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Craig CE, Schnorr CD, Then Paulino CJ, Payano EC, Guzmán PM, Ripkey C, de St Aubin M, Dumas D, Roberts KW, Duke W, Skewes-Ramm R, Lozier MJ, Nilles EJ. Hand hygiene perceptions, preferences, and practices among hospital staff in the Dominican Republic in the context of COVID-19: a qualitative study. Infect Prev Pract 2024; 6:100367. [PMID: 38765916 PMCID: PMC11101936 DOI: 10.1016/j.infpip.2024.100367] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
Background Proper hand hygiene (HH), which includes sanitizing with alcohol-based hand rub (ABHR) (or handwashing with soap and water if ABHR is unavailable), is key for preventing healthcare-associated infections (HCAI), including COVID-19. Understanding drivers of HH is key to improving adherence. Aim This study aims to explore drivers and barriers to HH practice at two hospitals in the Dominican Republic in the context of the COVID-19 pandemic to inform development of HH behaviour change interventions. Methods We conducted in-depth interviews with 20 hospital staff during September 2021. We used the COM-B (capability, opportunity, motivation, behaviour) model to explore HH experiences and preferences. Interviews were recorded, transcribed, coded, and analysed using a thematic approach. Results A total of 11 parent codes and 27 sub-codes were identified, and 1145 coded segments were analysed. Use of handwashing with soap and water and/or sanitizing with ABHR was reported by all participants; handwashing was generally preferred. Participants expressed knowledge of proper HH methods (capability), but inconsistent supplies and lack of time presented HH challenges (opportunity). Interviewees described practicing HH to protect themselves and their families from COVID-19 and other infections (reflective motivation) or out of habit (automatic motivation). Discussion By understanding and addressing underlying factors affecting HH, hospitals can decrease the risk of HCAIs. Our findings suggest that interventions implemented to improve HH in these hospitals should target motivation and opportunity. These findings informed a multimodal intervention to increase ABHR access and implement message-tested communications campaigns; end-point assessments will provide insights into the intervention's impact.
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Affiliation(s)
- Christina E. Craig
- National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Charles D. Schnorr
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Infectious Diseases & Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cecilia J. Then Paulino
- Dirección General de Epidemiología, Ministry of Public Health and Social Assistance, Santo Domingo, Dominican Republic
| | | | | | - Carrie Ripkey
- Infectious Disease Program, CDC Foundation, Atlanta, GA, USA
| | - Michael de St Aubin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Infectious Diseases & Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Devan Dumas
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Infectious Diseases & Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Kathryn W. Roberts
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Infectious Diseases & Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - William Duke
- Universidad Nacional Pedro Henríquez Ureña, Santo Domingo, Dominican Republic
| | - Ronald Skewes-Ramm
- Dirección General de Epidemiología, Ministry of Public Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Matthew J. Lozier
- National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric J. Nilles
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Infectious Diseases & Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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2
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Mario Martin B, Cadavid Restrepo A, Mayfield HJ, Then Paulino C, De St Aubin M, Duke W, Jarolim P, Zielinski Gutiérrez E, Skewes Ramm R, Dumas D, Garnier S, Etienne MC, Peña F, Abdalla G, Lopez B, de la Cruz L, Henríquez B, Baldwin M, Sartorius B, Kucharski A, Nilles EJ, Lau CL. Using Regional Sero-Epidemiology SARS-CoV-2 Anti-S Antibodies in the Dominican Republic to Inform Targeted Public Health Response. Trop Med Infect Dis 2023; 8:493. [PMID: 37999612 PMCID: PMC10675152 DOI: 10.3390/tropicalmed8110493] [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: 09/10/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Incidence of COVID-19 has been associated with sociodemographic factors. We investigated variations in SARS-CoV-2 seroprevalence at sub-national levels in the Dominican Republic and assessed potential factors influencing variation in regional-level seroprevalence. Data were collected in a three-stage cross-sectional national serosurvey from June to October 2021. Seroprevalence of antibodies against the SARS-CoV-2 spike protein (anti-S) was estimated and adjusted for selection probability, age, and sex. Multilevel logistic regression was used to estimate the effect of covariates on seropositivity for anti-S and correlates of 80% protection (PT80) against symptomatic infection for the ancestral and Delta strains. A total of 6683 participants from 134 clusters in all 10 regions were enrolled. Anti-S, PT80 for the ancestral and Delta strains odds ratio varied across regions, Enriquillo presented significant higher odds for all outcomes compared with Yuma. Compared to being unvaccinated, receiving ≥2 doses of COVID-19 vaccine was associated with a significantly higher odds of anti-S positivity (OR 85.94, [10.95-674.33]) and PT80 for the ancestral (OR 4.78, [2.15-10.62]) and Delta strains (OR 3.08, [1.57-9.65]) nationally and also for each region. Our results can help inform regional-level public health response, such as strategies to increase vaccination coverage in areas with low population immunity against currently circulating strains.
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Affiliation(s)
- Beatris Mario Martin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (A.C.R.); (H.J.M.); (B.S.); (C.L.L.)
| | - Angela Cadavid Restrepo
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (A.C.R.); (H.J.M.); (B.S.); (C.L.L.)
| | - Helen J. Mayfield
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (A.C.R.); (H.J.M.); (B.S.); (C.L.L.)
| | - Cecilia Then Paulino
- Ministry of Health and Social Assistance, Santo Domingo 10514, Dominican Republic (F.P.)
| | - Micheal De St Aubin
- Brigham and Women’s Hospital, Boston, MA 02115, USA (G.A.); (E.J.N.)
- Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA 02138, USA
| | - William Duke
- Faculty of Health Sciences, Pedro Henriquez Urena National University, Santo Domingo 10514, Dominican Republic;
| | - Petr Jarolim
- Brigham and Women’s Hospital, Boston, MA 02115, USA (G.A.); (E.J.N.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Emily Zielinski Gutiérrez
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City 01015, Guatemala (B.L.)
| | - Ronald Skewes Ramm
- Ministry of Health and Social Assistance, Santo Domingo 10514, Dominican Republic (F.P.)
| | - Devan Dumas
- Brigham and Women’s Hospital, Boston, MA 02115, USA (G.A.); (E.J.N.)
- Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA 02138, USA
| | - Salome Garnier
- Brigham and Women’s Hospital, Boston, MA 02115, USA (G.A.); (E.J.N.)
- Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA 02138, USA
| | | | - Farah Peña
- Ministry of Health and Social Assistance, Santo Domingo 10514, Dominican Republic (F.P.)
| | - Gabriela Abdalla
- Brigham and Women’s Hospital, Boston, MA 02115, USA (G.A.); (E.J.N.)
| | - Beatriz Lopez
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City 01015, Guatemala (B.L.)
| | - Lucia de la Cruz
- Ministry of Health and Social Assistance, Santo Domingo 10514, Dominican Republic (F.P.)
| | - Bernarda Henríquez
- Ministry of Health and Social Assistance, Santo Domingo 10514, Dominican Republic (F.P.)
| | - Margaret Baldwin
- Brigham and Women’s Hospital, Boston, MA 02115, USA (G.A.); (E.J.N.)
- Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA 02138, USA
| | - Benn Sartorius
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (A.C.R.); (H.J.M.); (B.S.); (C.L.L.)
| | - Adam Kucharski
- Department of Infectious Disease Epidemiology and Dynamics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Eric James Nilles
- Brigham and Women’s Hospital, Boston, MA 02115, USA (G.A.); (E.J.N.)
- Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA 02138, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Colleen L. Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (A.C.R.); (H.J.M.); (B.S.); (C.L.L.)
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Nilles EJ, de St Aubin M, Dumas D, Duke W, Etienne MC, Abdalla G, Jarolim P, Oasan T, Garnier S, Iihoshi N, Lopez B, de la Cruz L, Puello YC, Baldwin M, Roberts KW, Peña F, Durski K, Sanchez IM, Gunter SM, Kneubehl AR, Murray KO, Lino A, Strobel S, Baez AA, Lau CL, Kucharski A, Gutiérrez EZ, Skewes-Ramm R, Vasquez M, Paulino CT. Monitoring Temporal Changes in SARS-CoV-2 Spike Antibody Levels and Variant-Specific Risk for Infection, Dominican Republic, March 2021-August 2022. Emerg Infect Dis 2023; 29:723-733. [PMID: 36848869 PMCID: PMC10045678 DOI: 10.3201/eid2904.221628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
To assess changes in SARS-CoV-2 spike binding antibody prevalence in the Dominican Republic and implications for immunologic protection against variants of concern, we prospectively enrolled 2,300 patients with undifferentiated febrile illnesses in a study during March 2021-August 2022. We tested serum samples for spike antibodies and tested nasopharyngeal samples for acute SARS-CoV-2 infection using a reverse transcription PCR nucleic acid amplification test. Geometric mean spike antibody titers increased from 6.6 (95% CI 5.1-8.7) binding antibody units (BAU)/mL during March-June 2021 to 1,332 (95% CI 1,055-1,682) BAU/mL during May-August 2022. Multivariable binomial odds ratios for acute infection were 0.55 (95% CI 0.40-0.74), 0.38 (95% CI 0.27-0.55), and 0.27 (95% CI 0.18-0.40) for the second, third, and fourth versus the first anti-spike quartile; findings were similar by viral strain. Combining serologic and virologic screening might enable monitoring of discrete population immunologic markers and their implications for emergent variant transmission.
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Nilles EJ, Paulino CT, de St Aubin M, Duke W, Jarolim P, Sanchez IM, Murray KO, Lau CL, Gutiérrez EZ, Ramm RS, Vasquez M, Kucharski A. Tracking immune correlates of protection for emerging SARS-CoV-2 variants. Lancet Infect Dis 2023; 23:153-154. [PMID: 36640795 PMCID: PMC9833833 DOI: 10.1016/s1473-3099(23)00001-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Eric J Nilles
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA.
| | | | - Michael de St Aubin
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - William Duke
- Pedro Henríquez Ureña National University, Santo Domingo, Dominican Republic
| | - Petr Jarolim
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Kristy O Murray
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | | | - Emily Zielinski Gutiérrez
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City, Guatemala
| | - Ronald Skewes Ramm
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | | | - Adam Kucharski
- London School of Hygiene & Tropical Medicine, London, UK
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5
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Nilles EJ, Paulino CT, de St Aubin M, Restrepo AC, Mayfield H, Dumas D, Finch E, Garnier S, Etienne MC, Iselin L, Duke W, Jarolim P, Oasan T, Yu J, Wan H, Peña F, Iihoshi N, Abdalla G, Lopez B, Cruz LDL, Henríquez B, Espinosa-Bode A, Puello YC, Durski K, Baldwin M, Baez AA, Merchant RC, Barouch DH, Skewes-Ramm R, Gutiérrez EZ, Kucharski A, Lau CL. SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection - A multistage national household survey and modelling study, Dominican Republic, June-October 2021. Lancet Reg Health Am 2022; 16:100390. [PMID: 36408529 PMCID: PMC9642112 DOI: 10.1016/j.lana.2022.100390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022]
Abstract
Background Population-level SARS-CoV-2 immunological protection is poorly understood but can guide vaccination and non-pharmaceutical intervention priorities. Our objective was to characterise cumulative infections and immunological protection in the Dominican Republic. Methods Household members ≥5 years were enrolled in a three-stage national household cluster serosurvey in the Dominican Republic. We measured pan-immunoglobulin antibodies against the SARS-CoV-2 spike (anti-S) and nucleocapsid glycoproteins, and pseudovirus neutralising activity against the ancestral and B.1.617.2 (Delta) strains. Seroprevalence and cumulative prior infections were weighted and adjusted for assay performance and seroreversion. Binary classification machine learning methods and pseudovirus neutralising correlates of protection were used to estimate 50% and 80% protection against symptomatic infection. Findings Between 30 Jun and 12 Oct 2021 we enrolled 6683 individuals from 3832 households. We estimate that 85.0% (CI 82.1-88.0) of the ≥5 years population had been immunologically exposed and 77.5% (CI 71.3-83) had been previously infected. Protective immunity sufficient to provide at least 50% protection against symptomatic SARS-CoV-2 infection was estimated in 78.1% (CI 74.3-82) and 66.3% (CI 62.8-70) of the population for the ancestral and Delta strains respectively. Younger (5-14 years, OR 0.47 [CI 0.36-0.61]) and older (≥75-years, 0.40 [CI 0.28-0.56]) age, working outdoors (0.53 [0.39-0.73]), smoking (0.66 [0.52-0.84]), urban setting (1.30 [1.14-1.49]), and three vs no vaccine doses (18.41 [10.69-35.04]) were associated with 50% protection against the ancestral strain. Interpretation Cumulative infections substantially exceeded prior estimates and overall immunological exposure was high. After controlling for confounders, markedly lower immunological protection was observed to the ancestral and Delta strains across certain subgroups, findings that can guide public health interventions and may be generalisable to other settings and viral strains. Funding This study was funded by the US CDC.
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Affiliation(s)
- Eric J Nilles
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | | | - Michael de St Aubin
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | | | - Helen Mayfield
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Devan Dumas
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Emilie Finch
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Salome Garnier
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA.,Harvard University, Cambridge, MA, USA
| | - Marie Caroline Etienne
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | | | - William Duke
- Pedro Henríquez Ureña National University, Santo Domingo, Dominican Republic
| | - Petr Jarolim
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Timothy Oasan
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | - Jingyou Yu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Huahua Wan
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Farah Peña
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Naomi Iihoshi
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | - Gabriela Abdalla
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | - Beatriz Lopez
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City, Guatemala
| | - Lucia de la Cruz
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Bernarda Henríquez
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Andres Espinosa-Bode
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City, Guatemala
| | | | - Kara Durski
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | - Margaret Baldwin
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Amado Alejandro Baez
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic.,Pedro Henríquez Ureña National University, Santo Domingo, Dominican Republic
| | - Roland C Merchant
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ronald Skewes-Ramm
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Emily Zielinski Gutiérrez
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City, Guatemala
| | - Adam Kucharski
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Colleen L Lau
- School of Public Health, University of Queensland, Brisbane, Australia
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6
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Abraham A, Duke W. Pseudogout Causing Thoracic Outlet Syndrome. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Calcium pyrophosphate dihydrate (CPPD) crystal deposition or pseudogout is a common entity encountered in routine practice. However, when a common entity presents in uncommon locations with unusual clinical manifestations, it creates a diagnostic conundrum. Pseudogout commonly occurs in the joint extremities including knee, wrist, shoulder, hip, and ankle joints. The sternoclavicular joint is a rare site for pseudogout with very low incidence. To the best of our knowledge, there are only two other cases of pseudogout mimicking a tumor causing vascular obstruction in the literature.
Methods/Case Report
A 63 year old male presented with an enlarging supraclavicular mass. A computed tomography angiography scan of the chest revealed an irregular soft tissue mass located behind the medial clavicle measuring up to 4 cm and was noted to compress and partially occlude the right subclavian vein. Partial occlusion of right axillary vein, right internal jugular vein, and right brachiocephalic vein were also noted on imaging. The venous compression led to outflow obstruction and resultant recurrent deep vein thrombosis of the right upper extremity. Due to compression by the mass, he required stenting of the right subclavian vein which unfortunately reoccluded. Subsequently, the patient underwent excision of the mass and partial resection of the first rib with decompression of the thoracic outlet. The excisional biopsy revealed dense rhomboid-shaped CPPD crystal depositions in irregular nodules within a background of fibrinoid material and fragments of unremarkable cartilaginous tissue. The patients compressive symptoms were relieved following the excision. While clinically and radiologically the mass was concerning for a malignant tumor, histological examination provided a definitive diagnosis of a benign process.
Results (if a Case Study enter NA)
NA.
Conclusion
Pseudogout is a rare mimicker of bone and soft tissue tumors and differentiation from an enchondroma, or grade 1 chondrosarcoma becomes a challenge especially on small tissue biopsies and is a possible diagnostic pitfall.
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Affiliation(s)
- A Abraham
- Pathology, UMass Chan Medical School - Baystate , Springfield, Massachusetts , United States
| | - W Duke
- Pathology, UMass Chan Medical School - Baystate , Springfield, Massachusetts , United States
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7
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Gigoux M, Holmström MO, Zappasodi R, Park JJ, Pourpe S, Bozkus CC, Mangarin LMB, Redmond D, Verma S, Schad S, George MM, Venkatesh D, Ghosh A, Hoyos D, Molvi Z, Kamaz B, Marneth AE, Duke W, Leventhal MJ, Jan M, Ho VT, Hobbs GS, Knudsen TA, Skov V, Kjær L, Larsen TS, Hansen DL, Lindsley RC, Hasselbalch H, Grauslund JH, Lisle TL, Met Ö, Wilkinson P, Greenbaum B, Sepulveda MA, Chan T, Rampal R, Andersen MH, Abdel-Wahab O, Bhardwaj N, Wolchok JD, Mullally A, Merghoub T. Calreticulin mutant myeloproliferative neoplasms induce MHC-I skewing, which can be overcome by an optimized peptide cancer vaccine. Sci Transl Med 2022; 14:eaba4380. [PMID: 35704596 DOI: 10.1126/scitranslmed.aba4380] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The majority of JAK2V617F-negative myeloproliferative neoplasms (MPNs) have disease-initiating frameshift mutations in calreticulin (CALR), resulting in a common carboxyl-terminal mutant fragment (CALRMUT), representing an attractive source of neoantigens for cancer vaccines. However, studies have shown that CALRMUT-specific T cells are rare in patients with CALRMUT MPN for unknown reasons. We examined class I major histocompatibility complex (MHC-I) allele frequencies in patients with CALRMUT MPN from two independent cohorts. We observed that MHC-I alleles that present CALRMUT neoepitopes with high affinity are underrepresented in patients with CALRMUT MPN. We speculated that this was due to an increased chance of immune-mediated tumor rejection by individuals expressing one of these MHC-I alleles such that the disease never clinically manifested. As a consequence of this MHC-I allele restriction, we reasoned that patients with CALRMUT MPN would not efficiently respond to a CALRMUT fragment cancer vaccine but would when immunized with a modified CALRMUT heteroclitic peptide vaccine approach. We found that heteroclitic CALRMUT peptides specifically designed for the MHC-I alleles of patients with CALRMUT MPN efficiently elicited a CALRMUT cross-reactive CD8+ T cell response in human peripheral blood samples but not to the matched weakly immunogenic CALRMUT native peptides. We corroborated this effect in vivo in mice and observed that C57BL/6J mice can mount a CD8+ T cell response to the CALRMUT fragment upon immunization with a CALRMUT heteroclitic, but not native, peptide. Together, our data emphasize the therapeutic potential of heteroclitic peptide-based cancer vaccines in patients with CALRMUT MPN.
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Affiliation(s)
- Mathieu Gigoux
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Morten O Holmström
- Department of Oncology, National Center for Cancer Immune Therapy, Herlev Hospital, Herlev 2730, Denmark
- Department of Immunology and Microbiology, Copenhagen University Hospital, Herlev 2730, Denmark
| | - Roberta Zappasodi
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10021, USA
| | - Joseph J Park
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Weill Cornell Medical College, New York, NY 10065, USA
| | - Stephane Pourpe
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Levi M B Mangarin
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - David Redmond
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Division of Regenerative Medicine, Ansary Stem Cell Institute, Weill Cornell Medicine, New York, NY 10065, USA
| | - Svena Verma
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Weill Cornell Medical College, New York, NY 10065, USA
| | - Sara Schad
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Weill Cornell Medical College, New York, NY 10065, USA
| | - Mariam M George
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Divya Venkatesh
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Arnab Ghosh
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - David Hoyos
- Computational Oncology, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Zaki Molvi
- Weill Cornell Medicine, New York, NY 10065, USA
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Baransel Kamaz
- Department of Medicine, Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Anna E Marneth
- Department of Medicine, Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - William Duke
- Department of Medicine, Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Max Jan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Vincent T Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Gabriela S Hobbs
- Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Trine Alma Knudsen
- Department of Hematology, Zealand University Hospital, Roskilde 4000, Denmark
| | - Vibe Skov
- Department of Hematology, Zealand University Hospital, Roskilde 4000, Denmark
| | - Lasse Kjær
- Department of Hematology, Zealand University Hospital, Roskilde 4000, Denmark
| | | | - Dennis Lund Hansen
- Department of Hematology, Odense University Hospital, Odense 5000, Denmark
| | - R Coleman Lindsley
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Hans Hasselbalch
- Department of Hematology, Zealand University Hospital, Roskilde 4000, Denmark
| | - Jacob H Grauslund
- Department of Oncology, National Center for Cancer Immune Therapy, Herlev Hospital, Herlev 2730, Denmark
- Department of Immunology and Microbiology, Copenhagen University Hospital, Herlev 2730, Denmark
| | - Thomas L Lisle
- Department of Oncology, National Center for Cancer Immune Therapy, Herlev Hospital, Herlev 2730, Denmark
- Department of Immunology and Microbiology, Copenhagen University Hospital, Herlev 2730, Denmark
| | - Özcan Met
- Department of Oncology, National Center for Cancer Immune Therapy, Herlev Hospital, Herlev 2730, Denmark
- Department of Immunology and Microbiology, Copenhagen University Hospital, Herlev 2730, Denmark
| | - Patrick Wilkinson
- Janssen Oncology Therapeutic Area, Janssen Research and Development, LLC, Pharmaceutical Companies of Johnson & Johnson, Spring House, PA 19002, USA
| | - Benjamin Greenbaum
- Computational Oncology, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Weill Cornell Medicine, Physiology, Biophysics and Systems Biology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Manuel A Sepulveda
- Janssen Oncology Therapeutic Area, Janssen Research and Development, LLC, Pharmaceutical Companies of Johnson & Johnson, Spring House, PA 19002, USA
| | - Timothy Chan
- Weill Cornell Medical College, New York, NY 10065, USA
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Raajit Rampal
- Human Oncology and Pathogenesis Program and Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mads H Andersen
- Department of Oncology, National Center for Cancer Immune Therapy, Herlev Hospital, Herlev 2730, Denmark
- Department of Immunology and Microbiology, Copenhagen University Hospital, Herlev 2730, Denmark
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program and Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nina Bhardwaj
- Parker Institute for Cancer Immunotherapy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jedd D Wolchok
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Weill Cornell Medical College, New York, NY 10065, USA
| | - Ann Mullally
- Department of Medicine, Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Broad Institute, Cambridge, MA 02142, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Taha Merghoub
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Human Oncology and Pathogenesis Program and Immuno-Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Weill Cornell Medical College, New York, NY 10065, USA
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Gigoux M, Zappasodi R, Park J, Bozkus CC, Mangarin L, Redmond D, Verma S, Schad S, George M, Venkatesh D, Ghosh A, Molvi Z, Kamaz B, Marneth A, Duke W, Leventhal M, Jan M, Ho V, Hobbs G, Knudsen T, Skov V, Kjær L, Larsen T, Hansen D, Lindsley R, Hasselbalch H, Grauslund J, Andersen M, Holmstrom M, Chan T, Rampal R, Abdel-Wahab O, Bhardwaj N, Mullally A, Wolchok J, Merghoub T. 772 MHC-I skewing in mutant calreticulin-positive myeloproliferative neoplasms is countered by heteroclitic peptide cancer vaccination. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundThe majority of JAK2V617F-negative myeloproliferative neoplasms (MPN) have disease-initiating frameshift mutations in calreticulin (CALR) resulting in a common novel C-terminal mutant fragment (CALRMUT), representing an attractive source of neoantigens for cancer vaccines. However, studies have shown that CALRMUT-specific T cells are rare in CALRMUT MPN patients, but the underlying reasons for this phenomenon are unknown. We speculate that this is due to an increased chance of immune-mediated tumor rejection by individuals expressing one of these MHC-I alleles such that the disease never clinically manifests. As a consequence of this MHC-I allele restriction, we reasoned that CALRMUT MPN patients would not efficiently respond to cancer vaccines composed of the CALRMUT neoantigen, but could do so when immunized with a properly epitope-optimized CALRMUT heteroclitic peptide vaccine approach.MethodsWe examined MHC-I allele frequency in CALRMUT MPN patients from two independent cohorts to identify under-represented MHC-I alleles. These MHC-I alleles were assessed for their ability to bind to CALRMUT-derived peptides using NetMHC and were subsequently validated experimentally in healthy donors and in CALRMUT MPN patients having received a CALRMUT cancer vaccine (clinical trial NCT03566446) to determine if these MHC-I were potentiating immunogenicity against the CALRMUT antigen. Epitope-optimized heteroclitic variants of the CALRMUT neoantigen were identified and tested experimentally in vitro in human PBMCs and in vivo in mice for their ability to mount an immune response against the non-modified CALRMUT neoantigen.ResultsWe observed that MHC-I alleles that present CALRMUT neoepitopes with high affinity are under-represented in CALRMUT MPN patients. Heteroclitic CALRMUT peptides specifically designed for CALRMUT MPN patient MHC-I alleles efficiently elicited a cross-reactive CD8+ T cell response in human PBMC samples otherwise unable to respond to the matched weakly immunogenic CALRMUT native peptides. We also modeled this effect in mice and observed that C57BL/6J mice, which are unable to mount an immune response to the human CALRMUT fragment, can mount a cross-reactive CD8+ T cell response against a CALRMUT-derived peptide upon heteroclitic peptide immunization and this was further amplified by combining the heteroclitic peptide vaccine with blockade of the immune checkpoint molecule PD-1.ConclusionsOur study shows that MHC-I alleles able to present CALRMUT neoepitopes are under-represented in CALRMUT MPN patients, demonstrating that MHC-I haplotype is a major mechanism of passive immune-evasion in CALRMUT MPN. However, we show that a cancer vaccine composed of heteroclitic variants of the CALRMUT antigen could overcome this limitation.Ethics ApprovalApproval was obtained for the use of patient-derived specimens and access to clinical data extracted from patient charts by the Institutional Review Boards at Memorial Sloan Kettering Cancer Center, the Dana-Farber Cancer Institute and the Massachusetts General Hospital, as well as by the Danish Regional Science Ethics Committee.
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Gigoux M, Zappasodi R, Park JJ, Pourpe S, Ghosh A, Bozkus CC, Mangarin LM, Redmond D, Verma S, Schad S, Duke W, Leventhal M, Jan M, Ho V, Hobbs G, Knudsen TA, Skov V, Kjær L, Larsen TS, Hansen DL, Lindsley RC, Hasselbalch H, Grauslund JH, Andersen MH, Holmström MO, Chan T, Rampal R, Abdel-Wahab O, Bhardwaj N, Wolchok JD, Mullally A, Merghoub T. Heteroclitic peptide cancer vaccine counters MHC-I skewing in mutant calreticulin-positive myeloproliferative neoplasms. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.239.34] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
The majority of JAK2WT myeloproliferative neoplasms (MPN) have disease-initiating frameshift mutations in calreticulin (CALR) resulting in a common novel C-terminal mutant fragment (CALRMUT), representing an attractive source of neoantigens for cancer vaccines. However, studies have shown that CALRMUT-specific T cells are rare in CALRMUT MPN patients, but the reasons for this phenomenon are unknown. In this study, we examine class-I major histocompatibility complex (MHC-I) allele frequency in CALRMUT MPN patients from two independent cohorts and observed that MHC-I alleles that present CALRMUT neoepitopes with high affinity are under-represented in CALRMUT MPN patients. We speculate that this is due to an increased chance of immune-mediated tumor rejection by individuals expressing one of these MHC-I alleles. As a result of this MHC-I allele restriction, we reasoned that CALRMUT MPN patients would not efficiently respond to cancer vaccines composed of the CALRMUT fragment, but could do so with a properly modified CALRMUT heteroclitic peptide vaccine approach. We found that heteroclitic CALRMUT peptides designed for CALRMUT MPN patient MHC-I alleles elicited a cross-reactive CD8+ T cell response in human PBMC samples otherwise unable to respond to the matched weakly immunogenic CALRMUT native peptides. We also modeled this effect in mice and observed that C57BL/6J mice, which are unable to mount an immune response to CALRMUT, can mount a cross-reactive CD8+ T cell response against a CALRMUT peptide upon heteroclitic peptide immunization and this was further amplified by combining with anti-PD-1. Together, our data underscore the therapeutic potential of heteroclitic peptide-based cancer vaccines in CALRMUT MPN patients.
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Affiliation(s)
- Mathieu Gigoux
- 1Memorial Sloan Kettering Cancer Center
- 2Ludwig Inst. for Cancer Res
| | - Roberta Zappasodi
- 1Memorial Sloan Kettering Cancer Center
- 2Ludwig Inst. for Cancer Res
- 3Parker Institute for Cancer Immunotherapy
| | | | - Stephane Pourpe
- 1Memorial Sloan Kettering Cancer Center
- 2Ludwig Inst. for Cancer Res
| | - Arnab Ghosh
- 1Memorial Sloan Kettering Cancer Center
- 2Ludwig Inst. for Cancer Res
| | | | | | | | - Svena Verma
- 1Memorial Sloan Kettering Cancer Center
- 2Ludwig Inst. for Cancer Res
- 4Weill Cornell Med. Col
| | - Sara Schad
- 1Memorial Sloan Kettering Cancer Center
- 2Ludwig Inst. for Cancer Res
- 7Weill Cornell Grad. Sch. of Med. Sci
| | | | | | | | - Vincent Ho
- 10Dana Farber Cancer Institute, Harvard Medical School
| | | | | | - Vibe Skov
- 12Zealand University Hospital, Denmark, Denmark
| | - Lasse Kjær
- 12Zealand University Hospital, Denmark, Denmark
| | | | | | | | | | - Jacob H Grauslund
- 14National Center for Cancer Immune Therapy, University of Copenhagen, Denmark, Denmark
| | - Mads H Andersen
- 14National Center for Cancer Immune Therapy, University of Copenhagen, Denmark, Denmark
| | - Morten O Holmström
- 14National Center for Cancer Immune Therapy, University of Copenhagen, Denmark, Denmark
| | - Timothy Chan
- 1Memorial Sloan Kettering Cancer Center
- 4Weill Cornell Med. Col
| | | | | | | | - Jedd D Wolchok
- 1Memorial Sloan Kettering Cancer Center
- 2Ludwig Inst. for Cancer Res
- 4Weill Cornell Med. Col
| | - Ann Mullally
- 8Harvard Med. Sch
- 9Broad Inst. of MIT and Harvard
- 10Dana Farber Cancer Institute, Harvard Medical School
| | - Taha Merghoub
- 1Memorial Sloan Kettering Cancer Center
- 2Ludwig Inst. for Cancer Res
- 4Weill Cornell Med. Col
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Román-Poueriet J, Fernandez AD, Beck-Sagué CM, García Szabó R, Mercedes F, Duke W, Martinez A, Nicholas S. HIV infection and prevention of mother-to-child transmission in childbearing women: La Romana, Dominican Republic, 2002-2006. Rev Panam Salud Publica 2010; 26:315-23. [PMID: 20107679 DOI: 10.1590/s1020-49892009001000005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 04/27/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To strengthen prevention of mother-to-child HIV transmission (pMTCT) program implementation in La Romana (LR) province, by estimating HIV prevalence and identifying characteristics associated with HIV infection in parturients. METHODS Umbilical cord blood samples were collected at seven obstetrical sites where over 95% of LR's deliveries occur during four phases (pilot, expanded pilot, full study, and pMTCT program monitoring) from 2 August 2002 to 30 September 2006. Results were linked to data abstracted from delivery records. RESULTS HIV seroprevalence was 2.6% (263/10 040 overall; 114/4 452, full-study phase (95% confidence interval = 2.1%-3.1%)). Most HIV-infected parturients were Dominican (68.9%) and urban (64.0%). However, prevalence was higher among Haitians (3.7%) than Dominicans (2.3% (p < 0.001)), especially those aged 21-25 years (5.2% vs. 2.3% (p < 0.001)), and among rural, batey, and peri-urban (vs. urban) parturients (3.4% vs. 2.3%, (p = 0.003)). HIV prevalence was associated with commercial sex work (reported by only 0.4%), and prior pregnancy. In logistic regression analysis, commercial sex work, Haitian nationality, and prior pregnancy were independently associated with HIV infection. Caesarean deliveries were more frequent, and rose in the last years of the study, among HIV seropositives; however, most deliveries among seropositives (57.5%) were vaginal. CONCLUSIONS HIV prevalence among LR parturients was higher than the estimated prevalence in the Dominican Republic (0.8%-1.0%) and, in contrast to past studies, predominantly affected urban Dominicans. HIV prevalence among LR Haitian parturients was higher than among Dominican counterparts and prenatal clinic attendees in Haiti (who had a rate of 3.1%). Consistently implemented, targeted pMTCT interventions are needed.
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Wang AL, Duke W, Schmid GP. Print media reporting of male circumcision for preventing HIV infection in sub-Saharan Africa. Bull World Health Organ 2009; 87:595-603. [PMID: 19705009 DOI: 10.2471/blt.09.066704] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 06/16/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the types, content and accuracy of print media reports on male circumcision for preventing HIV infection among men in sub-Saharan Africa. METHODS We conducted a trilingual search (English, French, Portuguese) of LexisNexis(R) with the phrase 'male circumcision' for the period from 28 March 2007 to 30 June 2008. The articles identified were screened for the central theme of male circumcision for preventing HIV infection in men in sub-Saharan Africa and for publication types targeting lay audiences - newspapers, magazines, newswires or newsletters. We judged the accuracy of the reports and determined the context, public perceptions, misconceptions and areas of missing information in the print media. We also explored whether the media could be better used to maximize the impact of male circumcision. FINDINGS We identified 412 articles, of which 219 were unique and 193 were repeats. 'Peaks and valleys' occurred in the volume of articles over time. Most articles (56.0%) presented male circumcision for the prevention of HIV infection in a positive light. Those that portrayed it negatively had an overall repeat rate 2.9 times higher than positive articles. Public health messages formulated by international health agencies were few but generally accurate. CONCLUSION The accuracy of the reports was good, although the articles were few and frequently omitted important messages. This suggests that public health authorities must help the media understand important issues. A communication strategy to sequence important themes as male circumcision programmes are scaled up would allow strategic coverage of accurate messages over time.
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Affiliation(s)
- Alberta L Wang
- University of Texas Medical School at Houston, Houston, Texas, United States of America.
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Perkins JA, Duke W, Chen E, Manning S. Emerging Concepts in Airway Infantile Hemangioma Assessment and Management. Otolaryngol Head Neck Surg 2009; 141:207-212. [DOI: 10.1016/j.otohns.2009.04.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/08/2009] [Accepted: 04/15/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE: The purpose of this study was to evaluate changes in airway infantile hemangioma treatment. STUDY DESIGN: Retrospective. SUBJECTS: Airway hemangioma patients, tertiary pediatric hospital. METHODS: Data collected included age at diagnosis, evaluation methods, hospitalizations, airway size, and interventions. Patients were divided into group A (1981–1993) and group B (1994–2005) and were analyzed using descriptive statistics, the Fisher exact test, and the Student t test. RESULTS: Thirty-two subjects were identified. Nasopharyngoscopy was used more in group B (11/16 [69%]) than group A (4/16 [25%], P = 0.032). CT angiography (3/16 [19%]) and laryngeal distractors (11/16 [69%]) were only used in group B; these techniques showed airway hemangiomas to be “transglottic,” not just “subglottic.” Intralesional steroids alone (3/16 [19%]) and primary hemangioma excision (2/16 [13%]) were new treatments used in group B. Frequent direct laryngoscopies (>six) correlated with tracheotomy (5/32 [16%], P = 0.015). Presenting age (<2 months) impacted treatment more than airway hemangioma size. CONCLUSIONS: New methods of airway infantile hemangioma assessment changed our concept of airway hemangiomas and their primary treatment.
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Affiliation(s)
- Jonathan A. Perkins
- From the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
| | - William Duke
- Department of Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
- Division of Otolaryngology–Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Eunice Chen
- From the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
| | - Scott Manning
- From the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
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Chen EY, Hostikka SL, Oliaei S, Duke W, Schwartz SM, Perkins JA. Similar Histologic Features and Immunohistochemical Staining in Microcystic and Macrocystic Lymphatic Malformations. Lymphat Res Biol 2009; 7:75-80. [DOI: 10.1089/lrb.2009.0003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Eunice Y. Chen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Children's Hospital and Regional Medical Center, Seattle, Washington
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | | | - Sepehr Oliaei
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - William Duke
- Department of Otolaryngology, Madigan Army Medical Center, Tacoma, Washington
| | | | - Jonathan A. Perkins
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Children's Hospital and Regional Medical Center, Seattle, Washington
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
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Abstract
PURPOSE OF REVIEW This review of implantable middle ear hearing devices is relevant to hearing professionals and otolaryngologists as an update of technological developments and the status of performance of current devices used in the United States. The 9th International Conference on Cochlear Implants and related Sciences was conducted 14-17 June in Vienna, Austria. Middle ear implantable devices were considered a 'hot topic', as two fully implantable devices are nearing European CE and FDA approval. RECENT FINDINGS The main themes in this review focus on the fundamental technology applied to middle ear implantables, currently available devices, an overview of devices now off the US market and on challenges in improving performance and reliability. The necessary interplay with manufacturing devices which are more straightforward to surgically place and affordable enough to be accessed by the eligible population of people with hearing loss is discussed. SUMMARY Indications for middle ear implantable hearing devices are expanding and the reliability of systems continues to improve. Solving problems related to affordability and access has made little progress in comparison, as evidenced by the poor performance of several 'technologically successful' manufacturers in the US market.
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Affiliation(s)
- Douglas D Backous
- The Listen for Life Center at Virginia Mason, Section of Otolaryngology, Head and Neck Surgery, Virginia Mason Medical Center, Seattle, WA 98111-0900, USA.
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Duke W, Nordin R, Baker D, Mazumder A. The use and performance of BioSand filters in the Artibonite Valley of Haiti: a field study of 107 households. Rural Remote Health 2006. [DOI: 10.22605/rrh570] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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