile L, Garrido-Arandia M, Bernasconi Z, Peter J, Schneller A, Bernasconi A, Alassimone J, McDonald BA, Sánchez-Vallet A. Natural variation in Avr3D1 from Zymoseptoria sp. contributes to quantitative gene-for-gene resistance and to host specificity. THE NEW PHYTOLOGIST 2023; 238:1562-1577. [PMID: 36529883 DOI: 10.1111/nph.18690] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Successful host colonization by plant pathogens requires the circumvention of host defense responses, frequently through sequence modifications in secreted pathogen proteins known as avirulence factors (Avrs). Although Avr sequences are often polymorphic, the contribution of these polymorphisms to virulence diversity in natural pathogen populations remains largely unexplored. We used molecular genetic tools to determine how natural sequence polymorphisms of the avirulence factor Avr3D1 in the wheat pathogen Zymoseptoria tritici contributed to adaptive changes in virulence. We showed that there is a continuous distribution in the magnitude of resistance triggered by different Avr3D1 isoforms and demonstrated that natural variation in an Avr gene can lead to a quantitative resistance phenotype. We further showed that homologues of Avr3D1 in two nonpathogenic sister species of Z. tritici are recognized by some wheat cultivars, suggesting that Avr-R gene-for-gene interactions can contribute to nonhost resistance. We suggest that the mechanisms underlying host range, qualitative resistance, and quantitative resistance are not exclusive.
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Day C, Deetlefs M, O'Brien A, Smith J, Boyd M, Embling N, Patel S, Moody K, Ramabele T, Budge A, Tarwa T, Jim O, Maharaj T, Pandy S, Abrahams JM, Panieri A, Verhage S, Van der Merwe M, Geragotellis A, Amanjee W, Joseph C, Zhao Z, Moosa S, Bunting M, Pulani Y, Mukhari P, De Paiva M, Deyi G, Wonkam RP, Mancotywa N, Dunge A, Msimanga T, Singh A, Monnaruri O, Molale B, Butler TAG, Browde K, Muller C, Van der Walt J, Whitelaw R, Cronwright D, Sinha S, Binase U, Francis I, Boakye D, Dlamini S, Mendelson M, Peter J. Self-reported beta-lactam allergy in government and private hospitals in Cape Town, South Africa. S Afr Med J 2023; 113:69-74. [PMID: 36757070 DOI: 10.7196/samj.2023.v113i2.16760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Up to a quarter of inpatients in high-income countries (HICs) self-report beta-lactam allergy (BLA), which if incorrect,increases the use of alternative antibiotics, worsening individual health outcomes and driving bacterial resistance. In HICs, up to 95% ofself-reported BLAs are incorrect. The epidemiology of BLA in low- and middle-income African countries is unknown. OBJECTIVES To describe the epidemiology and de-labelling outcomes of self-reported BLA in hospitalised South African (SA) patients. METHODS Point-prevalence surveys were conducted at seven hospitals (adult, paediatric, government and privately funded, district andtertiary level) in Cape Town, SA, between April 2019 and June 2021. Ward prescription records and in-person interviews were conductedto identify and risk-stratify BLA patients using the validated PEN-FAST tool. De-labelling was attempted at the tertiary allergy clinic atGroote Schuur Hospital. RESULTS A total of 1 486 hospital inpatients were surveyed (1 166 adults and 320 children). Only 48 patients (3.2%) self-reported a BLA,with a higher rate in private than in government-funded hospitals (6.3% v. 2.8%; p=0.014). Using the PEN-FAST tool, only 10.4% (n=5/48)of self-reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (n=34/48)of self-reported BLA patients, with 64.7% (n=22/34) receiving a beta-lactam. Despite three attempts to contact patients for de-labelling atthe allergy clinic, only 3/36 underwent in vivo testing, with no positive results, and 1 patient proceeded to a negative oral challenge. CONCLUSION Unlike HICs, self-reported BLA is low among inpatients in SA. The majority of those who self-reported BLA were low risk fortype 1 hypersensitivity, but outpatient de-labelling efforts were largely unsuccessful.
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören-Pürsün E, Banerji A, Bara NA, Boccon-Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo A, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos-Fogelbach G, Hide M, Kang HR, Kaplan AP, Katelaris C, Kiani-Alikhan S, Lei WT, Lockey R, Longhurst H, Lumry WR, MacGinnitie A, Malbran A, Saguer IM, Matta JJ, Nast A, Nguyen D, Nieto-Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Sheikh FR, Smith WB, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. [Not Available]. ARERUGI = [ALLERGY] 2023; 72:237-272. [PMID: 37225467 DOI: 10.15036/arerugi.72.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
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Cherian L, Varghese L, Rupa V, Bright R, Abraham L, Panicker R, R. N, Peter J, Nayak A, Shyam A, Varghese G, Manesh A, Karuppusami R, George K, George T, Lenin A, Hansdak S, I. R, Michael J, Ninan M, Thomas M, Kurian R, Mammen S, Kurien R. Rhino-orbito-cerebral mucormycosis: patient characteristics in pre-COVID-19 and COVID-19 period. Rhinology 2022; 60:427-434. [DOI: 10.4193/rhin22.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Rhino-orbito-cerebral-mucormycosis (ROCM), a rare and potentially fatal disease was seen in increasing numbers during the COVID-19 pandemic. This study describes and compares the patient characteristics and outcomes in COVID-19 associated mucormycosis (CAM) and non-COVID-19 mucormycosis (non-CAM). Methodology: CAM patients (24 cases) were recruited from the COVID-19 period and non-CAM (24 controls) from the pre-COVID-19 period. Clinical data of the CAM group was collected retrospectively with 3 month outcomes prospectively. The non-CAM group data was collected retrospectively. Patient characteristics were compared and risk factors for mortality in ROCM were assessed. Results: Orbital symptoms [altered vision, restricted eye movements, ptosis] and intracranial involvement were higher in CAM patients on presentation. Similarly, the radiological involvement of orbit (orbital apex, superior orbital fissure) and intracranial cavity (intracranial thrombosis, cavernous sinus) was also higher in CAM patients. Newly detected diabetes was found only in CAM patients (29.2%). Although univariate analysis suggested an increased mortality risk in ROCM patients with orbital involvement, the multivariate analysis showed no increased risk with any of the parameters assessed, including COVID-19 positivity. Conclusions: Compared to the non-CAM, the disease presentation was severe in CAM with higher frequency of orbital and intracranial involvement. However, with early detection and treatment, the short term survival was comparable in both groups.
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Peter J. FV 18 Reducing hippocampal hyperactivity with real-time fMRI neurofeedback in patients with amnestic mild cognitive impairment. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tatti E, Ferraioli F, Peter J, Alalade T, Nelson AB, Ricci S, Quartarone A, Ghilardi MF. Frontal increase of beta modulation during the practice of a motor task is enhanced by visuomotor learning. Sci Rep 2021; 11:17441. [PMID: 34465846 PMCID: PMC8408223 DOI: 10.1038/s41598-021-97004-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022] Open
Abstract
Movement is accompanied by beta power changes over frontal and sensorimotor regions: a decrease during movement (event-related desynchronization, ERD), followed by an increase (event-related synchronization, ERS) after the movement end. We previously found that enhancements of beta modulation (from ERD to ERS) during a reaching test (mov) occur over frontal and left sensorimotor regions after practice in a visuo-motor adaptation task (ROT) but not after visual learning practice. Thus, these enhancements may reflect local cumulative effects of motor learning. Here we verified whether they are triggered by the learning component inherent in ROT or simply by motor practice in a reaching task without such learning (MOT). We found that beta modulation during mov increased over frontal and left areas after three-hour practice of either ROT or MOT. However, the frontal increase was greater after ROT, while the increase over the left area was similar after the two tasks. These findings confirm that motor practice leaves local traces in beta power during a subsequent motor test. As they occur after motor tasks with and without learning, these traces likely express the cost of processes necessary for both usage and engagement of long-term potentiation mechanisms necessary for the learning required by ROT.
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Peter J. COVID-19 vaccination: Recommendations for management of patients with allergy or immune-based diseases. S Afr Med J 2021; 111:291-294. [PMID: 33944757 DOI: 10.7196/samj.2021.v111i4.15576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 11/08/2022] Open
Abstract
As South Africa continues to battle the second wave of SARS-CoV-2 infections, the imminent arrival of vaccines against COVID-19 offers hope. Vaccine roll-out has been accompanied by heightened media coverage that has created both excitement and anxiety, reporting on the shortened timeline of vaccine trials and approvals, as well as the recent series of anaphylaxis cases associated with the two approved mRNA COVID-19 vaccines. Patients with allergic and other immune-based diseases are subgroups especially concerned about vaccine safety and efficacy. This practice guideline offers broad recommendations for COVID-19 vaccination in various subgroups of allergic and immunebased disease, highlighting risk/benefit evaluation, and where and how routine vaccination should be altered.
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Bouillet L, Maurer M, Reshef A, Kiani S, Wu A, Stobiecki M, Kinaciyan T, Peter J, Aygören-Pürsün E, Best J, Cornpropst M, Nagy E, Murray S, Collis P, Launay D, Farkas H. Sécurité et efficacité à long terme du bérotralstat (BCX7353) pour la prophylaxie des crises d’angiœdème héréditaire (AOH) : résultats de l’étude APeX-S. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gonçalo M, Gimenéz‐Arnau A, Al‐Ahmad M, Ben‐Shoshan M, Bernstein J, Ensina L, Fomina D, Galvàn C, Godse K, Grattan C, Hide M, Katelaris C, Khoshkhui M, Kocatürk E, Kulthanan K, Medina I, Nasr I, Peter J, Staubach P, Wang L, Weller K, Maurer M. The global burden of chronic urticaria for the patient and society*. Br J Dermatol 2020; 184:226-236. [DOI: 10.1111/bjd.19561] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
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Bendinger A, Seyler L, Saager M, Debus C, Peschke P, Komljenovic D, Debus J, Peter J, Floca R, Karger C, Glowa C. PH-0476: Impact of single dose photon or 12C-ion irradiation on rat prostate tumors assessed by DCE-MRI. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Meile L, Peter J, Puccetti G, Alassimone J, McDonald BA, Sánchez-Vallet A. Chromatin Dynamics Contribute to the Spatiotemporal Expression Pattern of Virulence Genes in a Fungal Plant Pathogen. mBio 2020; 11:e02343-20. [PMID: 33024042 PMCID: PMC7542367 DOI: 10.1128/mbio.02343-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022] Open
Abstract
Dynamic changes in transcription profiles are key for the success of pathogens in colonizing their hosts. In many pathogens, genes associated with virulence, such as effector genes, are located in regions of the genome that are rich in transposable elements and heterochromatin. The contribution of chromatin modifications to gene expression in pathogens remains largely unknown. Using a combination of a reporter gene-based approach and chromatin immunoprecipitation, we show that the heterochromatic environment of effector genes in the fungal plant pathogen Zymoseptoria tritici is a key regulator of their specific spatiotemporal expression patterns. Enrichment in trimethylated lysine 27 of histone H3 dictates the repression of effector genes in the absence of the host. Chromatin decondensation during host colonization, featuring a reduction in this repressive modification, indicates a major role for epigenetics in effector gene induction. Our results illustrate that chromatin modifications triggered during host colonization determine the specific expression profile of effector genes at the cellular level and, hence, provide new insights into the regulation of virulence in fungal plant pathogens.IMPORTANCE Fungal plant pathogens possess a large repertoire of genes encoding putative effectors, which are crucial for infection. Many of these genes are expressed at low levels in the absence of the host but are strongly induced at specific stages of the infection. The mechanisms underlying this transcriptional reprogramming remain largely unknown. We investigated the role of the genomic environment and associated chromatin modifications of effector genes in controlling their expression pattern in the fungal wheat pathogen Zymoseptoria tritici Depending on their genomic location, effector genes are epigenetically repressed in the absence of the host and during the initial stages of infection. Derepression of effector genes occurs mainly during and after penetration of plant leaves and is associated with changes in histone modifications. Our work demonstrates the role of chromatin in shaping the expression of virulence components and, thereby, the interaction between fungal pathogens and their plant hosts.
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Buhl S, Peter J, Stich A, Brückner R, Bulitta C. Durability and stability of antimicrobial coated surfaces. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2020. [DOI: 10.1515/cdbme-2020-3076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Antimicrobial surface coating of i.e. medical devices could contribute to infection prevention and reduction of hospital acquired infections (HAI). Recent studies showed a significant reduction in the microbial contamination of antimicrobial coated surfaces in clinical setups. Nevertheless, there are only few publications available that deal with the durability and stability of these coatings under routine clinical conditions. In this work different antimicrobial coating compositions were tested on different surfaces for their durability and remaining antimicrobial activity. Our results show that the durability and stability of a subsequent applied antimicrobial coating is strongly dependent on the chemical formulation of the coating and also the underlying surface condition. Whereas we could still detect remaining antimicrobial coating and activity on some samples after repeated abrasion testing, some other samples lost their coating and activity after only a few abrasion cycles. Interestingly the integrated antimicrobial substance in the 3-D printed samples showed strong antimicrobial activity even after rough treatment of the surfaces (brushing, scratching).
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Gray CM, Peter J, Mendelson M, Madhi S, Blackburn JM. COVID-19 antibody testing: From hype to immunological reality. S Afr Med J 2020; 110:837-841. [PMID: 32880263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023] Open
Abstract
The potential role for serological tests in the current COVID-19 pandemic has generated very considerable recent interest across many sectors worldwide, inter alia pathologists seeking additional weapons for their armoury of diagnostic tests; epidemiologists seeking tools to gain seroprevalence data that will inform improved models of the spread of disease; research scientists seeking tools to study the natural history of COVID-19 disease; vaccine developers seeking tools to assess vaccine efficacy in clinical trials; and companies and governments seeking tools to aid return-to-work decision-making. However, much of the local debate to date has centred on questions surrounding whether regulatory approval processes are limiting access to serological tests, and has not paused to consider the intrinsically limiting impact of underlying fundamental biology and immunology on where and how different COVID-19 serological tests can usefully be deployed in the response to the current pandemic. We review, from an immunological perspective, recent experimental evidence on the time-dependency of adaptive immune responses following SARS-CoV-2 infection and the impact of this on the sensitivity and specificity of COVID-19 antibody tests made at different time points post infection. We interpret this scientific evidence in terms of mooted clinical applications for current COVID-19 antibody tests in identifying acute infections, in confirming recent or past infections at the individual and population level, and in detecting re-infection and protective immunity. We conclude with guidance on where current COVID-19 antibody tests can make a genuine impact in the pandemic.
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Green RJ, Hockman M, Friedman R, Van Niekerk A, Feldman C, Vardas E, Quitter C, Els C, Van Bruwaene L, Nanan A, Peter J, Seedat RY, Levin M, Bateman On Behalf Of The South African Allergic Rhinitis Working Group Saarwg C. Chronic rhinitis in South Africa - more than just allergy! S Afr Med J 2020; 110:594-598. [PMID: 32880327 DOI: 10.7196/samj.2020.v110i7.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 06/11/2023] Open
Abstract
Chronic rhinitis is a troublesome condition for sufferers. It is tempting to label all patients with chronic nasal symptoms as having allergic rhinitis (AR), but many such patients have other causes of chronic rhinitis that need a specific diagnosis and management strategy. Even when the patient fully fits the definition of AR, their condition will be best served by combining medication with ongoing patient education.
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Van den Berg K, Vermeulen M, Glatt TN, Wasserman S, Barrett CL, Peter J, Brittain D, Louw VJ. COVID-19: Convalescent plasma as a potential therapy. S Afr Med J 2020; 110:562-563. [PMID: 32880317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023] Open
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Du Plooy N, Day C, Manning K, Abdullah F, James K, Grace L, Vorajee N, April C, Peter J, Raubenheimer PJ. Prevalence and outcome of delirium among acute general medical inpatients in Cape Town, South Africa. S Afr Med J 2020; 110:519-524. [PMID: 32880565 DOI: 10.7196/samj.2020.v110i6.14363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Delirium is a common, serious, underdiagnosed condition in medical and surgical inpatients with acute conditions. It is associated with increased risk of mortality and morbidity. Data of geriatric cohorts are largely limited to developed countries. OBJECTIVES To describe prevalence, risk factors and outcomes of delirium among general medical patients admitted to two hospitals in Cape Town, South Africa. METHODS This was a prospective cohort study of patients with acute conditions admitted to a general medical inpatient service in secondary- and tertiary-level public hospitals in the Metro West area of Cape Town. Patients ≥18 years of age were recruited daily from all acute medical admissions. Patients were excluded if they were aphasic or their Glasgow coma scale was <8/15. Delirium was diagnosed using the validated confusion assessment method (CAM) tool and performed by trained neuropsychologists. Demographic data were collected by a clinical team and short- and long-term mortality data were obtained using linkage analysis of hospitalised patients and routinely collected provincial death certification records. RESULTS The median age of inpatients was 51 (interquartile range 36 - 65) years, 29% were HIV-infected and the overall prevalence of delirium was 12.3%. Multivariate predictors of delirium included the presence of an indwelling urinary catheter (odds ratio (OR) 4.47; confidence interval (CI) 2.43 - 8.23), admission with a central nervous system disease (OR 4.34; CI 2.79 - 7.90), pre-existing cognitive impairment (OR 3.02; CI 1.22 - 7.43) and immobility (OR 1.88; CI 1.01 - 3.51). HIV infection was not associated with increased risk of delirium. Delirium was associated with an increased risk of inhospital (delirium v. no delirium: 29% v. 12%; p<0.01) and 12-month (30% v. 20%; p<0.01) mortality, as well as increased length of hospital stay (7 days v. 5 days; p<0.01). CONCLUSIONS In this cohort of medical inpatients (relatively young and with a high HIV prevalence) 1 of 8 (12.3%) patients was delirious. Delirium was associated with adverse outcomes. Delirium risk factors in this young cohort were similar to those in geriatric cohorts in developed countries, and neither HIV nor opportunistic infections increased risk.
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Krebs C, Peter J, Wyss P, Klöppel S. P119 Boosting the effect of cognitive training with transcranial electrical stimulation. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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May M, Schönthaler M, Gilfrich C, Wolff I, Peter J, Miernik A, Fritsche HM, Burger M, Schostak M, Lebentrau S. [Interrater reliability and clinical impact of the Post-Ureteroscopic Lesion Scale (PULS) grading system for ureteral lesions after ureteroscopy : Results of the German prospective multicenter BUSTER project]. Urologe A 2019; 57:172-180. [PMID: 29322235 DOI: 10.1007/s00120-017-0565-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Post-ureteroscopic Lesion Scale (PULS) was designed as a standardized classification system for ureteral lesions after uretero(reno)scopy (URS). This study evaluates its routine use and a possible clinical impact based on a representative patient cohort. MATERIALS AND METHODS Data of 307 patients in 14 German centers within the BUSTER project were used to test 3 hypotheses (H): PULS score shows a high interrater reliability (IRR) after independent assessment by urologic surgeon and assistance personnel (H1); PULS score is correlated with the frequency of postoperative complications during hospital stay (H2); post-URS stenting of the ureter is associated with higher PULS scores (H3). RESULTS Median age of patients was 54.4 years (interquartile range [IQR] 44.4-65.8; 65.5% male). Median diameter of index stones was 6 mm (IQR 4-8) with 117 (38.4%) pyelo-caliceal and 188 (61.6%) ureteral stones. Overall, 70 and 82.4% of patients had pre-stenting and post-URS stenting, respectively. Stone-free status was achieved in 68.7% after one URS procedure with a complication rate of 10.8% (mostly grade 1-2 according to Clavien-Dindo). PULS scores 0, 1, 2 and 3 were assessed in 40%, 52.1%, 6.9% and 1% of patients, respectively, when estimated by urologic surgeons. PULS score showed a high IRR between the urologic surgeon and assistance personnel (κ = 0.883, p < 0.001), but was not significantly correlated with complications (ρ = 0.09, p = 0.881). In contrast, a significant positive correlation was found between PULS score and post-URS stenting (ρ = 0.287, p < 0.001). A PULS score of 1 multiplied the likelihood of post-URS stenting by 3.24 (95% confidence interval 1.43-7.34; p = 0.005) as opposed to PULS score 0. CONCLUSIONS Removal of upper urinary tract stones using URS is safe and efficacious. Real-world data provided by this study confirm a high IRR of the PULS score and its clinical impact on the indication for post-URS stenting. A future prospective randomized trial should evaluate a possible standardization of post-URS stenting based on PULS score assessment.
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