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Ismail HS, Ali AI, Garcia-Godoy F. Influence of Manual and Ultrasonic Scaling on Surface Roughness of Four Different Base Materials Used to Elevate Proximal Dentin-Cementum Gingival Margins: An In Vitro Study. Oper Dent 2022; 47:E106-E118. [PMID: 35405002 DOI: 10.2341/20-007-c] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 11/23/2022]
Abstract
AIM To evaluate and compare the effects of both manual and ultrasonic scaling on surface roughness of four different base materials, used for elevating dentin/cementum gingival margins of proximal cavities. METHODS AND MATERIALS Eighty human upper molars with compound Class II mesial cavities, with gingival margins 1 mm below the cemento-enamel junction (CEJ), were divided into four different groups according to the type of the base material used; resin-modified glass ionomer (RMGI), glass hybrid (HV-GIC), flowable bulk-fill resin composite (Bulk Flow) and bioactive ionic resin (Activa). This was followed by completing the restorations with the same resin composite. All materials were used according to the manufacturers' instructions. All groups were further subdivided into two subgroups according to the scaling technique: manual (hand) or ultrasonic. All restorative and scaling procedures were performed after fixation of specimens with acrylic beside neighboring teeth to simulate natural contact. The mean surface roughness (Ra, μm) of all specimens was measured quantitatively and qualitatively by a three-dimensional (3D) surface analyzer system at two stages; (1) after thermal cycling for 5000 cycles without scaling and (2) after scaling. Data were statistically analyzed using analysis of variance (ANOVA), Tukey post hoc tests, and paired sample t-tests (at α=0.05). RESULTS For baseline readings, the Bulk Flow group had the lowest Ra values, while HV-GIC group had the highest. RMGI and Activa groups had no statistical significant difference between their Ra values (p>0.05). For post scaling readings, hand scaling had significantly lower Ra values than ultrasonic scaling in all the material groups (p<0.05), except in the Bulk Flow group, where both scaling methods were not significantly different from each other (p>0.05). CONCLUSION Bulk Flow had the smoothest surfaces when cured against a matrix band compared with the other tested base materials. When hand and ultrasonic scaling methods were compared, the latter technique had more detrimental effect on the surface texture of the four tested base materials.
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Affiliation(s)
- H S Ismail
- *Hoda Ismail, assistant lecturer, Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - A I Ali
- Ashraf Ibrahim Ali, associate professor, Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura Egypt
| | - F Garcia-Godoy
- Franklin Garcia-Godoy, professor, Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA; adjunct professor, The Forsyth Institute, Cambridge, MA, USA
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Ali AI, Wang M, von Scheidt B, Dominguez PM, Harrison AJ, Tantalo DG, Kang J, Oliver AJ, Chan JD, Du X, Bai Y, Lee B, Johnstone RW, Darcy PK, Kershaw MH, Slaney CY. A Histone Deacetylase Inhibitor, Panobinostat, Enhances Chimeric Antigen Receptor T-cell Antitumor Effect Against Pancreatic Cancer. Clin Cancer Res 2021; 27:6222-6234. [PMID: 34475103 DOI: 10.1158/1078-0432.ccr-21-1141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/19/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE In this article, we describe a combination chimeric antigen receptor (CAR) T-cell therapy that eradicated the majority of tumors in two immunocompetent murine pancreatic cancer models and a human pancreatic cancer xenograft model. EXPERIMENTAL DESIGN We used a dual-specific murine CAR T cell that expresses a CAR against the Her2 tumor antigen, and a T-cell receptor (TCR) specific for gp100. As gp100 is also known as pMEL, the dual-specific CAR T cells are thus denoted as CARaMEL cells. A vaccine containing live vaccinia virus coding a gp100 minigene (VV-gp100) was administered to the recipient mice to stimulate CARaMEL cells. The treatment also included the histone deacetylase inhibitor panobinostat (Pano). RESULTS The combination treatment enabled significant suppression of Her2+ pancreatic cancers leading to the eradication of the majority of the tumors. Besides inducing cancer cell apoptosis, Pano enhanced CAR T-cell gene accessibility and promoted CAR T-cell differentiation into central memory cells. To test the translational potential of this approach, we established a method to transduce human T cells with an anti-Her2 CAR and a gp100-TCR. The exposure of the human T cells to Pano promoted a T-cell central memory phenotype and the combination treatment of human CARaMEL cells and Pano eradicated human pancreatic cancer xenografts in mice. CONCLUSIONS We propose that patients with pancreatic cancer could be treated using a scheme that contains dual-specific CAR T cells, a vaccine that activates the dual-specific CAR T cells through their TCR, and the administration of Pano.
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Affiliation(s)
- Aesha I Ali
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Minyu Wang
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Bianca von Scheidt
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Pilar M Dominguez
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Translational Haematology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Aaron J Harrison
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Daniela Gm Tantalo
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Jian Kang
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Amanda J Oliver
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Jack D Chan
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Xin Du
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Yuchen Bai
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Belinda Lee
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Divsion of Systems Biology and Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ricky W Johnstone
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Translational Haematology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Phillip K Darcy
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Michael H Kershaw
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Clare Y Slaney
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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Lidington E, Darlington AS, Vlooswijk C, Beardsworth S, McCaffrey S, Tang S, Stallard K, Younger E, Edwards P, Ali AI, Nandhabalan M, Din A, Starling N, Larkin J, Stanway S, Nobbenhuis M, Banerjee S, Szucs Z, Gonzalez M, Sirohi B, Husson O, van der Graaf WTA. Beyond Teenage and Young Adult Cancer Care: Care Experiences of Patients Aged 25-39 Years Old in the UK National Health Service. Clin Oncol (R Coll Radiol) 2021; 33:494-506. [PMID: 33722412 DOI: 10.1016/j.clon.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/16/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022]
Abstract
AIMS Adolescents and young adults aged 15-39 years with cancer face unique medical, practical and psychosocial issues. In the UK, principal treatment centres and programmes have been designed to care for teenage and young adult patients aged 13-24 years in an age-appropriate manner. However, for young adults (YAs) aged 25-39 years with cancer, little access to age-specific support is available. The aim of this study was to examine this possible gap by qualitatively exploring YA care experiences, involving patients as research partners in the analysis to ensure robust results. MATERIALS AND METHODS We conducted a phenomenological qualitative study with YAs diagnosed with any cancer type between ages 25 and 39 years old in the last 5 years. Participants took part in interviews or focus groups and data were analysed using inductive thematic analysis. Results were shaped in an iterative process with the initial coders and four YA patients who did not participate in the study to improve the rigor of the results. RESULTS Sixty-five YAs with a range of tumour types participated. We identified seven themes and 13 subthemes. YAs found navigating the healthcare system difficult and commonly experienced prolonged diagnostic pathways. Participants felt under-informed about clinical details and the long-term implications of side-effects on daily life. YAs found online resources overwhelming but also a source of information and treatment support. Some patients regretted not discussing fertility before cancer treatment or felt uninformed or rushed when making fertility preservation decisions. A lack of age-tailored content or age-specific groups deterred YAs from accessing psychological support and rehabilitation services. CONCLUSIONS YAs with cancer may miss some benefits provided to teenagers and young adults in age-tailored cancer services. Improving services for YAs in adult settings should focus on provision of age-specific information and access to existing relevant support.
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Affiliation(s)
- E Lidington
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - C Vlooswijk
- The Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | | | | | - S Tang
- Imperial College Healthcare NHS Trust, London, UK; Public Health England, London, UK
| | | | - E Younger
- Royal Marsden NHS Foundation Trust, London, UK; Radboud University Medical Center, Nijmegen, the Netherlands
| | - P Edwards
- Royal Marsden NHS Foundation Trust, London, UK
| | - A I Ali
- St George's University Hospital NHS Foundation Trust, London, UK
| | | | - A Din
- University of Southampton, Southampton, UK
| | - N Starling
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - J Larkin
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - S Stanway
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - S Banerjee
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - Z Szucs
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - M Gonzalez
- Imperial College Healthcare NHS Trust, London, UK
| | - B Sirohi
- Barts Health NHS Trust, London, UK; Apollo Proton Cancer Centre, Chennai, India
| | - O Husson
- Institute of Cancer Research, London, UK; Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - W T A van der Graaf
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK; Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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Chan JD, von Scheidt B, Zeng B, Oliver AJ, Davey AS, Ali AI, Thomas R, Trapani JA, Darcy PK, Kershaw MH, Dolcetti R, Slaney CY. Enhancing chimeric antigen receptor T-cell immunotherapy against cancer using a nanoemulsion-based vaccine targeting cross-presenting dendritic cells. Clin Transl Immunology 2020; 9:e1157. [PMID: 32704371 PMCID: PMC7374388 DOI: 10.1002/cti2.1157] [Citation(s) in RCA: 17] [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: 04/04/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives Adoptive transfer of chimeric antigen receptor (CAR)-modified T cells is a form of cancer immunotherapy that has achieved remarkable efficacy in patients with some haematological cancers. However, challenges remain in CAR T-cell treatment of solid tumours because of tumour-mediated immunosuppression. Methods We have demonstrated that CAR T-cell stimulation through T-cell receptors (TCRs) in vivo can generate durable responses against solid tumours in a variety of murine models. Since Clec9A-targeting tailored nanoemulsion (Clec9A-TNE) vaccine enhances antitumour immune responses through selective activation of Clec9A+ cross-presenting dendritic cells (DCs), we hypothesised that Clec9A-TNE could prime DCs for antigen presentation to CAR T cells through TCRs and thus improve CAR T-cell responses against solid tumours. To test this hypothesis, we used CAR T cells expressing transgenic TCRs specific for ovalbumin (OVA) peptides SIINFEKL (CAROTI) or OVA323-339 (CAROTII). Results We demonstrated that the Clec9A-TNEs encapsulating full-length recombinant OVA protein (OVA-Clec9A-TNE) improved CAROT T-cell proliferation and inflammatory cytokine secretion in vitro. Combined treatment using the OVA-Clec9A-TNE and CAROT cells resulted in durable responses and some rejections of tumours in immunocompetent mice. Tumour regression was accompanied by enhanced CAROT cell proliferation and infiltration into the tumours. Conclusion Our study presents Clec9A-TNE as a prospective avenue to enhance CAR T-cell efficacy for solid cancers.
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Affiliation(s)
- Jack D Chan
- Cancer Immunology Program Peter MacCallum Cancer Center Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia
| | - Bianca von Scheidt
- Cancer Immunology Program Peter MacCallum Cancer Center Melbourne VIC Australia
| | - Bijun Zeng
- The University of Queensland Diamantina Institute Translational Research Institute Woolloongabba QLD Australia
| | - Amanda J Oliver
- Cancer Immunology Program Peter MacCallum Cancer Center Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia
| | - Ashleigh S Davey
- Cancer Immunology Program Peter MacCallum Cancer Center Melbourne VIC Australia
| | - Aesha I Ali
- Cancer Immunology Program Peter MacCallum Cancer Center Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia
| | - Ranjeny Thomas
- The University of Queensland Diamantina Institute Translational Research Institute Woolloongabba QLD Australia
| | - Joseph A Trapani
- Cancer Immunology Program Peter MacCallum Cancer Center Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia
| | - Phillip K Darcy
- Cancer Immunology Program Peter MacCallum Cancer Center Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia
| | - Michael H Kershaw
- Cancer Immunology Program Peter MacCallum Cancer Center Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia
| | - Riccardo Dolcetti
- The University of Queensland Diamantina Institute Translational Research Institute Woolloongabba QLD Australia
| | - Clare Y Slaney
- Cancer Immunology Program Peter MacCallum Cancer Center Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia
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Ali AI, Oliver AJ, Samiei T, Chan JD, Kershaw MH, Slaney CY. Genetic Redirection of T Cells for the Treatment of Pancreatic Cancer. Front Oncol 2019; 9:56. [PMID: 30809507 PMCID: PMC6379296 DOI: 10.3389/fonc.2019.00056] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/21/2019] [Indexed: 12/12/2022] Open
Abstract
Conventional treatments for pancreatic cancer are largely ineffective, and the prognosis for the vast majority of patients is poor. Clearly, new treatment options are desperately needed. Immunotherapy offers hope for the development of treatments for pancreatic cancer. A central requirement for the efficacy of this approach is the existence of cancer antigen-specific T cells, but these are often not present or difficult to isolate for most pancreatic tumors. Nevertheless, specific T cells can be generated using genetic modification to express chimeric antigen receptors (CAR), which can enable T cell responses against pancreatic tumor cells. CAR T cells can be produced ex vivo and expanded in vitro for infusion into patients. Remarkable responses have been documented using CAR T cells against several malignancies, including leukemias and lymphomas. Based on these successes, the extension of CAR T cell therapy for pancreatic cancer holds great promise. However, there are a number of challenges that limit the full potential of CAR T cell therapies for pancreatic cancer, including the highly immunosuppressive tumor microenvironment (TME). In this article, we will review the recent progress in using CAR T cells in pancreatic cancer preclinical and clinical settings, discuss hurdles for utilizing the full potential of CAR T cell therapy and propose research strategies and future perspectives. Research into the use of CAR T cell therapy in pancreatic cancer setting is rapidly gaining momentum and understanding strategies to overcome the current challenges in the pancreatic cancer setting will allow the development of effective CAR T cell therapies, either alone or in combination with other treatments to benefit pancreatic cancer patients.
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Affiliation(s)
- Aesha I Ali
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Amanda J Oliver
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Tinaz Samiei
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Jack D Chan
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Michael H Kershaw
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Clare Y Slaney
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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Talabani JM, Ali AI, Kadir AM, Rashid R, Samin F, Greenwood D, Hay A. Long-term health effects of chemical warfare agents on children following a single heavy exposure. Hum Exp Toxicol 2017; 37:836-847. [PMID: 29069930 DOI: 10.1177/0960327117734620] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In the 1980s, villages in the Kurdistan region of Iraq were exposed to chemical weapons (CWs), which killed and injured thousands of civilians. There has been no clinical assessment of the long-term effects of CWs exposure on those injured. We report the first such evaluation of CW effects on long-term health of children. Patients from the CW-exposed areas were interviewed to assess previous and current clinical history and underwent clinical examination. The status of organs known to be targets of CWs, including skin, eyes, respiratory and neuromuscular systems, was assessed. Children of similar age and social background, but with no history of CW exposure, were selected as a control population. Results showed that 70% of children in the CWs group had chronic health problems in contrast to 3.3% in the unexposed group ( p < 0.0001). Fifty-five per cent of the CW-exposed group had long-term visual impairment but none in the unexposed population. Thirty-six per cent of the CW-exposed group had chronic dermatological conditions compared with 0.8% of the unexposed group ( p < 0.0001), 31% of the CWs group had neurological sequelae compared with 0.4% of the unexposed group ( p < 0.0001) and 51% of the CWs group had long-term respiratory problems compared with 1.5% of the unexposed group ( p < 0.0001). Respiratory complaints including asthma, chronic bronchitis and bronchiectasis were particularly common. Our study suggests that CWs used were probably a combination of sulphur mustard and organophosphate nerve agents. Results also indicate that the prevalence of acute and chronic health problems following exposure to CW agents appear to be higher in children compared with reported data in adults.
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Affiliation(s)
- J M Talabani
- 1 Paediatric Department, Good Hope Hospital, Heart of England NHS Foundation Trust, Sutton Coldfield, UK
| | - A I Ali
- 2 Sulaimanyah Children's Hospital, Sulaimanyah, Iraq
| | - A M Kadir
- 3 Ministry of Health, Division of Child and Primary Care, Erbil, Iraq
| | - R Rashid
- 2 Sulaimanyah Children's Hospital, Sulaimanyah, Iraq
| | - F Samin
- 2 Sulaimanyah Children's Hospital, Sulaimanyah, Iraq
| | - D Greenwood
- 4 Division of Epidemiology and Biostatistics, Faculty of Medicine and Health, University of Leeds, UK
| | - Awm Hay
- 5 Leeds Institute of Cardiovascular and Molecular Medicine, Faculty of Medicine and Health, University of Leeds, UK
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Lees CW, Ali AI, Thompson AI, Ho GT, Forsythe RO, Marquez L, Cochrane CJ, Aitken S, Fennell J, Rogers P, Shand AG, Penman ID, Palmer KR, Wilson DC, Arnott IDR, Satsangi J. The safety profile of anti-tumour necrosis factor therapy in inflammatory bowel disease in clinical practice: analysis of 620 patient-years follow-up. Aliment Pharmacol Ther 2009; 29:286-97. [PMID: 19132970 DOI: 10.1111/j.1365-2036.2008.03882.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anti-TNF agents are now widely used in Crohn's disease (CD), and in ulcerative colitis (UC). AIM To review the safety profile of anti-TNF agents in all patients treated with infliximab in Edinburgh from 1999 to 2007. METHODS Complete data were available on 202/207 patients comprising 157 CD, 42 UC and three coeliac disease. Median follow-up was 2.4 years (1.0-4.9) with a total of 620 patient-years follow-up. About 19.1% of CD patients were subsequently treated with adalimumab. RESULTS Seven deaths (3.3%) occurred in follow-up; only one death was <1 year post-infliximab (at day 72, from lung cancer). A total of six malignancies (three haematological, three bronchogenic) and six cases of suspected demyelination (three with confirmed neurological disease) were reported. In the 90 days following infliximab, 95 adverse events (36 serious) occurred in 58/202 (28.7%) patients. In all, 42/202 (20.8%) had an infectious event (22 serious) and 27/202 (13.4%) of patients had an infusion reaction: 19 acute (four serious) and eight delayed (three serious). CONCLUSIONS Serious infections, malignancies and neurological disease complicate anti-TNF use in clinical practice. Although evidence for causality is unclear, potential mechanisms and predisposing factors need to be explored. In individual patients, the risk/benefit analysis needs to be carefully assessed and discussed prior to commencement of therapy.
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Affiliation(s)
- C W Lees
- Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.
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Abstract
Histoplasmosis is an important systemic mycotic infection with a wide geographic distribution. Its occurrence has been mostly studied in the US (6) and in Central America (6), but very little is known about its distribution in Africa, where a specific variant exists. Skin test surveys in the Democratic Republic of Somali indicate that Histoplasma capsulatum or a closely related agent has a focus in this east African country.
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