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Sawadogo M, Ciza F, Nzeyimana SD, Shingiro A, Ndikumana T, Demeulenaere T, Khogali M, Edginton M, Reid AJ, Kumar AMV, Harries AD. Effect of increased ART-CPT uptake on tuberculosis outcomes and associated factors, Burundi, 2009-2013. Public Health Action 2015; 5:214-6. [PMID: 26767173 DOI: 10.5588/pha.15.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 09/06/2015] [Indexed: 11/10/2022] Open
Abstract
We retrospectively examined 3579 records of human immunodeficiency virus infected tuberculosis (TB) patients diagnosed from January 2009 to June 2013 in 55 TB treatment facilities in Burundi, to demonstrate whether improvement of combined cotrimoxazole preventive therapy and antiretroviral therapy (ART) uptake was accompanied by improvement of treatment outcomes, and to describe associated factors. Treatment success rates increased from 71% to 80% (P < 0.001). While loss to follow-up and transfer-out rates declined significantly, death rates decreased modestly, and remained high, at 14%. ART uptake was worse in suburban areas and private for-profit institutions. World Health Organization targets could be achieved if peripheral health facilities were prioritised.
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Affiliation(s)
| | - F Ciza
- National Tuberculosis Control Programme, Ministry of Health, Bujumbura, Burundi
| | - S D Nzeyimana
- National Tuberculosis Control Programme, Ministry of Health, Bujumbura, Burundi
| | - A Shingiro
- National Antituberculosis Centre, Bujumbura, Burundi
| | - T Ndikumana
- National Tuberculosis Control Programme, Ministry of Health, Bujumbura, Burundi
| | | | - M Khogali
- Médecins Sans Frontières, Operational Research Unit, Operational Centre Brussels, Luxembourg
| | - M Edginton
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Public Health, Faculty of Health Sciences, University of Witwaterstand, Johannesburg, South Africa
| | - A J Reid
- Médecins Sans Frontières, Operational Research Unit, Operational Centre Brussels, Luxembourg
| | - A M V Kumar
- The Union, South-East Asia Regional Office, New Delhi, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Ramsay A, Harries AD, Zachariah R, Bissell K, Hinderaker SG, Edginton M, Enarson DA, Satyanarayana S, Kumar AMV, Hoa NB, Tweya H, Reid AJ, Van den Bergh R, Tayler-Smith K, Manzi M, Khogali M, Kizito W, Ali E, Delaunois P, Reeder JC. The Structured Operational Research and Training Initiative for public health programmes. Public Health Action 2015; 4:79-84. [PMID: 26399203 DOI: 10.5588/pha.14.0011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In 2009, the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins sans Frontières Brussels-Luxembourg (MSF) began developing an outcome-oriented model for operational research training. In January 2013, The Union and MSF joined with the Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO) to form an initiative called the Structured Operational Research and Training Initiative (SORT IT). This integrates the training of public health programme staff with the conduct of operational research prioritised by their programme. SORT IT programmes consist of three one-week workshops over 9 months, with clearly-defined milestones and expected output. This paper describes the vision, objectives and structure of SORT IT programmes, including selection criteria for applicants, the research projects that can be undertaken within the time frame, the programme structure and milestones, mentorship, the monitoring and evaluation of the programmes and what happens beyond the programme in terms of further research, publications and the setting up of additional training programmes. There is a growing national and international need for operational research and related capacity building in public health. SORT IT aims to meet this need by advocating for the output-based model of operational research training for public health programme staff described here. It also aims to secure sustainable funding to expand training at a global and national level. Finally, it could act as an observatory to monitor and evaluate operational research in public health. Criteria for prospective partners wishing to join SORT IT have been drawn up.
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Affiliation(s)
- A Ramsay
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland ; Bute Medical School, University of St Andrews, Fife, Scotland, UK
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - R Zachariah
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, The University of Auckland, New Zealand
| | - S G Hinderaker
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Center for International Health, University of Bergen, Bergen, Norway
| | - M Edginton
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union South-East Asia Regional Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union South-East Asia Regional Office, New Delhi, India
| | - N B Hoa
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - H Tweya
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A J Reid
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - R Van den Bergh
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - K Tayler-Smith
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - M Manzi
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - M Khogali
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - W Kizito
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - E Ali
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - P Delaunois
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - J C Reeder
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
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Harries AD, Kumar AMV, Satyanarayana S, Bissell K, Hinderaker SG, Edginton M, Reid AJ, Zachariah R. References for scientific papers: why not standardise to one global style? Public Health Action 2015; 3:255-7. [PMID: 26393041 DOI: 10.5588/pha.13.0066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/05/2013] [Indexed: 11/10/2022] Open
Abstract
The different reference styles demanded by journals, both for in-text citations and manuscript bibliographies, require that significant time and attention be paid to minute detail that constitute a tedious obstacle on the road to publication for all authors, but especially for those from resource-limited countries and/or writing in a second language. To illustrate this, we highlight different reference styles requested by five popular journals to which operational research papers are often submitted. We call for a simpler, standardised format for in-text and bibliography reference citations, so that researchers can concentrate on the science and its interpretation rather than fonts and punctuation.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union, South-East Asia Regional Office, New Delhi, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union, South-East Asia Regional Office, New Delhi, India
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - S G Hinderaker
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Center for International Health, University of Bergen, Bergen, Norway
| | - M Edginton
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A J Reid
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, Operational Research Unit, MSF-Luxembourg, Luxembourg
| | - R Zachariah
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, Operational Research Unit, MSF-Luxembourg, Luxembourg
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Bissell K, Harries AD, Reid AJ, Edginton M, Hinderaker SG, Satyanarayana S, Enarson DA, Zachariah R. Operational research training: the course and beyond. Public Health Action 2015; 2:92-7. [PMID: 26392960 DOI: 10.5588/pha.12.0022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/10/2012] [Indexed: 11/10/2022] Open
Abstract
Insufficient operational research (OR) is generated within programmes and health systems in low- and middle-income countries, partly due to limited capacity and skills to undertake and publish OR in peer-reviewed journals. To address this, a three-module course was piloted by the International Union Against Tuberculosis and Lung Disease and Médecins Sans Frontières in 2009-2010, with 12 participants. Five received mentorship and financial support as OR Fellows. Eleven of 12 participants submitted a paper to a peer-reviewed journal within 4 weeks of the end of the course. Evaluation shows that participants continued OR activities beyond the course. During the subsequent year, they submitted and/or published 19 papers, made 10 posters and/or presentations, and many participated in training, mentoring and/or paper reviewing. Some described changes in policy and practice influenced by their research, and changes in their organisation's approach to OR. They provided recommendations for improving and expanding OR. We conclude that participants can, with certain enabling conditions, take research questions through to publication, use skills gained to undertake and promote OR thereafter and contribute to improvement in policy and practice. An internet-based network will provide participants and graduates with a platform for collection of course outcomes and ongoing mentor- and peer-based support, resources and incentives.
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Affiliation(s)
- K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - A J Reid
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
| | - M Edginton
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S G Hinderaker
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Centre for International Health, University of Bergen, Bergen, Norway
| | | | - D A Enarson
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - R Zachariah
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
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Mlilo N, Sandy C, Harries AD, Kumar AMV, Masuka N, Nyathi B, Edginton M, Isaakidis P, Manzi M, Siziba N. Does the type of treatment supporter influence tuberculosis treatment outcomes in Zimbabwe? Public Health Action 2013; 3:146-8. [PMID: 26393018 DOI: 10.5588/pha.13.0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 04/26/2013] [Indexed: 11/10/2022] Open
Abstract
Zimbabwe National Tuberculosis Guidelines advise that direct observation of anti-tuberculosis treatment (DOT) can be provided by a family member/relative as a last resort. In 2011, in Nkayi District, of 763 registered tuberculosis (TB) patients, 59 (8%) received health facility-based DOT, 392 (51%) received DOT from a trained community worker and 306 (40%) from a family member/relative. There were no differences in TB treatment outcomes between the three DOT groups, apart from a higher frequency rate of 'no reported outcomes' for those receiving family-based DOT. Family members should be trained to use a suitable DOT support package.
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Affiliation(s)
- N Mlilo
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - C Sandy
- National Tuberculosis Control Programme, Harare, Zimbabwe
| | - A D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - N Masuka
- Ministry of Health and Child Welfare, Matabeleland, North Province, Zimbabwe
| | - B Nyathi
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - M Edginton
- Ethics Advisory Group, The Union, Paris, France
| | - P Isaakidis
- Médecins Sans Frontières-Luxembourg, Luxembourg
| | - M Manzi
- Médecins Sans Frontières-Luxembourg, Luxembourg
| | - N Siziba
- National Tuberculosis Control Programme, Harare, Zimbabwe
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Kanyerere HS, Mpunga J, Tweya H, Edginton M, Harries AD, Hinderaker SG, Chimbwandira F, Gonani A, Mbendera K. Timing of antiretroviral therapy and effects on tuberculosis treatment outcomes in HIV-co-infected patients in Malawi. Public Health Action 2012; 2:174-7. [PMID: 26392979 DOI: 10.5588/pha.12.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 09/03/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING Queen Elizabeth Central Hospital, Blantyre, Malawi. OBJECTIVES To determine 1) the proportion of human immunodeficiency virus (HIV) infected tuberculosis (TB) patients started on antiretroviral therapy (ART), 2) the timing of ART and 3) the effect of the timing on TB treatment outcomes. DESIGN A retrospective record review of HIV-infected TB patients registered from January to December 2009. RESULTS A total of 3376 TB patients were registered, of whom 2665 (79%) were HIV-tested and 2042 (77%) were HIV-infected. A total of 1190 HIV-infected TB patients who were not on ART at the time of starting TB treatment were studied. Of 688 (58%) who started ART, 61% started therapy within 2 months of anti-tuberculosis treatment and 39% started later (≥2 months). Treatment success for patients with TB who started ART within 2 months was higher than for those starting ART later (RR 1.6, 95%CI 1.4-1.8), and death rates were lower (RR 0.25, 95%CI 0.19-0.35). CONCLUSION Under routine programme conditions in Malawi, a higher proportion of HIV-infected TB patients who started ART did so within 2 months of starting TB treatment, and early ART intervention was associated with better treatment outcomes. This confirms recommendations that co-infected TB patients should start ART early.
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Affiliation(s)
- H S Kanyerere
- National Tuberculosis Programme, Ministry of Health, Lilongwe, Malawi
| | - J Mpunga
- National Tuberculosis Programme, Ministry of Health, Lilongwe, Malawi
| | - H Tweya
- Lighthouse Trust, Lilongwe, Malawi
| | - M Edginton
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - S G Hinderaker
- Centre for International Health, University of Bergen, Bergen, Norway
| | - F Chimbwandira
- HIV and AIDS Department, Ministry of Health, Lilongwe, Malawi
| | - A Gonani
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - K Mbendera
- National Tuberculosis Programme, Ministry of Health, Lilongwe, Malawi
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Edginton M, Enarson D, Zachariah R, Reid T, Satyanarayana S, Bissell K, Hinderaker SG, Harries T. Why ethics is indispensable for good-quality operational research. Public Health Action 2012; 2:21-2. [PMID: 26392940 PMCID: PMC4536562 DOI: 10.5588/pha.12.0001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 02/05/2012] [Indexed: 11/10/2022] Open
Abstract
This article outlines challenges encountered when ethics is taught and promoted in the Operational Research courses of the International Union Against Tuberculosis and Lung Disease, with a focus on ethical issues related to studies that involve health records reviews. Problems observed by the Ethics Advisory Group include engagement of all stakeholders, maintenance of confidentiality and authorship. The omission of ethics in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement and its explanatory commentary published in 2007 is highlighted and questioned.
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Affiliation(s)
- M Edginton
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Ethics Advisory Group, The Union, Paris, France
| | - D Enarson
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - R Zachariah
- Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg
| | - T Reid
- Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg
| | - S Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union South-East Asia, New Delhi, India
| | - K Bissell
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S G Hinderaker
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Center for International Health, University of Bergen, Bergen, Norway
| | - T Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Harries AD, Rusen ID, Reid T, Detjen AK, Berger SD, Bissell K, Hinderaker SG, Edginton M, Fussell M, Fujiwara PI, Zachariah R. The Union and Médecins Sans Frontières approach to operational research. Int J Tuberc Lung Dis 2011; 15:144-i. [PMID: 21219672] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Operational research (OR) has become a hot topic at national meetings, international conferences and donor fora. The International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) Operational Centre Brussels strongly promote and implement OR with colleagues in low- and middle-income countries. Here we describe how the two organisations define OR, and explain the guiding principles and methodology that underpin the strategy for developing and expanding OR in those countries. We articulate The Union's and MSF's approach to supporting OR, highlighting the main synergies and differences. Then, using the Malawi National Tuberculosis Control Programme as an example, we show how OR can be embedded within tuberculosis control activities, leading to changes in policy and practice at the national level. We discuss the difficult, yet vitally important, issue of capacity building, and share our vision of a new paradigm of product-related training and performance-based OR fellowships as two ways of developing the necessary skills at country level to ensure research is actually performed. Finally, we highlight the need to consider and incorporate into practice the ethical components of OR. This is a key moment to be involved in OR. We are confident that in partnership with interested stakeholders, including the World Health Organization, we can stimulate the implementation of quality, relevant OR as an integral part of health service delivery that in turn will lead to better health for people, particularly for those living in the poorer parts of the world.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.
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Clayton PT, Eaton S, Aynsley-Green A, Edginton M, Hussain K, Krywawych S, Datta V, Malingre HE, Berger R, van den Berg IE. Hyperinsulinism in short-chain L-3-hydroxyacyl-CoA dehydrogenase deficiency reveals the importance of beta-oxidation in insulin secretion. J Clin Invest 2001; 108:457-65. [PMID: 11489939 PMCID: PMC209352 DOI: 10.1172/jci11294] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2000] [Accepted: 06/11/2001] [Indexed: 12/14/2022] Open
Abstract
A female infant of nonconsanguineous Indian parents presented at 4 months with a hypoglycemic convulsion. Further episodes of hypoketotic hypoglycemia were associated with inappropriately elevated plasma insulin concentrations. However, unlike other children with hyperinsulinism, this patient had a persistently elevated blood spot hydroxybutyrylcarnitine concentration when fed, as well as when fasted. Measurement of the activity of L-3-hydroxyacyl-CoA dehydrogenase in cultured skin fibroblasts with acetoacetyl-CoA substrate showed reduced activity. In fibroblast mitochondria, the activity was less than 5% that of controls. Sequencing of the short-chain L-3-hydroxyacyl-CoA dehydrogenase (SCHAD) genomic DNA from the fibroblasts showed a homozygous mutation (C773T) changing proline to leucine at amino acid 258. Analysis of blood from the parents showed they were heterozygous for this mutation. Western blot studies showed undetectable levels of immunoreactive SCHAD protein in the child's fibroblasts. Expression studies showed that the P258L enzyme had no catalytic activity. We conclude that C773T is a disease-causing SCHAD mutation. This is the first defect in fatty acid beta-oxidation that has been associated with hyperinsulinism and raises interesting questions about the ways in which changes in fatty acid and ketone body metabolism modulate insulin secretion by the beta cell. The patient's hyperinsulinism was easily controlled with diazoxide and chlorothiazide.
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Affiliation(s)
- P T Clayton
- London Centre for Paediatric Endocrinology and Metabolism, Biochemistry, Endocrinology and Metabolism Unit, Institute of Child Health, University College London, United Kingdom.
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Ades AE, Parker S, Walker J, Edginton M, Taylor GP, Weber JN. Human T cell leukaemia/lymphoma virus infection in pregnant women in the United Kingdom: population study. BMJ 2000; 320:1497-501. [PMID: 10834889 PMCID: PMC27390 DOI: 10.1136/bmj.320.7248.1497] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2000] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the prevalence of human T cell leukaemia/lymphoma virus (HTLV) infection in pregnant women in the United Kingdom. DESIGN Population study. SUBJECTS Guthrie card samples from babies born in 1997-8. Samples were linked to data on mother's age and ethnic status and parents' country of birth and then anonymised. SETTING North Thames Regional Health Authority. MAIN OUTCOME MEASURES Presence of antibodies against HTLV in eluates tested by gelatin particle agglutination assay and results confirmed by immunoblot. RESULTS Of 126 010 samples tested, 67 had confirmed antibodies to HTLV (59 HTLV-I, 2 HTLV-II, 6 untyped) and six had indeterminate results. Seroprevalence was 17.0 per 1000 (95% confidence interval 9.2 to 28.3) in infants whose mothers were born in the Caribbean, 3.2/1000 (1.5 to 5.9) with mothers born in west and central Africa, and 6.8/1000 (3.1 to 12.9) in infants of black Caribbean mothers born in non-endemic regions. In infants with no known risk (both parents born in non-endemic regions and mother not black Caribbean) seroprevalence was 0.06-0.12 per 1000. Mother's country of birth, father's country of birth, and mother's ethnic status were all independently associated with neonatal seroprevalence. An estimated 223 (95% confidence interval 110 to 350) of the 720 000 pregnant women each year in the United Kingdom are infected with HTLV. CONCLUSIONS The prevalence of HTLV and HIV infections in pregnant women in the United Kingdom are comparable. The cost effectiveness of antenatal HTLV screening should be evaluated, and screening of blood donations should be considered.
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Affiliation(s)
- A E Ades
- Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH.
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