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Dunlop CE, Jack SA, Telfer EE, Zahra S, Anderson RA. Clinical pregnancy in Turner syndrome following re-implantation of cryopreserved ovarian cortex. J Assist Reprod Genet 2023; 40:2385-2390. [PMID: 37566317 PMCID: PMC10504145 DOI: 10.1007/s10815-023-02905-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
Turner syndrome (TS) leads to a characteristic phenotype, including premature ovarian insufficiency and infertility. Ovarian tissue cryopreservation (OTC) is becoming an established fertility preservation strategy for both pre- and post-pubertal females and may offer the chance of having a biological family to selected patients with TS. To date, women with TS have had ovarian tissue cryopreserved but there are few reports of autologous re-implantation and none of pregnancy. We herein report, to our knowledge, the first clinical pregnancy in a patient with TS, conceived naturally following re-implantation of cryopreserved ovarian tissue which had been removed soon after spontaneous puberty. This provides proof of concept for OTC as a means of fertility preservation in TS.
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Affiliation(s)
- C E Dunlop
- Simpson's Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, EH16 4SA, UK.
| | - S A Jack
- Simpson's Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - E E Telfer
- Institute of Cell Biology and CDBS, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - S Zahra
- Tissues, Cells & Advanced Therapeutics, Scottish National Blood Transfusion Service, Edinburgh, EH14 4BE, UK
| | - R A Anderson
- Simpson's Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, EH16 4SA, UK
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, EH16 4TJ, UK
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2
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Amjad R, Ruby T, Talib S, Zahra S, Liaquat M, Batool A. Noise-induced hormonal & morphological malformations in breeding pigeons. BRAZ J BIOL 2023; 84:e271945. [PMID: 37255177 DOI: 10.1590/1519-6984.271945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/12/2023] [Indexed: 06/01/2023] Open
Abstract
Environmental pollution has the potential to have a significant impact on animal's health especially on birds due to daily exposure and habitat. This experimental study was carried out for a 60 days period in which, a total of 24 pigeon birds with suitable weight (80-100 g) were kept in Animal house with suitable environmental conditions viz, controlled temperature, humidity & light source to minimize any other stress. Out of twenty-four, eighteen birds were divided into three treatment groups (6 birds in each group). Whole experiment was run in triplicate manner in breeding season. One served as Control (Group 1) and remaining three were experimental groups including Road traffic noise (Group 2), Military noise (Group 3) & Human activities noise (Group 4). Noise was applied as recorded high intensity music (1125 Hz/ 90 dB) through speakers for 5-6 hrs. daily. Blood sampling was done after 20, 40 and 60 days by sacrificing treatment birds. Noise stress significantly (p<0.05) increase the serum levels of corticosterone and thyroid stimulating hormone (TSH) in Group 2 while significantly (p<0.05) decrease the serum levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) of Group 3 birds. Moreover, major fault bars formation was seen both in Group 2 and Group 3. It was concluded as that Noise stress caused rise in serum levels of Corticosterone and TSH but fall in LH and FSH. Along with fault bars formation was also prominent in all treatment groups due to stress hormone.
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Affiliation(s)
- R Amjad
- The Islamia University of Bahawalpur, Department of Zoology, Bahawalpur, Pakistan
| | - T Ruby
- Bahauddin Zakariya University, Institute of Pure and Applied Biology, Zoology Division, Multan, Pakistan
| | - S Talib
- Government Sadiq College Women University, Department of Zoology, Bahawalpur, Pakistan
| | - S Zahra
- Government Sadiq College Women University, Department of Zoology, Bahawalpur, Pakistan
| | - M Liaquat
- Bahauddin Zakariya University, Institute of Pure and Applied Biology, Zoology Division, Multan, Pakistan
| | - A Batool
- University of Narowal, Department of Zoology, Narowal, Pakistan
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3
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Arundel CE, Welch C, Saramago P, Adderley U, Atkinson R, Chetter I, Cullum N, Davill T, Griffiths J, Hewitt C, Hirst C, Kletter M, Mullings J, Roberts G, Smart B, Soares M, Stather P, Strachan L, Stubbs N, Torgerson DJ, Watson J, Zahra S, Dumville J. A randomised controlled trial of compression therapies for the treatment of venous leg ulcers (VenUS 6): study protocol for a pragmatic, multicentre, parallel-group, three-arm randomised controlled trial. Trials 2023; 24:357. [PMID: 37237393 DOI: 10.1186/s13063-023-07349-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Venous leg ulcer(s) are common, recurring, open wounds on the lower leg, resulting from diseased or damaged leg veins impairing blood flow. Wound healing is the primary treatment aim for venous leg ulceration, alongside the management of pain, wound exudate and infection. Full (high) compression therapy delivering 40 mmHg of pressure at the ankle is the recommended first-line treatment for venous leg ulcers. There are several different forms of compression therapy available including wraps, two-layer hosiery, and two-layer or four-layer bandages. There is good evidence for the clinical and cost-effectiveness of four-layer bandage and two-layer hosiery but more limited evidence for other treatments (two-layer bandage and compression wraps). Robust evidence is required to compare clinical and cost-effectiveness of these and to investigate which is the best compression treatment for reducing time to healing of venous leg ulcers whilst offering value for money. VenUS 6 will therefore investigate the clinical and cost-effectiveness of evidence-based compression, two-layer bandage and compression wraps for time to healing of venous leg ulcers. METHODS VenUS 6 is a pragmatic, multi-centre, three-arm, parallel-group, randomised controlled trial. Adult patients with a venous leg ulcer will be randomised to receive (1) compression wraps, (2) two-layer bandage or (3) evidence-based compression (two-layer hosiery or four-layer bandage). Participants will be followed up for between 4 and 12 months. The primary outcome will be time to healing (full epithelial cover in the absence of a scab) in days since randomisation. Secondary outcomes will include key clinical events (e.g. healing of the reference leg, ulcer recurrence, ulcer/skin deterioration, amputation, admission/discharge, surgery to close/remove incompetent superficial veins, infection or death), treatment changes, adherence and ease of use, ulcer related pain, health-related quality of life and resource use. DISCUSSION VenUS 6 will provide robust evidence on the clinical and cost-effectiveness of the different forms of compression therapies for venous leg ulceration. VenUS 6 opened to recruitment in January 2021 and is currently recruiting across 30 participating centres. TRIAL REGISTRATION ISRCTN67321719 . Prospectively registered on 14 September 2020.
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Affiliation(s)
- C E Arundel
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK.
| | - C Welch
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - P Saramago
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - U Adderley
- Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - R Atkinson
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - I Chetter
- University of Hull, Hull York Medical School and Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - N Cullum
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - T Davill
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - J Griffiths
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - C Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - C Hirst
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - M Kletter
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - J Mullings
- Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - G Roberts
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - B Smart
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - M Soares
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - P Stather
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - L Strachan
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - N Stubbs
- NCS Woundcare Consulting Limited, Cornmill Lane, Leeds, LS17 9EQ, UK
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - J Watson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - S Zahra
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - J Dumville
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Chaudhary A, Akram AM, Ahmad QUA, Hussain Z, Zahra S, Minahal Q, Azhar S, Ahmad S, Hayat S, Javed MA, Haider MS, Ali Q, Karita S. Optimized biotransformation of acid-treated water melon peel hydrolyzate into ethanol. BRAZ J BIOL 2021; 83:e253009. [PMID: 34495170 DOI: 10.1590/1519-6984.253009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
Today, global focus of research is to explore the solution of energy crisis and environmental pollution. Like other agricultural countries, bulk quantities of watermelon peels (WMP) are disposed-off in environment as waste in Pakistan and appropriate management of this waste is the need of hour to save environment from pollution. The work emphasizes the role of ethanologenic yeasts to utilize significant sugars present in WMP for low-cost bioethanol fermentation. Dilute hydrochloric acid hydrolysis of WMP was carried out on optimized conditions employing RSM (response surface methodology) following central composite design (CCD). This experimental design is based on optimization of ethanologenesis involving some key independent parameters such as WMP hydrolysate and synthetic media ratio (X1), incubation temperature (X2) and incubation temperature (X3) for maximal ethanol yield exploiting standard (Saccharomyces cerevisiae K7) as well as experimental (Metchnikowia cibodasensisY34) yeasts. The results revealed that maximal ethanol yields obtained from S. cerevisiae K7 was 0.36±0.02 g/g of reducing sugars whereas M. cibodasensisY34, yielded 0.40±0.01 g ethanol/g of reducing sugars. The yeast isolate M. cibodasensisY34 appeared as promising ethanologen and embodies prospective potential for fermentative valorization of WMP-to-bioethanol.
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Affiliation(s)
- A Chaudhary
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - A M Akram
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - Qurat-Ul-Ain Ahmad
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - Z Hussain
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - S Zahra
- University of Education, Department of Physics, Division of Science and Technology, Lahore, Pakistan
| | - Q Minahal
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - S Azhar
- University of the Punjab, Institute of Zoology, Lahore, Pakistan
| | - S Ahmad
- University of the Punjab Lahore, Department of Entomology, Lahore, Pakistan
| | - S Hayat
- The University of Lahore, Institute of Molecular Biology and Biotechnology, Lahore, Pakistan
| | - M A Javed
- University of the Punjab Lahore, Department of Plant Breeding and Genetics, Lahore, Pakistan
| | - M S Haider
- University of the Punjab Lahore, Department of Plant Pathology, Lahore, Pakistan
| | - Q Ali
- The University of Lahore, Institute of Molecular Biology and Biotechnology, Lahore, Pakistan
| | - S Karita
- Mie University, Graduate School of Bioresources, Tsu city, Mie, Japan
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5
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Jashari R, Vanzeebroeck S, Petit P, Rodriguez-Villalobos H, Zahra S, Ben Said N, Bouzet V, Mastrobuoni S. The BD BACTEC FX blood culture system with the gentlemacs dissociator is suitable for sterility testing of heart valve and vascular allografts-A validation study. Cell Tissue Bank 2021; 22:453-466. [PMID: 33417135 DOI: 10.1007/s10561-020-09893-6] [Citation(s) in RCA: 1] [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: 11/22/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
To present our validation study of the BD BACTEC FX blood culture system for sterility testing of cardiovascular tissues aimed for human application. For operational qualification, we performed temperature mapping of the system, vacuum test using non-inoculated BACTEC vials, and growth promotion tests by injecting contaminant strains into aerobic and anaerobic bottles. For performance qualification, negative control, assessment of method suitability, evaluation of sensitivity limits, control of neutralization of antibiotics in biopsy samples from allografts and tissue toxicity effects, were performed. Tissue samples and transport/cryopreservation solutions were homogenized in GentleMACS Dissociator and injected into BACTEC Plus aerobic and anaerobic vials for incubation at 35 °C for 14 days. Tissues were spiked with aerobic and anaerobic bacteria and fungi. Growth of contaminants appeared in all aerobic and anaerobic vials for Staphylococcus aureus, Staphylococcus epidermidis, Bacillus subtilis, Enterococcus faecalis, Escherichia coli and Pseudomonas aeruginosa; in anaerobic vials for Cutibacterium (Propionibacterium) acnes and Clostridium sporogenes; and only in aerobic vials for Candida albicans and Aspergillus brasiliensis. The majority of bacterial strains were detected within two days (59-100%), exceptionally between 3 and 14 days. In contrast, fungal contaminations were detected within 2, 3-6, 7-10 and after 10 days of incubation in 33.3, 71.6, 96.6 and 99.9% of cases,respectively. Uninhibited growth appeared in the tissue biopsies and homogenized tissues with and without antibiotics and in other solutions. BD BACTEC blood culture system with GentleMACS Dissociator is a rapid and efficient tool for detection of contamination in cardio-vascular tissues aimed for human application.
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Affiliation(s)
- Ramadan Jashari
- European Homograft Bank (EHB), UCL Saint Luc Clinics, Brussels, Belgium.
| | | | - Pieter Petit
- Medical Microbiology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | | | - Sharon Zahra
- Clinical Lead, Tissues, Cells and Advanced Therapeutics Scottish National Blood Transfusion Service, Scottland, UK
| | - Naziha Ben Said
- European Homograft Bank (EHB), UCL Saint Luc Clinics, Brussels, Belgium
| | - Vanessa Bouzet
- European Homograft Bank (EHB), UCL Saint Luc Clinics, Brussels, Belgium
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6
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Cooper RS, Fraser AR, Smith L, Burgoyne P, Imlach SN, Jarvis LM, Turner DM, Zahra S, Turner ML, Campbell JDM. Rapid GMP-Compliant Expansion of SARS-CoV-2-Specific T Cells From Convalescent Donors for Use as an Allogeneic Cell Therapy for COVID-19. Front Immunol 2021; 11:598402. [PMID: 33488592 PMCID: PMC7819874 DOI: 10.3389/fimmu.2020.598402] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022] Open
Abstract
COVID-19 disease caused by the SARS-CoV-2 virus is characterized by dysregulation of effector T cells and accumulation of exhausted T cells. T cell responses to viruses can be corrected by adoptive cellular therapy using donor-derived virus-specific T cells. One approach is the establishment of banks of HLA-typed virus-specific T cells for rapid deployment to patients. Here we show that SARS-CoV-2–exposed blood donations contain CD4 and CD8 memory T cells which recognize SARS-CoV-2 spike, nucleocapsid and membrane antigens. Peptides of these antigens can be used to isolate virus-specific T cells in a GMP-compliant process. The isolated T cells can be rapidly expanded using GMP-compliant reagents for use as an allogeneic therapy. Memory and effector phenotypes are present in the selected virus-specific T cells, but our method rapidly expands the desirable central memory phenotype. A manufacturing yield ranging from 1010 to 1011 T cells can be obtained within 21 days culture. Thus, multiple therapeutic doses of virus-specific T cells can be rapidly generated from convalescent donors for potential treatment of COVID-19 patients.
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Affiliation(s)
- Rachel S Cooper
- Tissues, Cells and Advanced Therapeutics, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Alasdair R Fraser
- Tissues, Cells and Advanced Therapeutics, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Linda Smith
- Tissues, Cells and Advanced Therapeutics, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Paul Burgoyne
- Tissues, Cells and Advanced Therapeutics, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Stuart N Imlach
- Tissues, Cells and Advanced Therapeutics, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Lisa M Jarvis
- National Microbiological Reference Unit, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - David M Turner
- Histocompatibility and Immunogenetics, Scottish National Blood Transfusion Service, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Sharon Zahra
- Tissues, Cells and Advanced Therapeutics, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Marc L Turner
- Tissues, Cells and Advanced Therapeutics, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - John D M Campbell
- Tissues, Cells and Advanced Therapeutics, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
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7
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Green L, Bolton-Maggs P, Beattie C, Cardigan R, Kallis Y, Stanworth SJ, Thachil J, Zahra S. British Society of Haematology Guidelines on the spectrum of fresh frozen plasma and cryoprecipitate products: their handling and use in various patient groups in the absence of major bleeding (Br J Haematol. 2018;181:54-67). Addendum August 2020. Br J Haematol 2020; 191:728-729. [PMID: 33206372 DOI: 10.1111/bjh.17104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Laura Green
- NHS Blood and Transplant, London, Barts Health NHS Trust, London and Blizard Institute, Queen Mary University of London, London, UK
| | - Paula Bolton-Maggs
- Faculty of Biology, Medicine and Health, University of Manchester and Serious Hazards of Transfusion Office, Manchester Blood Centre, Manchester, UK
| | - Craig Beattie
- Departmentt of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rebecca Cardigan
- NHS Blood and Transplant/Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Yiannis Kallis
- Department of Hepatology, Barts Health NHS Trust and Blizard Institute, Queen Mary University of London, London, UK
| | - Simon J Stanworth
- Oxford University Hospitals NHS Trust/NHS Blood and Transplant, University of Oxford, Oxford, UK
| | - Jecko Thachil
- Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, UK
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8
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Chandrasekar A, Paulus U, Bokhorst A, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, van Kraaij M, Merz EM, van den Hurk K, Hansen MB, Slot E, Ullum H. How donor selection criteria can be evaluated with limited scientific evidence: lessons learned from the TRANSPOSE project. Vox Sang 2020; 116:342-350. [PMID: 33191514 DOI: 10.1111/vox.13028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/29/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Donor selection criteria (DSC) are a vital link in the chain of supply of Substances of Human Origin (SoHO) but are also subject to controversy and differences of opinion. Traditionally, DSC have been based on application of the precautionary principle. MATERIALS AND METHODS From 2017 to 2020, TRANSPOSE (TRANSfusion and transplantation PrOtection and SElection of donors), a European research project, aimed to identify discrepancies between current DSC by proposing a standardized risk assessment method for all SoHO (solid organs excluded) and all levels of evidence. RESULTS The current DSC were assessed using a modified risk assessment method based on the Alliance of Blood Operators' Risk-based decision-making framework for blood safety. It was found that with limited or diverging scientific evidence, it was difficult to reach consensus and an international standardized method for decision-making was lacking. Furthermore, participants found it hard to disregard their local guidelines when providing expert opinion, which resulted in substantial influence on the consensus-based decision-making process. CONCLUSIONS While the field of donation-safety research is expanding rapidly, there is an urgent need to formalize the decision-making process regarding DSC. This includes the need for standardized methods to increase transparency in the international decision-making process and to ensure that this is performed consistently. Our framework provides an easy-to-implement approach for standardizing risk assessments, especially in the context of limited scientific evidence.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | - Livia Cannata
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Solna, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | | | | | | | - Arlinke Bokhorst
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | | | - Eva-Maria Merz
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands.,Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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9
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, Pozenel P, van Kraaij M, Hansen MB, Slot E, Ullum H. Putting the spotlight on donation-related risks and donor safety - are we succeeding in protecting donors? Vox Sang 2020; 116:313-323. [PMID: 33103801 DOI: 10.1111/vox.13014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The European consortium project TRANSPOSE (TRANSfusion and transplantation: PrOtection and SElection of donors) aimed to assess and evaluate the risks to donors of Substances of Human Origin (SoHO), and to identify gaps between current donor vigilance systems and perceived risks. MATERIALS AND METHODS National and local data from participating organizations on serious and non-serious adverse reactions in donors were collected from 2014 to 2017. Following this, a survey was performed among participants to identify risks not included in the data sets. Finally, participants rated the risks according to severity, level of evidence and prevalence. RESULTS Significant discrepancies between anticipated donor risks and the collected data were found. Furthermore, many participants reported that national data on adverse reactions in donors of stem cells, gametes, embryos and tissues were not routinely collected and/or available. CONCLUSIONS These findings indicate that there is a need to further develop and standardize donor vigilance in Europe and to include long-term risks to donors, which are currently underreported, ensuring donor health and securing the future supply of SoHO.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, Berne and University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | - Livia Cannata
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | | | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Primoz Pozenel
- Blood transfusion Center of Slovenia, Ljubljana, Slovenia
| | | | - Morten Bagge Hansen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Henrik Ullum
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
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Bagtache R, Zahra S, Abdi A, Trari M. Characterization of CuCo2O4 Prepared by Nitrate Route: Application to Ni2+ reduction under visible light. J Photochem Photobiol A Chem 2020. [DOI: 10.1016/j.jphotochem.2020.112728] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Zahra S, Galea G, Jashari R, Petit P, de By TMMH. Validation of microbiological testing in cardiovascular tissue establishments: results of a second international quality-round trial. Eur J Clin Microbiol Infect Dis 2019; 38:1481-1490. [DOI: 10.1007/s10096-019-03576-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/30/2019] [Indexed: 12/01/2022]
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12
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Green L, Bolton-Maggs P, Beattie C, Cardigan R, Kallis Y, Stanworth SJ, Thachil J, Zahra S. British Society of Haematology Guidelines on the spectrum of fresh frozen plasma and cryoprecipitate products: their handling and use in various patient groups in the absence of major bleeding. Br J Haematol 2018; 181:54-67. [PMID: 29527654 DOI: 10.1111/bjh.15167] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Laura Green
- NHS Blood and Transplant, London, UK
- Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
| | - Paula Bolton-Maggs
- Serious Hazards of Transfusion Office, Manchester Blood Centre, Manchester, UK
| | - Craig Beattie
- Dept of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rebecca Cardigan
- NHS Blood and Transplant/Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Yiannis Kallis
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Hepatology, Barts Health NHS Trust, London, UK
| | - Simon J Stanworth
- Oxford University Hospitals NHS Trust/NHS Blood and Transplant, University of Oxford, Oxford, UK
| | - Jecko Thachil
- Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, UK
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13
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O'Sullivan ED, Battle RK, Zahra S, Keating JF, Marson LP, Turner DM. Allosensitization Following Bone Graft. Am J Transplant 2017; 17:2207-2211. [PMID: 28199784 DOI: 10.1111/ajt.14231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/04/2017] [Revised: 01/27/2017] [Accepted: 02/04/2017] [Indexed: 01/25/2023]
Abstract
It is recognized that patients may become sensitized to donor-specific HLA antigens as a result of previous antigenic exposures, classically through previous transplantation, pregnancy, or blood transfusion. We present an unusual case of a patient who unexpectedly developed a range of anti-HLA antibodies following orthopedic surgery where a bone graft was deployed intraoperatively. We describe the case of a 52-year-old man awaiting a renal transplantation, undergoing elective orthopedic surgery requiring a small-volume bone graft. His postoperative antibody profile was found to be substantially changed compared to his previous negative samples, with the presence of HLA-DR, DQ, and DP specificities, at levels that would be likely to give a positive flow cytometry crossmatch and therefore according to local procedures required listing as unacceptable antigens for organ allocation. We perform a literature review of all previous cases of allosensitization following bone graft. This case is the first to demonstrate allosensitization following minor surgery with ;low-volume bone graft. Previous evidence is very limited and pertains only to massive osteochondral surgery for trauma or malignancy, and is confounded by potential concomitant blood transfusion. Clinicians should be aware of the risk of allosensitization where bone grafts are used.
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Affiliation(s)
- E D O'Sullivan
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R K Battle
- H&I Department, Scottish National Blood Transfusion Service, Edinburgh, UK
| | - S Zahra
- Tissue and Cells Services, Scottish National Blood Transfusion Service, Edinburgh, UK
| | - J F Keating
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - L P Marson
- Department of Transplant Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D M Turner
- H&I Department, Scottish National Blood Transfusion Service, Edinburgh, UK
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14
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Bhatti FU, Mehmood A, Latief N, Zahra S, Cho H, Khan SN, Riazuddin S. Vitamin E protects rat mesenchymal stem cells against hydrogen peroxide-induced oxidative stress in vitro and improves their therapeutic potential in surgically-induced rat model of osteoarthritis. Osteoarthritis Cartilage 2017; 25:321-331. [PMID: 27693502 DOI: 10.1016/j.joca.2016.09.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 09/04/2016] [Accepted: 09/23/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Oxidative stress is a major obstacle against cartilage repair in osteoarthritis (OA). Anti-oxidant agents can play a vital role in addressing this issue. We evaluated the effect of Vitamin E preconditioning in improving the potential of mesenchymal stem cells (MSCs) to confer resistance against oxidative stress prevailing during OA. METHODS Vitamin E pretreated MSCs were exposed to oxidative stress in vitro by hydrogen peroxide (H2O2) and also implanted in surgically-induced rat model of OA. Analysis was done in terms of cell proliferation, apoptosis, cytotoxicity, chondrogenesis and repair of cartilage tissue. RESULTS Vitamin E pretreatment enabled MSCs to counteract H2O2-induced oxidative stress in vitro. Proliferative markers, proliferating cell nuclear antigen (PCNA) and Ki67 were up-regulated, along with the increase in the viability of MSCs. Expression of transforming growth factor-beta (TGFβ) was also increased. Reduction of apoptosis, expression of vascular endothelial growth factor (VEGF) and caspase 3 (Casp3) genes, and lactate dehydrogenase (LDH) release were also observed. Transplantation of Vitamin E pretreated MSCs resulted in increased proteoglycan contents of cartilage matrix. Increased expression of chondrogenic markers, Aggrecan (Acan) and collagen type-II alpha (Col2a1) accompanied by decreased expression of collagen type-I alpha (Col1a1) resulted in increased differentiation index that signifies the formation of hyaline cartilage. Further, there was an increased expression of PCNA and TGFβ genes along with a decreased expression of Casp3 and VEGF genes with increased histological score. CONCLUSION Taken together results of this study demonstrated that Vitamin E pretreated MSCs have an improved ability to impede the progression of OA and thus increased potential to treat OA.
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Affiliation(s)
- F U Bhatti
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan; University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA.
| | - A Mehmood
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan.
| | - N Latief
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan.
| | - S Zahra
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan.
| | - H Cho
- University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA; Veterans Affairs Medical Center, Memphis, TN, USA.
| | - S N Khan
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan.
| | - S Riazuddin
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan; Allama Iqbal Medical College, University of Health Sciences, Lahore, Pakistan.
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15
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Green L, Cardigan R, Beattie C, Bolton-Maggs P, Stanworth SJ, Thachil J, Kallis Y, Zahra S. Addendum to the British Committee for Standards in Haematology (BCSH): guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant, 2004 (Br. J Haematol 2004,126,11-28) - response to Neisser-Svae and Heger. Br J Haematol 2016; 180:749-750. [PMID: 27879999 DOI: 10.1111/bjh.14434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Laura Green
- NHS Blood and Transplant, London, Barts Health NHS Trust, London & Blizard Institute, Queen Mary University of London, London, UK
| | | | - Craig Beattie
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Simon J Stanworth
- Oxford University Hospitals NHS Trust/NHS Blood and Transplant Oxford, University of Oxford, Oxford, UK
| | - Jecko Thachil
- Haematology Department, Manchester Royal Infirmary, Edinburgh, UK
| | - Yiannis Kallis
- Department of Hepatology, Barts Health NHS Trust and Blizard Institute, Queen Mary University of London, London, UK
| | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, UK
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16
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Green L, Cardigan R, Beattie C, Bolton-Maggs P, Stanworth SJ, Thachil J, Kallis Y, Zahra S. Addendum to the British Committee for Standards in Haematology (BCSH): Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant, 2004 (Br. J Haematol 2004,126,11-28). Br J Haematol 2016; 178:646-647. [PMID: 27306832 DOI: 10.1111/bjh.14163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Laura Green
- NHS Blood and Transplant, London, UK.,Barts Health NHS Trust, London, London, UK.,Blizard Institute Queen Mary University of London, London, UK
| | | | - Craig Beattie
- Dept of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Simon J Stanworth
- Oxford University Hospitals NHS Trust/NHS Blood and Transplant, Oxford, UK.,University of Oxford, London, UK
| | - Jecko Thachil
- Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Yiannis Kallis
- Blizard Institute Queen Mary University of London, London, UK.,Department of Hepatology, Barts Health NHS Trust, London, UK
| | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, UK
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17
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Mohamed FE, Zaky EA, Youssef A, Elhossiny R, Zahra S, Khalaf R, Youssef W, Wafiq A, Ibrahim R, Abd-Elhakim R, Obada A, Eldin WS. Screening of Egyptian toddlers for autism spectrum disorder using an Arabic validated version of M-CHAT; report of a community-based study (Stage I). Eur Psychiatry 2016; 34:43-48. [PMID: 26928345 DOI: 10.1016/j.eurpsy.2016.01.2421] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/17/2016] [Accepted: 01/17/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although there is a recommendation that toddlers be screened for Autism spectrum disorder (ASD) during their 18- and 24-month well-care child visits, diagnosis often occurs well after the child turns 4 years old. Such delayed diagnosis hinders the implementation of early intervention thus worsens the long-term prognosis of ASD. OBJECTIVE The current community-based study in its stage I aimed at early screening of Egyptian toddlers for ASD using an Arabic validated version of Modified Checklist for Autism in Toddlers (M-CHAT). METHODOLOGY A cross-sectional community-based descriptive study was carried out enrolling 5546 Egyptian toddlers. They were randomly recruited from those attending Primary Health Care Units in six Egyptian governorates with a fair representation of the urban, semi-urban, and rural Egyptian populations. An Arabic validated version of M-CHAT was used as a screening tool for ASD. RESULTS The current study revealed failure of M-CHAT (suspected to have ASD and needs further evaluation) in 1320 out of the enrolled 5546 Egyptian toddlers (23.8%). CONCLUSION M-CHAT as a screening tool for ASD has flagged a considerable percent of the enrolled toddlers that necessitates referral for further evaluation (stage II) to settle the diagnosis of ASD in the true positive cases. Perfecting the delicate balance between sensitivity and specificity for ASD screening tools is crucial in order not to miss early detection of ASD cases and at the same time, to avoid over-diagnosis with subsequent abuse of the limited healthcare resources in developing countries.
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Affiliation(s)
- F E Mohamed
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - E A Zaky
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
| | - A Youssef
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - R Elhossiny
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - S Zahra
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - R Khalaf
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - W Youssef
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - A Wafiq
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - R Ibrahim
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - R Abd-Elhakim
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - A Obada
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt
| | - W S Eldin
- Community Medicine, Faculty of Medicine, Ain Shams University, Egypt
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El Kholy M, Mella P, Rashad M, Buzi F, Meazza C, Zahra S, Elsedfy HH. Growth hormone/IGF-I axis and growth hormone receptor mutations in idiopathic short stature. Horm Res Paediatr 2012; 76:300-6. [PMID: 21846964 DOI: 10.1159/000330191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 06/16/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS It was hypothesized that some children with idiopathic short stature (ISS) may have partial insensitivity to growth hormone (GH). In this study analysis of the GH/IGF-I axis as well as GH receptor (GHR) gene was done in children with ISS to determine the possible underlying factor(s) to their short stature. METHODS Forty-eight patients with a diagnosis of ISS were studied; 33 boys and 15 girls aged 13.6 ± 3.7 years. Molecular analysis of the GHR was performed and GH sensitivity was tested by the IGF-I generation test. RESULTS Basal IGF-I levels were <-2 SD in 22.9%, and 53.5% showed an IGF-I response below 40% (0-38%) to GH stimulation. GH-binding protein (GHBP) levels were below the normative mean in almost all patients. Mutations in the region of the GHR gene that codes for the extracellular domain of the receptor were found in 15.5%; one newly described mutation was recorded. CONCLUSION With the possible exception of the novel G62V mutation, functional studies of the other 2 heterozygous mutations found in 6 of our patients are needed in order to prove their impact on short stature.
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Affiliation(s)
- M El Kholy
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
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Zahra S, Anderson J, Stirling D, Ludlam C. Plasma microparticles are not elevated in fresh plasma from patients with gynaecological malignancy — An observational study. Gynecol Oncol 2011; 123:152-6. [DOI: 10.1016/j.ygyno.2011.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 06/27/2011] [Accepted: 06/30/2011] [Indexed: 01/01/2023]
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Abstract
BACKGROUND Until recently, only two cases of acute adrenal crisis associated with inhaled corticosteroids (ICS) had been reported worldwide. We identified four additional cases and sought to survey the frequency of this side effect in the United Kingdom. METHODS Questionnaires were sent to all consultant paediatricians and adult endocrinologists registered in a UK medical directory, asking whether they had encountered asthmatic patients with acute adrenal crisis associated with ICS. Those responding positively completed a more detailed questionnaire. Diagnosis was confirmed by symptoms/signs and abnormal hypothalamic-pituitary-adrenal axis function test results. RESULTS From an initial 2912 questionnaires, 33 patients met the diagnostic criteria (28 children, five adults). Twenty-three children had acute hypoglycaemia (13 with decreased levels of consciousness or coma; nine with coma and convulsions; one with coma, convulsions and death); five had insidious onset of symptoms. Four adults had insidious onset of symptoms; one had hypoglycaemia and convulsions. Of the 33 patients treated with 500-2000 micro g/day ICS, 30 (91%) had received fluticasone, one (3%) fluticasone and budesonide, and two (6%) beclomethasone. CONCLUSIONS The frequency of acute adrenal crisis was greater than expected as the majority of these patients were treated with ICS doses supported by British Guidelines on Asthma Management. Despite being the least prescribed and most recently introduced ICS, fluticasone was associated with 94% of the cases. We therefore advise that the licensed dosage of fluticasone for children, 400 micro g/day, should not be exceeded unless the patient is being supervised by a physician with experience in problematic asthma. We would also emphasise that until adrenal function has been assessed patients receiving high dose ICS should not have this therapy abruptly terminated as this could precipitate adrenal crisis.
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