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Stark D, Denzinger M, Ebert L, Brandl R, Knorr C. Therapeutic approaches of diametaphyseal radius fractures in children. Arch Orthop Trauma Surg 2024; 144:1179-1188. [PMID: 38231205 DOI: 10.1007/s00402-023-05118-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/28/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND There are clear standards for when to operate on both distal epiphyseal and diaphyseal forearm fractures in children. However, paediatric surgeons are often faced with fractures in the transition zone between metaphysis and diaphysis. This aim of the study is to compare different treatment approaches for diametaphyseal forearm fractures, to classify different types of these fractures, and to define further assessment parameters and treatment recommendations. METHODS This retrospective study included all patients with diametaphyseal radial fractures who were seen at a paediatric surgery clinic between 01.01.2010 and 31.12.2013. Patients were treated either non-surgically (C) or surgically using bicortical Kirschner wire (BC-KW), intramedullary K-wire (IM-KW), elastic stable intramedullary nailing (ESIN), or combined bicortical and intramedullary K-wire (BCIM-KW). RESULTS During the study period, 547 patients presented with forearm fractures of which 88 patients (16%) had a fracture in the diametaphyseal region. The majority of diametaphyseal fractures were greenstick fractures (54.4%) followed by transverse fractures (44.3%). Distal fractures were predominantly treated with bicortical K-wiring (BC-KW, 40.5%) or non-surgically (C, 26.2%). Proximal fractures were treated by ESIN osteosynthesis (50%), followed by IM-KW (30%). Intermediate fractures were just as likely to be treated with one out of the 5 above-mentioned techniques. The ulna was involved in 64 of 88 cases. Depending on the type of fracture, it was treated either by ESIN osteosynthesis or non-surgically. No superior operative technique was identified. CONCLUSIONS The description of diametaphyseal fractures as a separate entity is important, because the therapy of these fractures is heterogeneous and challenging. A classification into proximal, intermediate, and distal may be useful in clinical decision-making. Despite the retrospective nature of this study, our data suggest that the use of a K-wire or combined technique BCIM-KW-technique, whenever technically feasible, achieves better radiological results without secondary dislocation. Further prospective studies are needed to provide better guidance to trauma surgeons.
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Affiliation(s)
- D Stark
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany.
| | - M Denzinger
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
| | - L Ebert
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
| | - R Brandl
- Klinik für Radiologie, Krankenhaus der Barmherzigen Brüder, Regensburg, Germany
| | - C Knorr
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
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2
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Hall LM, Munasinghe VS, Vella NGF, Ellis JT, Stark D. Observations on the transmission of Dientamoeba fragilis and the cyst life cycle stage. Parasitology 2024; 151:337-345. [PMID: 38250789 PMCID: PMC11007279 DOI: 10.1017/s0031182024000076] [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: 07/20/2023] [Revised: 11/20/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
Little is known about the life cycle and mode of transmission of Dientamoeba fragilis. Recently it was suggested that fecal–oral transmission of cysts may play a role in the transmission of D. fragilis. In order to establish an infection, D. fragilis is required to remain viable when exposed to the pH of the stomach. In this study, we investigated the ability of cultured trophozoites to withstand the extremes of pH. We provide evidence that trophozoites of D. fragilis are vulnerable to highly acidic conditions. We also investigated further the ultrastructure of D. fragilis cysts obtained from mice and rats by transmission electron microscopy. These studies of cysts showed a clear cyst wall surrounding an encysted parasite. The cyst wall was double layered with an outer fibrillar layer and an inner layer enclosing the parasite. Hydrogenosomes, endoplasmic reticulum and nuclei were present in the cysts. Pelta-axostyle structures, costa and axonemes were identifiable and internal flagellar axonemes were present. This study therefore provides additional novel details and knowledge of the ultrastructure of the cyst stage of D. fragilis.
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Affiliation(s)
- Luke M. Hall
- School of Life Sciences, University of Technology Sydney, Broadway, NSW 2007, Australia
- Division of Microbiology, Sydpath, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Varuni S. Munasinghe
- School of Life Sciences, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Nicole G. F. Vella
- Macquarie University Microscopy Unit, Faculty of Science and Engineering, Macquarie University, North Ryde, NSW 2109, Australia
| | - John T. Ellis
- School of Life Sciences, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Damien Stark
- Division of Microbiology, Sydpath, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
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3
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Wallace H, Stark D, Weaving P, Inkster T. Development of an infection prevention and control pathway to facilitate high-throughput cataract surgery in Scotland. J Hosp Infect 2024; 147:107-114. [PMID: 38423131 DOI: 10.1016/j.jhin.2024.02.009] [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: 01/08/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Cataract surgery offers significant improvement to quality of life for patients with cataracts. However, there are growing waiting lists and challenges in providing this type of surgery in a timely manner. Feedback from stakeholders had previously indicated infection prevention and control (IPC) as a potential barrier to high-throughput surgery. Antimicrobial Resistance and Healthcare Associated Infection Scotland was asked to support the implementation of high-throughput cataract surgery aimed at addressing these challenges. AIM To develop an IPC pathway to facilitate high-throughput surgery. This would be based on best practice, and would address any barriers identified by stakeholders. METHODS A short life working group with input from key stakeholders, including clinical teams, was established. A rapid literature review was also undertaken. RESULTS An agreed patient pathway was developed, with the aim of helping to facilitate high-throughput surgery. Pre-, intra- and postoperative phases were considered. Where literature was unavailable, expert/consensus opinion was utilized. Facilities for high-throughput surgery were also considered, including the Jack and Jill theatre arrangement which lends itself well to this concept. CONCLUSION Through collaboration with stakeholders, an IPC pathway was developed to facilitate high-throughput cataract surgery and address any potential IPC barriers to implementation. The process and the output described could be utilized to develop similar pathways for other surgeries that lend themselves well to high throughput, improving quality of life for patients and reducing waiting times. This study highlights the importance of establishing surveillance for postoperative endophthalmitis following implementation.
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Affiliation(s)
- H Wallace
- Antimicrobial Resistance and Healthcare Associated Infection, National Services Scotland, Glasgow, UK
| | - D Stark
- Antimicrobial Resistance and Healthcare Associated Infection, National Services Scotland, Glasgow, UK
| | - P Weaving
- Antimicrobial Resistance and Healthcare Associated Infection, National Services Scotland, Glasgow, UK
| | - T Inkster
- Antimicrobial Resistance and Healthcare Associated Infection, National Services Scotland, Glasgow, UK.
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4
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Aghazadeh M, Jones M, Perera S, Nair J, Tan L, Clark B, Curtis A, Jones J, Ellem J, Olma T, Stark D, Melki J, Coulston N, Baker R, Millar D. The Application of 3base™ Technology to Diagnose Eight of the Most Clinically Important Gastrointestinal Protozoan Infections. Int J Mol Sci 2023; 24:13387. [PMID: 37686192 PMCID: PMC10487386 DOI: 10.3390/ijms241713387] [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: 07/04/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Globally, over 3.5 billion people are infected with intestinal parasites each year, resulting in over 200,000 deaths. Three of the most common protozoan pathogens that affect the gastrointestinal tract of humans are Cryptosporidium spp., Giardia intestinalis, and Entamoeba histolytica. Other protozoan agents that have been implicated in gastroenteritis in humans include Cyclospora cayetanensis, Dientamoeba fragilis, Blastocystis hominis, and the microsporidia Enterocytozoon bieneusi and Encephalitozoon intestinalis. Genetic Signatures previously developed a 3base™ multiplexed Real-Time PCR (mRT-PCR) enteric protozoan kit (EP001) for the detection of Giardia intestinalis/lamblia/duodenalis, Cryptosporidium spp., E. histolytica, D. fragilis, and B. hominis. We now describe improvements to this kit to produce a more comprehensive assay, including C. cayetanensis, E. bieneusi, and E. intestinalis, termed EP005. The clinical performance of EP005 was assessed using a set of 380 clinical samples against a commercially available PCR test and other in-house nucleic acid amplification tests where commercial tests were not available. All methods provided at least 90% agreement. EP005 had no cross-reactivity against 82 organisms commonly found in the gut. The EP005 method streamlines the detection of gastrointestinal parasites and addresses the many challenges of traditional microscopic detection, resulting in cost savings and significant improvements in patient care.
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Affiliation(s)
- Mahdis Aghazadeh
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Meghan Jones
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Suneth Perera
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Jiny Nair
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Litty Tan
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Brett Clark
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Angela Curtis
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Jackson Jones
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Justin Ellem
- Microbiology Department, Westmead Hospital, Westmead, NSW 2145, Australia; (J.E.); (T.O.)
| | - Tom Olma
- Microbiology Department, Westmead Hospital, Westmead, NSW 2145, Australia; (J.E.); (T.O.)
| | - Damien Stark
- St. Vincent’s Pathology, Level 6, Xavier Building, 390 Victoria Street, Darlinghurst, NSW 2010, Australia;
| | - John Melki
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Neralie Coulston
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Rohan Baker
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
| | - Douglas Millar
- Genetic Signatures, 7 Eliza Street, Newtown, NSW 2042, Australia; (M.A.); (M.J.); (S.P.); (J.N.); (B.C.); (A.C.); (J.J.); (J.M.); (N.C.); (R.B.)
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5
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Trama A, Stark D, Bozovic-Spasojevic I, Gaspar N, Peccatori F, Toss A, Bernasconi A, Quarello P, Scheinemann K, Jezdic S, Blondeel A, Mountzios G, Bielack S, Saloustros E, Ferrari A. Cancer burden in adolescents and young adults in Europe. ESMO Open 2023; 8:100744. [PMID: 36753992 PMCID: PMC10024081 DOI: 10.1016/j.esmoop.2022.100744] [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: 08/25/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer epidemiology is unique in adolescents and young adults (AYAs; aged 15-39 years). The European Society for Medical Oncology/European Society for Paediatric Oncology (ESMO/SIOPE) AYA Working Group aims to describe the burden of cancers in AYAs in Europe and across European Union (EU) countries. PATIENTS AND METHODS We used data available on the Global Cancer Observatory. We retrieved crude and age-standardised (World Standard Population) incidence and mortality rates. We reported about AYA cancer burden in Europe and between 28 EU member states. We described incidence and mortality for all cancers and for the 13 cancers most relevant to the AYA population. RESULTS Incidence and mortality varied widely between countries with the highest mortality observed in Eastern EU countries. Cancers of the female breast, thyroid and male testis were the most common cancers across countries followed by melanoma of skin and cancers of the cervix. Variations in cancer incidence rates across different populations may reflect different distribution of risk factors, variations in the implementation or uptake of screening as well as overdiagnosis. AYA cancer mortality disparities may be due to variation in early-stage diagnoses, different public education and awareness of cancer symptoms, different degrees of access or availability of treatment. CONCLUSIONS Our results highlight the future health care needs and requirements for AYA-specialised services to ensure a homogeneous treatment across different countries as well as the urgency for preventive initiatives that can mitigate the increasing burden.
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Affiliation(s)
- A Trama
- Research Department, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - D Stark
- Leeds Institute of Medical Research, School of Medicine University of Leeds, Leeds, UK
| | - I Bozovic-Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - N Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - F Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - A Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - A Bernasconi
- Research Department, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - P Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Torino, Italy; University of Torino, Torino, Italy
| | - K Scheinemann
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Canada
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOP Europe), Brussels, Belgium
| | - G Mountzios
- 2nd Department of Medical Oncology and Clinical Trial Unit, Henry Dunant Hospital, Athens, Greece
| | - S Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - E Saloustros
- Department of Oncology, University Hospital of Larissa, Larissa, Greece
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Gow I, Smith N, Stark D, Ellis J. Molecular Detection of Neglected Tropical Diseases: The Case for Automated Near-Point-of-Care Diagnosis of Leishmaniasis. Am J Trop Med Hyg 2023; 108:2-6. [PMID: 36450231 PMCID: PMC9833060 DOI: 10.4269/ajtmh.22-0373] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/13/2022] [Indexed: 12/03/2022] Open
Abstract
Neglected tropical diseases affect those in poorer nations disproportionately across the globe. One example of these, leishmaniasis, is a debilitating and potentially fatal parasitic infection. Molecular detection of this disease can provide accurate and fast diagnosis, and with near point-of-care technologies, detection can be provided in many health-care settings. Traditionally, the perceived limitations to such detection methods have hindered their provision to resource-limited nations, but new technologies and techniques are helping to overcome these perceptions. The current pandemic offers an opportunity to maintain and develop further advances, ensuring molecular diagnostics are accessible to all.
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Affiliation(s)
- Ineka Gow
- School of Life Sciences, University of Technology Sydney, NSW, Australia
| | - Nicholas Smith
- School of Life Sciences, University of Technology Sydney, NSW, Australia
| | - Damien Stark
- Department of Microbiology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - John Ellis
- School of Life Sciences, University of Technology Sydney, NSW, Australia
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7
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Zajaczkowski P, Lee R, Fletcher-Lartey SM, Alexander K, Mahimbo A, Stark D, Ellis JT. The controversies surrounding Giardia intestinalis assemblages A and B. Curr Res Parasitol Vector Borne Dis 2022; 1:100055. [PMID: 35284870 PMCID: PMC8906113 DOI: 10.1016/j.crpvbd.2021.100055] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022]
Abstract
Giardia intestinalis continues to be one of the most encountered parasitic diseases around the world. Although more frequently detected in developing countries, Giardia infections nonetheless pose significant public health problems in developed countries as well. Molecular characterisation of Giardia isolates from humans and animals reveals that there are two genetically different assemblages (known as assemblage A and B) that cause human infections. However, the current molecular assays used to genotype G. intestinalis isolates are quite controversial. This is in part due to a complex phenomenon where assemblages are incorrectly typed and underreported depending on which targeted locus is sequenced. In this review, we outline current knowledge based on molecular epidemiological studies and raise questions as to the reliability of current genotyping assays and a lack of a globally accepted method. Additionally, we discuss the clinical symptoms caused by G. intestinalis infection and how these symptoms vary depending on the assemblage infecting an individual. We also introduce the host-parasite factors that play a role in the subsequent clinical presentation of an infected person, and explore which assemblages are most seen globally.
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Affiliation(s)
- Patricia Zajaczkowski
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Australia
| | - Rogan Lee
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | | | - Kate Alexander
- Public Health Unit, South Western Sydney Local Health District, Liverpool, Australia
| | - Abela Mahimbo
- Faculty of Health, School of Public Health, University of Technology Sydney, Australia
| | - Damien Stark
- Department of Microbiology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - John T Ellis
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Australia
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8
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Stark D, Nagrath N. 122 Tetanus Prophylaxis for Injuries Referred to a Plastic Surgery Service. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.067] [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: 11/14/2022]
Abstract
Abstract
Aim
To ascertain whether there is appropriate documentation of tetanus immunisation status. To determine whether appropriate tetanus prophylaxis is offered to those with an incomplete or unknown immunisation history for tetanus prone and high-risk tetanus prone wounds. To improve adherence to the green book of immunisation tetanus guidance.
Method
We performed an audit of wounds referred to plastic surgery in a 3-week period to ascertain whether the green book guidance was satisfied. A poster intervention for junior colleagues that illustrated the guidance was implemented. Re-audit was performed.
Results
Tetanus immunisation status was documented in 17 (34%) patients. Of 22 with tetanus prone wounds, 11 (50%) had an incomplete tetanus immunisation, but only 3 (27%) received a booster vaccine. Of the 11 high risk tetanus prone wounds, 10 (91%) had an incomplete tetanus immunisation status, but only 5 (50%) received a booster vaccine and none were offered tetanus immunoglobulins.
Following intervention, tetanus immunisation status was documented in 23 (46%) patients. In the re-audit, 12 (24%) sustained a tetanus prone injury and 4 (33%) of these had complete immunisation. Of the remaining 8, 7 (88%) received a booster vaccine and 1 patient refused. Of the 4 high risk tetanus prone wounds, 3 (75%) had an incomplete tetanus immunisation status, all of whom received a booster vaccine and 1 (25%) was offered tetanus immunoglobulins.
Conclusions
We observed greater engagement with the tetanus immunisation guidance and improvement in the assessment and management of tetanus prone injuries.
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Affiliation(s)
- D. Stark
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - N. Nagrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
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9
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Chan D, Suk HJ, Jackson B, Milman NP, Stark D, Beach SD, Tsai LH. Induction of specific brain oscillations may restore neural circuits and be used for the treatment of Alzheimer's disease. J Intern Med 2021; 290:993-1009. [PMID: 34156133 DOI: 10.1111/joim.13329] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 12/22/2020] [Revised: 03/24/2021] [Accepted: 05/17/2021] [Indexed: 01/08/2023]
Abstract
Brain oscillations underlie the function of our brains, dictating how we both think and react to the world around us. The synchronous activity of neurons generates these rhythms, which allow different parts of the brain to communicate and orchestrate responses to internal and external stimuli. Perturbations of cognitive rhythms and the underlying oscillator neurons that synchronize different parts of the brain contribute to the pathophysiology of diseases including Alzheimer's disease, (AD), Parkinson's disease (PD), epilepsy and other diseases of rhythm that have been studied extensively by Gyorgy Buzsaki. In this review, we discuss how neurologists manipulate brain oscillations with neuromodulation to treat diseases and how this can be leveraged to improve cognition and pathology underlying AD. While multiple modalities of neuromodulation are currently clinically indicated for some disorders, nothing is yet approved for improving memory in AD. Recent investigations into novel methods of neuromodulation show potential for improving cognition in memory disorders. Here, we demonstrate that neuronal stimulation using audiovisual sensory stimulation that generated 40-HZ gamma waves reduced AD-specific pathology and improved performance in behavioural tests in mouse models of AD, making this new mode of neuromodulation a promising new avenue for developing a new therapeutic intervention for the treatment of dementia.
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Affiliation(s)
- D Chan
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - H-J Suk
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - B Jackson
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.,McGovern Institute, Massachusetts Institute of Technology, Cambridge, MA, USA.,Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - N P Milman
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Behavioral Neuroscience, Northeastern University, Boston, MA, USA
| | - D Stark
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - S D Beach
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.,Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA.,Division of Medical Sciences, Harvard Medical School, Boston, MA, USA
| | - L-H Tsai
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
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10
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Marriott D, Beresford R, Mirdad F, Stark D, Glanville A, Chapman S, Harkness J, Dore GJ, Andresen D, Matthews GV. Concomitant Marked Decline in Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Other Respiratory Viruses Among Symptomatic Patients Following Public Health Interventions in Australia: Data from St Vincent's Hospital and Associated Screening Clinics, Sydney, NSW. Clin Infect Dis 2021; 72:e649-e651. [PMID: 32841316 PMCID: PMC7499558 DOI: 10.1093/cid/ciaa1256] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/21/2020] [Indexed: 01/10/2023] Open
Abstract
Our Australian hospital tested almost 22,000 symptomatic people over 11 weeks for SARS-CoV-2 in a multiplex PCR assay. Following travel bans and physical distancing, SARS-CoV-2 and other respiratory viruses diagnoses fell dramatically. Increasing rhinovirus diagnoses as social control measures were relaxed may indirectly indicate an elevated risk of COVID-19 resurgence
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Affiliation(s)
- Deborah Marriott
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | | | - Feras Mirdad
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - Damien Stark
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - Allan Glanville
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - Scott Chapman
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - Jock Harkness
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - Gregory J Dore
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia.,Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - David Andresen
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - Gail V Matthews
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia.,Kirby Institute, University of New South Wales Sydney, Sydney, Australia
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Birckhead A, Combs M, Croser E, Montgomery A, Peters A, Stark D, Malik R. Presumptive neural microsporidiosis in a young adult German Shepherd dog from rural Australia. Aust Vet J 2021; 99:351-355. [PMID: 33904161 DOI: 10.1111/avj.13071] [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: 12/06/2020] [Revised: 02/21/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
CASE REPORT A 1-year-old, neutered male German Shepherd was presented with a 5-month history of episodic lethargy, intermittent fever, weight loss and a hunched posture. The dog was diagnosed with presumptive microsporidian meningoencephalitis based on cytological findings on cerebrospinal fluid analysis and a positive PCR test. The dog initially responded favourably to a 4-week course of trimethoprim-sulfadiazine, pyrimethamine and fenbendazole, and remained well for 12 weeks following cessation of treatment. Disease then recurred, and despite an initial positive response to treatment, he deteriorated and was euthanased 11 weeks later, 7.5 months after definitive diagnosis and 13 months after clinical signs were first reported. CONCLUSION To the authors knowledge, this is the first case of canine microsporidiosis in Australia.
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Affiliation(s)
- A Birckhead
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - M Combs
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - E Croser
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - A Montgomery
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - A Peters
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - D Stark
- Microbiology Department, St Vincent's Hospital, Sydney, New South Wales, 2010, Australia
| | - R Malik
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia.,Centre for Veterinary Education, University of Sydney, Sydney, New South Wales, 2006, Australia
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12
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Ferrari A, Stark D, Peccatori FA, Fern L, Laurence V, Gaspar N, Bozovic-Spasojevic I, Smith O, De Munter J, Derwich K, Hjorth L, van der Graaf WTA, Soanes L, Jezdic S, Blondeel A, Bielack S, Douillard JY, Mountzios G, Saloustros E. Adolescents and young adults (AYA) with cancer: a position paper from the AYA Working Group of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). ESMO Open 2021; 6:100096. [PMID: 33926710 PMCID: PMC8103533 DOI: 10.1016/j.esmoop.2021.100096] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
It is well recognised that adolescents and young adults (AYA) with cancer have inequitable access to oncology services that provide expert cancer care and consider their unique needs. Subsequently, survival gains in this patient population have improved only modestly compared with older adults and children with cancer. In 2015, the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE) established the joint Cancer in AYA Working Group in order to increase awareness among adult and paediatric oncology communities, enhance knowledge on specific issues in AYA and ultimately improve the standard of care for AYA with cancer across Europe. This manuscript reflects the position of this working group regarding current AYA cancer care, the challenges to be addressed and possible solutions. Key challenges include the lack of specific biological understanding of AYA cancers, the lack of access to specialised centres with age-appropriate multidisciplinary care and the lack of available clinical trials with novel therapeutics. Key recommendations include diversifying interprofessional cooperation in AYA care and specific measures to improve trial accrual, including centralising care where that is the best means to achieve trial accrual. This defines a common vision that can lead to improved outcomes for AYA with cancer in Europe.
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Affiliation(s)
- A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - D Stark
- Leeds Institute of Medical Research, School of Medicine University of Leeds, Leeds, UK.
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - L Fern
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Laurence
- Medical Oncology Department and SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
| | - N Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - I Bozovic-Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - O Smith
- National Children's Cancer Service, Children's Health Ireland at Crumlin and Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - J De Munter
- University Hospital Ghent Cancer Center, UZ Gent, Ghent, Belgium
| | - K Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - L Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - W T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Soanes
- Teenage Cancer Trust, London, UK
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - S Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, KlinikumStuttgart - Olgahospital, Stuttgart, Germany
| | - J-Y Douillard
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Mountzios
- 2nd Department of Medical Oncology and Clinical Trial Unit, Henry Dunant Hospital, Athens, Greece
| | - E Saloustros
- Department of Oncology, University Hospital of Larissa, Larissa, Greece
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13
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Kaufer A, Stark D, Ellis J. A review of the systematics, species identification and diagnostics of the Trypanosomatidae using the maxicircle kinetoplast DNA: from past to present. Int J Parasitol 2020; 50:449-460. [PMID: 32333942 DOI: 10.1016/j.ijpara.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/19/2019] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 11/25/2022]
Abstract
The Trypanosomatid family are a diverse and widespread group of protozoan parasites that belong to the higher order class Kinetoplastida. Containing predominantly monoxenous species (i.e. those having only a single host) that are confined to invertebrate hosts, this class is primarily known for its pathogenic dixenous species (i.e. those that have two hosts), serving as the aetiological agents of the important neglected tropical diseases including leishmaniasis, American trypanosomiasis (Chagas disease) and human African trypanosomiasis. Over the past few decades, a multitude of studies have investigated the diversity, classification and evolutionary history of the trypanosomatid family using different approaches and molecular targets. The mitochondrial-like DNA of the trypanosomatid parasites, also known as the kinetoplast, has emerged as a unique taxonomic and diagnostic target for exploring the evolution of this diverse group of parasitic eukaryotes. This review discusses recent advancements and important developments that have made a significant impact in the field of trypanosomatid systematics and diagnostics in recent years.
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Affiliation(s)
- Alexa Kaufer
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Damien Stark
- Department of Microbiology, St Vincent's Hospital Sydney, Darlinghurst, NSW 2010, Australia
| | - John Ellis
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Kaufer A, Ellis J, Stark D. Identification of Clinical Infections of Leishmania Imported into Australia: Revising Speciation with Polymerase Chain Reaction-RFLP of the Kinetoplast Maxicircle. Am J Trop Med Hyg 2020; 101:590-601. [PMID: 31333156 DOI: 10.4269/ajtmh.19-0095] [Citation(s) in RCA: 3] [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] [Indexed: 11/07/2022] Open
Abstract
Leishmaniasis is a vector-borne disease caused by protozoan parasites of the Leishmania genus. In Australia, leishmaniasis is an imported disease that is presenting itself at increased rates because of international travel, the influx of immigrants, and deployment of military operations to endemic regions. Although Leishmania species are morphologically indistinguishable, there is a strong correlation between some causative species of leishmaniasis and the subsequent response to the treatments available and patient outcome. Consequently, identification of the infective species is imperative as misidentification can result in the administering of an ineffective drug. The aim of this study was to develop a simple diagnostic tool with high sensitivity and specificity, which is capable of detecting the presence of the parasite and accurately differentiating the causative species in question. Using the advantageous properties of the maxi-circle kinetoplast DNA, a polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) targeting the ND7 gene was developed for the analysis of imported cases of human leishmaniasis in Australia. Designed as a dual analysis, concurrent PCR of Leishmania maxi-circle DNA and digestion with two separate enzymes (NlaIII and HpyCH4IV), this study provides an appraisal on 24 imported cases of leishmaniasis between 2008 and 2017. Five Leishmania species were reported, with members of the Viannia subgenus being the most common. The implementation of novel diagnostic procedures for leishmaniasis such as the one reported here is needed to establish a gold standard practice for the diagnosis and treatment of leishmaniasis.
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Affiliation(s)
- Alexa Kaufer
- School of Life Sciences, University of Technology Sydney, Ultimo, Australia
| | - John Ellis
- School of Life Sciences, University of Technology Sydney, Ultimo, Australia
| | - Damien Stark
- Department of Microbiology, St. Vincent's Hospital Sydney, Darlinghurst, Australia
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Gow I, Millar D, Ellis J, Melki J, Stark D. Semi-Quantitative, Duplexed qPCR Assay for the Detection of Leishmania spp. Using Bisulphite Conversion Technology. Trop Med Infect Dis 2019; 4:E135. [PMID: 31683788 PMCID: PMC6958480 DOI: 10.3390/tropicalmed4040135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 10/06/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 02/04/2023] Open
Abstract
Leishmaniasis is caused by the flagellated protozoan Leishmania, and is a neglected tropical disease (NTD), as defined by the World Health Organisation (WHO). Bisulphite conversion technology converts all genomic material to a simplified form during the lysis step of the nucleic acid extraction process, and increases the efficiency of multiplex quantitative polymerase chain reaction (qPCR) reactions. Through utilization of qPCR real-time probes, in conjunction with bisulphite conversion, a new duplex assay targeting the 18S rDNA gene region was designed to detect all Leishmania species. The assay was validated against previously extracted DNA, from seven quantitated DNA and cell standards for pan-Leishmania analytical sensitivity data, and 67 cutaneous clinical samples for cutaneous clinical sensitivity data. Specificity was evaluated by testing 76 negative clinical samples and 43 bacterial, viral, protozoan and fungal species. The assay was also trialed in a side-by-side experiment against a conventional PCR (cPCR), based on the Internal transcribed spacer region 1 (ITS1 region). Ninety-seven percent of specimens from patients that previously tested positive for Leishmania were positive for Leishmania spp. with the bisulphite conversion assay, and a limit of detection (LOD) of 10 copies per PCR was achieved, while the LOD of the ITS1 methodology was 10 cells/1000 genomic copies per PCR. This method of rapid, accurate and simple detection of Leishmania can lead to improved diagnosis, treatment and public health outcomes.
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Affiliation(s)
- Ineka Gow
- School of Life Sciences, University of Technology, Sydney, NSW 2007, Australia.
- Genetic Signatures Ltd., Sydney, NSW 2042, Australia.
| | | | - John Ellis
- School of Life Sciences, University of Technology, Sydney, NSW 2007, Australia.
| | - John Melki
- Genetic Signatures Ltd., Sydney, NSW 2042, Australia.
| | - Damien Stark
- Microbiology Department, St. Vincent's Hospital, Sydney, NSW 2010, Australia.
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Kaufer A, Barratt J, Stark D, Ellis J. The complete coding region of the maxicircle as a superior phylogenetic marker for exploring evolutionary relationships between members of the Leishmaniinae. Infection, Genetics and Evolution 2019; 70:90-100. [DOI: 10.1016/j.meegid.2019.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 02/05/2023]
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Sutrave G, Maundrell A, Keighley C, Jennings Z, Brammah S, Wang MX, Pamphlett R, Webb CE, Stark D, Englert H, Gottlieb D, Bilmon I, Watts MR. Anncaliia algerae Microsporidial Myositis, New South Wales, Australia. Emerg Infect Dis 2019; 24:1528-1531. [PMID: 30014835 PMCID: PMC6056123 DOI: 10.3201/eid2408.172002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We describe the successful management of Anncaliia algerae microsporidial myositis in a man with graft versus host disease after hemopoietic stem cell transplantation. We also summarize clinical presentation and management approaches and discuss the importance of research into the acquisition of this infection and strategies for prevention.
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Dalvi R, Li CK, Yonemori K, Ariffin H, Lyu C, Farid M, Gonzales-Santos J, Zhou Q, Bielack S, Brugieres L, Blondeel A, Essiaf S, Peccatori F, Jezdic S, Stark D, Douillard JY, Saloustros E, Mountzios G. Adolescents and young adults with cancer care in Asia: The joint ESMO/SIOPE/SIOP ASIA survey. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy442.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Domazetovska A, Lee R, Adhikari C, Watts M, Gilroy N, Stark D, Sivagnanam S. A 12-Year Retrospective Study of Invasive Amoebiasis in Western Sydney: Evidence of Local Acquisition. Trop Med Infect Dis 2018; 3:tropicalmed3030073. [PMID: 30274469 PMCID: PMC6160945 DOI: 10.3390/tropicalmed3030073] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/16/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023] Open
Abstract
In Australia, amoebiasis is thought to occur in travellers, immigrants from endemic areas, and among men who have sex with men. Prevalence of amoebiasis in communities with immigrants from Entamoeba histolytica-endemic countries is unknown. The present study is a retrospective case series analysis of patients with laboratory-confirmed amoebiasis from Western Sydney Local Health District, Australia, between years 2005 and 2016. Forty-nine patients with amoebiasis were identified, resulting in an estimated annual incidence of up to 1.1 cases per 100,000 adults. Many were born in Australia (15/47) and India (12/47). Three patients (3/37) had no history of overseas travel, two others had not travelled to an endemic country, and an additional two had a very remote history of overseas travel; one died of fulminant amoebic colitis. Three patients (3/16) were employed in the food industry and one had a history of colonic irrigation in an Australian ‘wellness clinic’. Patients had invasive amoebiasis with either liver abscess (41/48) or colitis (7/48), diagnosed most commonly by serology. Invasive procedures were common, including aspiration of liver abscess (28/41), colonoscopy (11/49), and partial hepatectomy (1/49). Although rare, local acquisition of amoebiasis occurs in Western Sydney and contributes to significant morbidity and hospital admissions.
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Affiliation(s)
- Ana Domazetovska
- Department of Infectious Diseases, Blacktown Hospital, Blacktown NSW 2148, Australia.
- Department of Infectious Diseases, Westmead Hospital, Westmead NSW 2145, Australia.
- Department of Microbiology, Liverpool Hospital, Liverpool NSW 2170, Australia.
| | - Rogan Lee
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145, Australia.
- The University of Sydney Medical School, Westmead Hospital, Westmead NSW 2145, Australia.
| | - Chandra Adhikari
- Department of Anatomical Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145, Australia.
| | - Matthew Watts
- Department of Infectious Diseases, Westmead Hospital, Westmead NSW 2145, Australia.
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145, Australia.
- The University of Sydney Medical School, Westmead Hospital, Westmead NSW 2145, Australia.
| | - Nicole Gilroy
- Department of Infectious Diseases, Westmead Hospital, Westmead NSW 2145, Australia.
| | - Damien Stark
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst NSW 2010, Australia.
| | - Shobini Sivagnanam
- Department of Infectious Diseases, Blacktown Hospital, Blacktown NSW 2148, Australia.
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Touati N, Schöffski P, Litière S, Judson I, Sleijfer S, van der Graaf WT, Italiano A, Isambert N, Gil T, Blay JY, Stark D, Brodowicz T, Marréaud S, Gronchi A. European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Experience with Advanced/Metastatic Epithelioid Sarcoma Patients Treated in Prospective Trials: Clinical Profile and Response to Systemic Therapy. Clin Oncol (R Coll Radiol) 2018; 30:448-454. [PMID: 29550245 DOI: 10.1016/j.clon.2018.02.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 12/08/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/01/2022]
Abstract
AIMS Epithelioid sarcoma is a soft tissue sarcoma associated with a high rate of local recurrence after wide resection and high incidence of distant metastasis. Little is known about the clinical course and response to systemic treatments in epithelioid sarcoma patients. We carried out a retrospective analysis of clinical data from epithelioid sarcoma patients to provide a reference for the design of future epithelioid sarcoma-specific studies. PATIENTS AND METHODS Data from patients with epithelioid sarcoma entered in prospective multi-sarcoma phase II/III trials were pooled: EORTC trial 62012 (doxorubicin versus doxorubicin/ifosfamide), 62043 (pazopanib), 62072 (pazopanib versus placebo) and 62091 (doxorubicin versus trabectedin). Patients had either a local or a centrally confirmed diagnosis of epithelioid sarcoma, had inoperable/metastatic disease at study entry and were eligible for the according trial. Response was assessed according to RECIST 1.1. Progression-free survival (PFS) and overall survival were calculated from date of entry. RESULTS Among 976 patients with advanced sarcomas, 27 epithelioid sarcoma patients (2.8%) were eligible for the analysis (17 men, median age at diagnosis 50 years, range 19-72). Eighteen (66.7%) received chemotherapy as first-line treatment (five doxorubicin, eight doxorubicin/ifosfamide, two pazopanib, three trabectedin) and nine (33.3%) received pazopanib as second line or later. The primary tumour was located in the lower extremity (n = 8; 29.6%), upper extremity (n = 5; 18.5%), retro/intra-abdominal (n = 4; 14.8%) and in other locations (n = 10; 37.0%). At entry, metastases were mainly found in lung (n = 17; 63%), lymph nodes (n = 9; 33.3%), bone (n = 8; 29.6%) and soft tissue (n = 7; 25.9%). The best response for first-line patients was four partial responses (22.2%), 10 stable disease (55.6%) and four progressive disease (22.2%). In subsequent lines, pazopanib achieved one partial response (11.1%), four stable disease (44.4%) and four progressive disease (44.4%). All patients but one progressed on treatment. The median PFS and overall survival were 3.8 (95% confidence interval 2.2-4.8) and 10.8 months (95% confidence interval 8.1-21.3), respectively. Five patients were still alive at the time of the according trial analysis. CONCLUSION With all limitations of such a rare disease and small data set, objective response and survival outcomes are similar in epithelioid sarcoma to non-selected sarcoma populations. The clinical testing of novel systemic treatments for epithelioid sarcoma remains an unmet medical need and a high priority.
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Affiliation(s)
- N Touati
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Litière
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - I Judson
- Royal Marsden Hospital, London, UK
| | - S Sleijfer
- Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - W T van der Graaf
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - N Isambert
- Centre Georges-François Leclerc, Dijon, France
| | - T Gil
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - J Y Blay
- Centre Léon Bérard, Lyon, France
| | - D Stark
- Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - T Brodowicz
- Medical University Vienna, General Hospital, Vienna, Austria
| | - S Marréaud
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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21
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Touati N, Schoffski P, Litière S, Judson I, Sleijfer S, van der Graaf W, Italiano A, Isambert N, Gil T, Blay JY, Stark D, Brodowicz T, Marreaud S, Gronchi A. EORTC experience with advanced/metastatic epithelioid sarcoma patients treated in prospective trials: Clinical profile and response to systemic therapy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx387.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Trypanosomatids are protozoan parasites of the class Kinetoplastida predominately restricted to invertebrate hosts (i.e. possess a monoxenous life-cycle). However, several genera are pathogenic to humans, animals and plants, and have an invertebrate vector that facilitates their transmission (i.e. possess a dixenous life-cycle). Phytomonas is one dixenous genus that includes several plant pathogens transmitted by phytophagous insects. Trypanosoma and Leishmania are dixenous genera that infect vertebrates, including humans, and are transmitted by hematophagous invertebrates. Traditionally, monoxenous trypanosomatids such as Leptomonas were distinguished from morphologically similar dixenous species based on their restriction to an invertebrate host. Nonetheless, this criterion is somewhat flawed as exemplified by Leptomonas seymouri which reportedly infects vertebrates opportunistically. Similarly, Novymonas and Zelonia are presumably monoxenous genera yet sit comfortably in the dixenous clade occupied by Leishmania. The isolation of Leishmania macropodum from a biting midge (Forcipomyia spp.) rather than a phlebotomine sand fly calls into question the exclusivity of the Leishmania-sand fly relationship, and its suitability for defining the Leishmania genus. It is now accepted that classic genus-defining characteristics based on parasite morphology and host range are insufficient to form the sole basis of trypanosomatid taxonomy as this has led to several instances of paraphyly. While improvements have been made, resolution of evolutionary relationships within the Trypanosomatidae is confounded by our incomplete knowledge of its true diversity. The known trypanosomatids probably represent a fraction of those that exist and isolation of new species will help resolve relationships in this group with greater accuracy. This review incites a dialogue on how our understanding of the relationships between certain trypanosomatids has shifted, and discusses new knowledge that informs the present taxonomy of these important parasites.
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Affiliation(s)
- Alexa Kaufer
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - John Ellis
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - Damien Stark
- Department of Microbiology, St Vincent’s Hospital Sydney, Darlinghurst, NSW 2010 Australia
| | - Joel Barratt
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007 Australia
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Jones GL, Hughes J, Mahmoodi N, Greenfield D, Brauten-Smith G, Skull J, Gath J, Yeomanson D, Baskind E, Snowden JA, Jacques RM, Velikova G, Collins K, Stark D, Phillips R, Lane S, Bekker HL. Observational study of the development and evaluation of a fertility preservation patient decision aid for teenage and adult women diagnosed with cancer: the Cancer, Fertility and Me research protocol. BMJ Open 2017; 7:e013219. [PMID: 28289046 PMCID: PMC5353284 DOI: 10.1136/bmjopen-2016-013219] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Women diagnosed with cancer and facing potentially sterilising cancer treatment have to make time-pressured decisions regarding fertility preservation with specialist fertility services while undergoing treatment of their cancer with oncology services. Oncologists identify a need for resources enabling them to support women's fertility preservation decisions more effectively; women report wanting more specialist information to make these decisions. The overall aim of the 'Cancer, Fertility and Me' study is to develop and evaluate a new evidence-based patient decision aid (PtDA) for women with any cancer considering fertility preservation to address this unmet need. METHODS AND ANALYSIS This is a prospective mixed-method observational study including women of reproductive age (16 years +) with a new diagnosis of any cancer across two regional cancer and fertility centres in Yorkshire, UK. The research involves three stages. In stage 1, the aim is to develop the PtDA using a systematic method of evidence synthesis and multidisciplinary expert review of current clinical practice and patient information. In stage 2, the aim is to assess the face validity of the PtDA. Feedback on its content and format will be ascertained using questionnaires and interviews with patients, user groups and key stakeholders. Finally, in stage 3 the acceptability of using this resource when integrated into usual cancer care pathways at the point of cancer diagnosis and treatment planning will be evaluated. This will involve a quantitative and qualitative evaluation of the PtDA in clinical practice. Measures chosen include using count data of the PtDAs administered in clinics and accessed online, decisional and patient-reported outcome measures and qualitative feedback. Quantitative data will be analysed using descriptive statistics, paired sample t-tests and CIs; interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION Research Ethics Committee approval (Ref: 16/EM/0122) and Health Research Authority approval (Ref: 194751) has been granted. Findings will be published in open access peer-reviewed journals, presented at conferences for academic and health professional audiences, with feedback to health professionals and program managers. The Cancer, Fertility and Me patient decision aid (PtDA) will be disseminated via a diverse range of open-access media, study and charity websites, professional organisations and academic sources. External endorsement will be sought from the International Patient Decision Aid Standards (IPDAS) Collaboration inventory of PtDAs and other relevant professional organisations, for example, the British Fertility Society. TRIAL REGISTRATION NUMBER NCT02753296; pre-results.
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Affiliation(s)
- G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - J Hughes
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - N Mahmoodi
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - D Greenfield
- Department of Oncology, Sheffield Teaching NHS Hospitals Foundation Trust, Sheffield University, Sheffield, UK
| | | | - J Skull
- Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Gath
- Independent Cancer Patients' Voice, London, UK
| | - D Yeomanson
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - E Baskind
- Seacroft Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - R M Jacques
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Velikova
- University of Leeds, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - K Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - D Stark
- University of Leeds, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - R Phillips
- Center for Review and Dissemination, University of York, Leeds General Infirmary, Leeds Teaching Hospitals, York, UK
| | - S Lane
- Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - H L Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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Barratt J, Kaufer A, Peters B, Craig D, Lawrence A, Roberts T, Lee R, McAuliffe G, Stark D, Ellis J. Isolation of Novel Trypanosomatid, Zelonia australiensis sp. nov. (Kinetoplastida: Trypanosomatidae) Provides Support for a Gondwanan Origin of Dixenous Parasitism in the Leishmaniinae. PLoS Negl Trop Dis 2017; 11:e0005215. [PMID: 28081121 PMCID: PMC5230760 DOI: 10.1371/journal.pntd.0005215] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/29/2016] [Indexed: 01/28/2023] Open
Abstract
The genus Leishmania includes approximately 53 species, 20 of which cause human leishmaniais; a significant albeit neglected tropical disease. Leishmaniasis has afflicted humans for millennia, but how ancient is Leishmania and where did it arise? These questions have been hotly debated for decades and several theories have been proposed. One theory suggests Leishmania originated in the Palearctic, and dispersed to the New World via the Bering land bridge. Others propose that Leishmania evolved in the Neotropics. The Multiple Origins theory suggests that separation of certain Old World and New World species occurred due to the opening of the Atlantic Ocean. Some suggest that the ancestor of the dixenous genera Leishmania, Endotrypanum and Porcisia evolved on Gondwana between 90 and 140 million years ago. In the present study a detailed molecular and morphological characterisation was performed on a novel Australian trypanosomatid following its isolation in Australia’s tropics from the native black fly, Simulium (Morops) dycei Colbo, 1976. Phylogenetic analyses were conducted and confirmed this parasite as a sibling to Zelonia costaricensis, a close relative of Leishmania previously isolated from a reduviid bug in Costa Rica. Consequently, this parasite was assigned the name Zelonia australiensis sp. nov. Assuming Z. costaricensis and Z. australiensis diverged when Australia and South America became completely separated, their divergence occurred between 36 and 41 million years ago at least. Using this vicariance event as a calibration point for a phylogenetic time tree, the common ancestor of the dixenous genera Leishmania, Endotrypanum and Porcisia appeared in Gondwana approximately 91 million years ago. Ultimately, this study contributes to our understanding of trypanosomatid diversity, and of Leishmania origins by providing support for a Gondwanan origin of dixenous parasitism in the Leishmaniinae. The genus Leishmania includes approximately 53 species, 20 of which cause human leishmaniais, a significant disease that has afflicted humans for millennia. But how ancient is Leishmania and where did it arise? Some suggest Leishmania originated in the Palearctic. Others suggest it appeared in the Neotropics. The Multiple Origins theory proposes that separation of certain Old World and Neotropical species occurred following the opening of the Atlantic. Others suggest that an ancestor to the Euleishmania and Paraleishmania appeared on Gondwana 90 to 140 million years ago (MYA). We performed a detailed molecular and morphological characterisation of a novel Australian trypanosomatid. This parasite is a sibling to the Neotropical Zelonia costaricensis, a close relative of Leishmania, and designated as Zelonia australiensis sp. nov. Assuming Z. costaricensis and Z. australiensis split when Australia and South America separated, their divergence occurred between 36 and 41 MYA. Using this event as a calibration point for a phylogenetic time tree, an ancestor of the dixenous Leishmaniinae appeared in Gondwana ~ 91 MYA. This study contributes to our understanding of trypanosomatid diversity by describing a unique Australian trypanosomatid and to our understanding of Leishmania evolution by inferring a Gondwanan origin for dixenous parasitism in the Leishmaniinae.
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Affiliation(s)
- Joel Barratt
- School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Alexa Kaufer
- School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Bryce Peters
- School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
- Insect Research Facility, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Douglas Craig
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Lawrence
- Faculty of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Entomology, University of Sydney & Pathology West - ICPMR, Westmead Hospital, Westmead, New South Wales, Australia
| | - Tamalee Roberts
- St. Vincent's Hospital Sydney, Division of Microbiology, Sydney, New South Wales, Australia
| | - Rogan Lee
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, New South Wales, Australia
| | - Gary McAuliffe
- Microbiology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Damien Stark
- St. Vincent's Hospital Sydney, Division of Microbiology, Sydney, New South Wales, Australia
| | - John Ellis
- School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
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Chan D, Barratt J, Roberts T, Phillips O, Šlapeta J, Ryan U, Marriott D, Harkness J, Ellis J, Stark D. Detection of Dientamoeba fragilis in animal faeces using species specific real time PCR assay. Vet Parasitol 2016; 227:42-7. [PMID: 27523936 DOI: 10.1016/j.vetpar.2016.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 04/01/2016] [Revised: 06/18/2016] [Accepted: 07/19/2016] [Indexed: 11/26/2022]
Abstract
Dientamoeba fragilis is a potentially pathogenic, enteric, protozoan parasite with a worldwide distribution. While clinical case reports and prevalence studies appear regularly in the scientific literature, little attention has been paid to this parasite's biology, life cycle, host range, and possible transmission routes. Overall, these aspects of Dientamoeba biology remain poorly understood at best. In this study, a total of 420 animal samples, collected from Australia, were surveyed for the presence of Dientamoeba fragilis using PCR. Several PCR assays were evaluated for sensitivity and specificity. Two previously published PCR methods demonstrated cross reactivity with other trichomonads commonly found in animal samples. Only one assay exhibited excellent specificity. Using this assay D. fragilis was detected from one dog and one cat sample. This is the first report of D. fragilis from these animals and highlights the role companion animals may play in D. fragilis transmission. This study demonstrated that some published D. fragilis molecular assays cross react with other closely related trichomonads and consequently are not suitable for animal prevalence studies.
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Affiliation(s)
- Douglas Chan
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia; i3 Institute, University of Technology, Sydney, Ultimo, N.S.W, Australia; School of Life Sciences, University of Technology, Sydney, Ultimo, N.S.W, Australia
| | - Joel Barratt
- i3 Institute, University of Technology, Sydney, Ultimo, N.S.W, Australia; School of Life Sciences, University of Technology, Sydney, Ultimo, N.S.W, Australia
| | - Tamalee Roberts
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia
| | - Owen Phillips
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia
| | - Jan Šlapeta
- School of Life and Environmental Sciences, Faculty of Veterinary Science, The University of Sydney, N.S.W., Australia
| | - Una Ryan
- School of Veterinary and Life Sciences, Murdoch University, Western Australia, Australia
| | - Deborah Marriott
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia
| | - John Harkness
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia
| | - John Ellis
- School of Life Sciences, University of Technology, Sydney, Ultimo, N.S.W, Australia
| | - Damien Stark
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia; School of Life Sciences, University of Technology, Sydney, Ultimo, N.S.W, Australia.
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Abstract
Dientamoeba fragilis is a protozoan parasite of the human bowel, commonly reported throughout the world in association with gastrointestinal symptoms. Despite its initial discovery over 100 years ago, arguably, we know less about this peculiar organism than any other pathogenic or potentially pathogenic protozoan that infects humans. The details of its life cycle and mode of transmission are not completely known, and its potential as a human pathogen is debated within the scientific community. Recently, several major advances have been made with respect to this organism's life cycle and molecular biology. While many questions remain unanswered, these and other recent advances have given rise to some intriguing new leads, which will pave the way for future research. This review encompasses a large body of knowledge generated on various aspects of D. fragilis over the last century, together with an update on the most recent developments. This includes an update on the latest diagnostic techniques and treatments, the clinical aspects of dientamoebiasis, the development of an animal model, the description of a D. fragilis cyst stage, and the sequencing of the first D. fragilis transcriptome.
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Affiliation(s)
- Damien Stark
- Division of Microbiology, Sydpath, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Joel Barratt
- School of Life Sciences and the I3 Institute, University of Technology Sydney, Broadway, NSW, Australia
| | - Douglas Chan
- School of Life Sciences and the I3 Institute, University of Technology Sydney, Broadway, NSW, Australia
| | - John T Ellis
- School of Life Sciences and the I3 Institute, University of Technology Sydney, Broadway, NSW, Australia
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Barratt J, Gough R, Stark D, Ellis J. Bulky Trichomonad Genomes: Encoding a Swiss Army Knife. Trends Parasitol 2016; 32:783-797. [PMID: 27312283 DOI: 10.1016/j.pt.2016.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 04/11/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 01/01/2023]
Abstract
The trichomonads are a remarkably successful lineage of ancient, predominantly parasitic protozoa. Recent molecular analyses have revealed extensive duplication of certain genetic loci in trichomonads. Consequently, their genomes are exceptionally large compared to other parasitic protozoa. Retention of these large gene expansions across different trichomonad families raises the question: do these duplications afford an advantage? Many duplicated genes are linked to the parasitic lifestyle and some are regulated differently to their paralogues, suggesting they have acquired new functions. It is proposed that these large genomes encode a Swiss army knife of sorts, packed with a multitude of tools for use in many different circumstances. This may have bestowed trichomonads with the extraordinary versatility that has undoubtedly contributed to their success.
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Affiliation(s)
- Joel Barratt
- I3 Institute, University of Technology Sydney, Broadway, NSW, Australia; School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia.
| | - Rory Gough
- I3 Institute, University of Technology Sydney, Broadway, NSW, Australia; School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia
| | - Damien Stark
- Division of Microbiology, Sydpath, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - John Ellis
- School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia
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Faulkner D, Britton J, Eng S, Del Galdo F, Stark D, Buch M. FRI0272 Evaluation of Bleomycin Induced Raynaud's Phenomenon and Systemic Sclerosis Vasculopathy in Germ Cell Tumour Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Levine B, Boyd J, Jinivizian K, Jeschke M, Suhoski Davis M, Zheng Z, Stark D, Keir C, Wood P. Successful Technology Transfer of Chimeric Antigen Receptor (CAR) Targeting CD19 (CTL019) Cell Processing From Academia to Industry Enables Scale-Up to Support Global Clinical Trials. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gibson F, Hibbins S, Grew T, Morgan S, Pearce S, Stark D, Fern LA. How young people describe the impact of living with and beyond a cancer diagnosis: feasibility of using social media as a research method. Psychooncology 2016; 25:1317-1323. [PMID: 26748434 DOI: 10.1002/pon.4061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 02/09/2015] [Revised: 11/20/2015] [Accepted: 12/06/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Young people with cancer exhibit unique needs. During a time of normal physical and psychological change, multiple disease and treatment-related symptoms cause short and long-term physical and psychosocial effects. Little is known about how young people cope with the impact of cancer and its treatment on daily routines and their strategies to manage the challenges of cancer and treatments. We aimed to determine how young people describe these challenges through a social media site. METHODS Using the principles of virtual ethnography and watching videos on a social media site we gathered data from young people describing their cancer experience. Qualitative content analysis was employed to analyse and interpret the narrative from longitudinal 'video diaries' by 18 young people equating to 156 films and 27 h and 49 min of recording. Themes were described then organized and clustered into typologies grouping commonalities across themes. RESULTS Four typologies emerged reflective of the cancer trajectory: treatment and relenting side effects, rehabilitation and getting on with life, relapse, facing more treatment and coming to terms with dying. CONCLUSIONS This study confirms the need for young people to strive towards normality and creating a new normal, even where uncertainty prevailed. Strategies young people used to gain mastery over their illness and the types of stories they choose to tell provide the focus of the main narrative. Social Media sites can be examined as a source of data, to supplement or instead of more traditional routes of data collection known to be practically challenging with this population. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- F Gibson
- London South Bank University, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S Hibbins
- London South Bank University, London, UK
| | - T Grew
- Oxford University Clinical Academic Graduate School, Oxford, UK
| | - S Morgan
- St James's University Hospital, Leeds, UK
| | - S Pearce
- University College London Hospitals NHS Foundation Trust, London, UK
| | - D Stark
- Section of Oncology and Clinical Research, Leeds Institute of Molecular Medicine, Leeds, UK
| | - L A Fern
- University College London Hospitals NHS Foundation Trust, London, UK.
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31
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Banik GR, Stark D, Rashid H, Ellis JT. Recent advances in molecular biology of parasitic viruses. Infect Disord Drug Targets 2015; 14:155-67. [PMID: 25019235 DOI: 10.2174/1871526514666140713160905] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/10/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
Abstract
The numerous protozoa that can inhabit the human gastro-intestinal tract are known, yet little is understood of the viruses which infect these protozoa. The discovery, morphologic details, purification methods of virus-like particles, genome and proteome of the parasitic viruses, Entamoeba histolytica, Giardia lamblia, Trichomonas vaginalis, and the Eimeria sp. are described in this review. The protozoan viruses share many common features: most of them are RNA or double-stranded RNA viruses, ranging between 5 and 8 kilobases, and are spherical or icosahedral in shape with an average diameter of 30-40 nm. These viruses may influence the function and pathogenicity of the protozoa which they infect, and may be important to investigate from a clinical perspective. The viruses may be used as specific genetic transfection vectors for the parasites and may represent a research tool. This review provides an overview on recent advances in the field of protozoan viruses.
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Affiliation(s)
| | | | | | - John T Ellis
- National Centre for Immunisation Research and Surveillance (NCIRS), Kids research Institute, Children Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead NSW 2145, University of Sydney, Australia.
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Stark D, Bielack S, Brugieres L, Dirksen U, Duarte X, Dunn S, Erdelyi D, Grew T, Hjorth L, Jazbec J, Kabickova E, Konsoulova A, Kowalczyk J, Lassaletta A, Laurence V, Lewis I, Monrabal A, Morgan S, Mountzios G, Olsen P, Renard M, Saeter G, van der Graaf W, Ferrari A. Teenagers and young adults with cancer in Europe: from national programmes to a European integrated coordinated project. Eur J Cancer Care (Engl) 2015; 25:419-27. [DOI: 10.1111/ecc.12365] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/28/2023]
Affiliation(s)
- D. Stark
- Leeds Institute of Cancer and Pathology; Leeds Institute of Oncology and St James's University Hospital; University of Leeds; Leeds UK
| | - S. Bielack
- Klinikum Stuttgart; Center for Pediatric and Adolescent Medicine; Pediatrics 5 (Oncology, Hematology, Immunology); Olgahospital; Stuttgart Germany
| | - L. Brugieres
- Department of Children and Adolescents Oncology; Institut Gustave Roussy; Villejuif France
| | - U. Dirksen
- University Hospital Muenster; Department of Pediatric Hematology and Oncology; Westfalian Wilhelms University; Muenster Germany
- Hospital Infantil Universitario Niño Jesús; Madrid Spain
| | - X. Duarte
- Instituto Português de Oncologia de Lisboa; Lisbon Portugal
| | - S. Dunn
- Teenage Cancer Trust; London UK
| | | | - T. Grew
- Oxford University Clinical Academic Graduate School; Oxford UK
| | - L. Hjorth
- Department of Pediatrics; Skåne University Hospital; Clinical Sciences Lund University; Lund Sweden
| | - J. Jazbec
- Division of Pediatrics; Unit of Hematooncology; University Medical Centre Ljubljana; Ljubljana Slovenia
| | | | | | - J.R. Kowalczyk
- Children's University Hospital; Skubiszewski Medical University of Lublin; Lublin Poland
| | - A. Lassaletta
- Hospital Infantil Universitario Niño Jesús; Madrid Spain
| | - V. Laurence
- Department of Medical and Pediatric Oncology; Institut Curie; Paris France
| | - I. Lewis
- Alder Hey Children's NHS Foundation Trust; Liverpool
| | - A. Monrabal
- Spanish Association of Adolescents and Young Adult with Cancer; London
| | - S. Morgan
- Teenage Cancer Trust Unit; St James's University Hospital; Leeds UK
| | - G. Mountzios
- University of Athens School of Medicine; Athens Greece
| | - P.R. Olsen
- Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - M. Renard
- Department of Pediatric Hemato-Oncology; University Hospitals Leuven; Leuven Belgium
| | - G. Saeter
- Institute for Cancer Research; Oslo University Hospital; Oslo Norway
| | - W.T. van der Graaf
- Department of Medical Oncology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - A. Ferrari
- Pediatric Oncology Unit; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
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Chan D, Barratt J, Roberts T, Lee R, Shea M, Marriott D, Harkness J, Malik R, Jones M, Aghazadeh M, Ellis J, Stark D. The Prevalence of Angiostrongylus cantonensis/mackerrasae Complex in Molluscs from the Sydney Region. PLoS One 2015; 10:e0128128. [PMID: 26000568 PMCID: PMC4441457 DOI: 10.1371/journal.pone.0128128] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/22/2015] [Indexed: 11/18/2022] Open
Abstract
Angiostrongylus cantonensis and Angiostrongylus mackerrasae are metastrongyloid nematodes that infect various rat species. Terrestrial and aquatic molluscs are intermediate hosts of these worms while humans and dogs are accidental hosts. Angiostrongylus cantonensis is the major cause of angiostrongyliasis, a disease characterised by eosinophilic meningitis. Although both A. cantonensis and A. mackerrasae are found in Australia, A. cantonensis appears to account for most infections in humans and animals. Due to the occurrence of several severe clinical cases in Sydney and Brisbane, the need for epidemiological studies on angiostrongyliasis in this region has become apparent. In the present study, a conventional PCR and a TaqMan assay were compared for their ability to amplify Angiostrongylus DNA from DNA extracted from molluscs. The TaqMan assay was more sensitive, capable of detecting the DNA equivalent to one hundredth of a nematode larva. Therefore, the TaqMan assay was used to screen molluscs (n=500) of 14 species collected from the Sydney region. Angiostrongylus DNA was detected in 2 of the 14 mollusc species; Cornu aspersum [14/312 (4.5%)], and Bradybaenia similaris [1/10 (10%)], which are non-native terrestrial snails commonly found in urban habitats. The prevalence of Angiostrongylus spp. was 3.0% ± 0.8% (CI 95%). Additionally, experimentally infected Austropeplea lessoni snails shed A. cantonensis larvae in their mucus, implicating mucus as a source of infection. This is the first Australian study to survey molluscs using real-time PCR and confirms that the garden snail, C. aspersum, is a common intermediate host for Angiostrongylus spp. in Sydney.
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Affiliation(s)
- Douglas Chan
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
- i3 Institute, University of Technology, Sydney, Ultimo, NSW, Australia
- * E-mail:
| | - Joel Barratt
- i3 Institute, University of Technology, Sydney, Ultimo, NSW, Australia
- School of Medical and Molecular Sciences, University of Technology, Sydney, Ultimo, NSW, Australia
| | - Tamalee Roberts
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
| | - Rogan Lee
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, NSW, Australia
| | - Michael Shea
- Malacology Department, Australian Museum, Sydney, NSW, Australia
| | - Deborah Marriott
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
| | - John Harkness
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
| | - Richard Malik
- Centre for Veterinary Education, University of Sydney, Camperdown, NSW, Australia
| | - Malcolm Jones
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Mahdis Aghazadeh
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - John Ellis
- School of Medical and Molecular Sciences, University of Technology, Sydney, Ultimo, NSW, Australia
| | - Damien Stark
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
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Crowe A, Slavin J, Stark D, Aboltins C. A case of imported Leishmania infantum cutaneous leishmaniasis; an unusual presentation occurring 19 years after travel. BMC Infect Dis 2014; 14:597. [PMID: 25428722 PMCID: PMC4262283 DOI: 10.1186/s12879-014-0597-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 10/29/2014] [Indexed: 11/21/2022] Open
Abstract
Background Leishmania infantum is a flagellated protozoan parasite that is able to parasitize blood and tissue. Leishmania species cause a spectrum of clinical disease with cutaneous, visceral or mucosal involvement. L. infantum is recognised as a cause of visceral leishmaniasis (VL) and is less commonly reported as a cause of cutaneous leishmaniasis (CL) from countries around the Mediterranean basin. This is the first report of imported L. infantum CL to Australia and is remarkable for a 19 year period between the patient's exposure to an endemic region, and the manifestation of symptoms. Case presentation A 76 year old Italian-born man presented to our institution with a non-healing lesion over his upper lip, abutting his nasal mucosa. The patient had travelled to Italy, an endemic area for L. infantum 19 years earlier but had resided in Australia, a non-endemic area since. Histopathology performed on a biopsy of the lesion demonstrated findings consistent with CL. A species specific polymerase chain reaction (PCR) performed on the tissue detected L. infantum. The patient had complete clinical recovery following treatment with Liposomal amphotericin B at a dose of 3 mg/kg for five days followed by a subsequent 3 mg/kg dose at day ten. Conclusions L. infantum should be recognised as a cause of imported CL in returned travellers from the Mediterranean. In this case, the incubation period for L. infantum CL was at least 19 years. This case adds to the described spectrum of clinical presentations of leishmaniasis and supports the theory of parasite persistence underlying natural immunity and recurrence of disease. Clinicians should consider L. infantum CL in the differential diagnosis of a non-healing skin lesion in any patient who reports travel to the Mediterranean, even when travel occurred several years before clinical presentation. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0597-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy Crowe
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia.
| | - John Slavin
- Department of Pathology, St Vincent's Hospital, Melbourne, Australia.
| | - Damien Stark
- Department of Microbiology, SydPath, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
| | - Craig Aboltins
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia. .,Department of Infectious Diseases, Northwest Academic Centre, The University of Melbourne, Epping, Victoria, Australia.
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Watts MR, Chan RCF, Cheong EYL, Brammah S, Clezy KR, Tong C, Marriott D, Webb CE, Chacko B, Tobias V, Outhred AC, Field AS, Prowse MV, Bertouch JV, Stark D, Reddel SW. Anncaliia algerae microsporidial myositis. Emerg Infect Dis 2014; 20:185-91. [PMID: 24447398 PMCID: PMC3901472 DOI: 10.3201/eid2002.131126] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The insect microsporidian Anncaliia algerae was first described in 2004 as a cause of fatal myositis in an immunosuppressed person from Pennsylvania, USA. Two cases were subsequently reported, and we detail 2 additional cases, including the only nonfatal case. We reviewed all 5 case histories with respect to clinical characteristics, diagnosis, and management and summarized organism life cycle and epidemiology. Before infection, all case-patients were using immunosuppressive medications for rheumatoid arthritis or solid-organ transplantation. Four of the 5 case-patients were from Australia. All diagnoses were confirmed by skeletal muscle biopsy; however, peripheral nerves and other tissues may be infected. The surviving patient received albendazole and had a reduction of immunosuppressive medications and measures to prevent complications. Although insects are the natural hosts for A. algerae, human contact with water contaminated by spores may be a mode of transmission. A. algerae has emerged as a cause of myositis, particularly in coastal Australia.
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Stark D, Cook A, Brown J, Velikova G, Brundage M, Embleton A, Raja F, Ledermann J. Quality of Life in a Randomised Double-Blind Phase III Trial of Cediranib (Azd2171) in Relapsed Platinum Sensitive Ovarian Cancer (Icon6). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dunwoodie E, Watkins V, Lane M, van Laar M, Phillips R, Hall G, Stark D. When and Why Do Teenage and Young Adult Oncology Patients Die Early in the Cancer Pathway? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu353.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stark D, Barratt JLN, Roberts T, Marriott D, Harkness JT, Ellis J. Activity of benzimidazoles against Dientamoeba fragilis (Trichomonadida, Monocercomonadidae) in vitro and correlation of beta-tubulin sequences as an indicator of resistance. ACTA ACUST UNITED AC 2014; 21:41. [PMID: 25148459 PMCID: PMC4141546 DOI: 10.1051/parasite/2014043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 08/07/2014] [Indexed: 11/14/2022]
Abstract
Recently, Dientamoeba fragilis has emerged as a significant and common enteropathogen. The majority of patients with dientamoebiasis present with gastrointestinal complaints and chronic symptoms are common. Numerous studies have successfully demonstrated parasite clearance, coupled with complete resolution of clinical symptoms following treatment with various antiparasitic compounds. Despite this, there is very little in vitro susceptibility data available for the organism. Benzimidazoles are a class of antiparasitic drugs that are commonly used for the treatment of protozoan and helminthic infections. Susceptibility testing was undertaken on four D. fragilis clinical isolates against the following benzimidazoles: albendazole, flubendazole, mebendazole, nocodazole, triclabendazole and thiabendazole. The activities of the antiprotozoal compounds at concentrations ranging from 2 μg/mL to 500 μg/mL were determined via cell counts of D. fragilis grown in xenic culture. All tested drugs showed no efficacy. The beta-tubulin transcript was sequenced from two of the D. fragilis isolates and amino acid sequences predicted a susceptibility to benzimidazoles. This is the first study to report susceptibility profiles for benzimidazoles against D. fragilis, all of which were not active against the organism. This study also found that beta-tubulin sequences cannot be used as a reliable marker for resistance of benzimidazoles in D. fragilis.
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Affiliation(s)
- Damien Stark
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, NSW 2010, Australia - University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway 2007, Australia
| | - Joel L N Barratt
- University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway 2007, Australia - University of Technology Sydney, iThree Institute, Broadway 2007, Australia
| | - Tamalee Roberts
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, NSW 2010, Australia - University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway 2007, Australia
| | - Deborah Marriott
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, NSW 2010, Australia - University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway 2007, Australia
| | - John T Harkness
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, NSW 2010, Australia - University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway 2007, Australia
| | - John Ellis
- University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway 2007, Australia
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Fletcher S, Caprarelli G, Merif J, Andresen D, Hal SV, Stark D, Ellis J. Epidemiology and geographical distribution of enteric protozoan infections in sydney, australia. J Public Health Res 2014; 3:298. [PMID: 25343139 PMCID: PMC4207027 DOI: 10.4081/jphr.2014.298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 07/08/2014] [Accepted: 08/05/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Enteric protozoa are associated with diarrhoeal illnesses in humans; however there are no recent studies on their epidemiology and geographical distribution in Australia. This study describes the epidemiology of enteric protozoa in the state of New South Wales and incorporates spatial analysis to describe their distribution. DESIGN AND METHODS Laboratory and clinical records from four public hospitals in Sydney for 910 patients, who tested positive for enteric protozoa over the period January 2007 - December 2010, were identified, examined and analysed. We selected 580 cases which had residence post code data available, enabling us to examine the geographic distribution of patients, and reviewed the clinical data of 252 patients to examine possible links between protozoa, demographic and clinical features. RESULTS Frequently detected protozoa were Blastocystis spp. (57%), Giardia intestinalis (27%) and Dientamoeba fragilis (12%). The age distribution showed that the prevalence of protozoa decreased with age up to 24 years but increasing with age from 25 years onwards. The geographic provenance of the patients indicates that the majority of cases of Blastocystis (53.1%) are clustered in and around the Sydney City Business District, while pockets of giardiasis were identified in regional/rural areas. The distribution of cases suggests higher risk of protozoan infection may exist for some communities. CONCLUSIONS These findings provide useful information for policy makers to design and tailor interventions to target high risk communities. Follow-up investigation into the risk factors for giardiasis in regional/rural areas is needed. Significance for public healthThis research is significant since it provides the most recent epidemiological update on the common enteric protozoa affecting Australians. It reveals that enteric protozoa cause considerable disease burden in high risk city dwellers, and provides the evidence base for development of targeted interventions for their prevention and control in high risk populations. The prevalence of enteric protozoa in this metropolitan setting underscores that microorganisms do not respect borders and that a collaborative approach is needed to contain the global spread of infectious diseases. Incorporating spatial analysis is valuable in providing a compelling picture of the geographical distribution of these often neglected diseases. Local and State Public Health departments can use this information to support further inves-
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Affiliation(s)
- Stephanie Fletcher
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney
| | - Graziella Caprarelli
- Division of IT, Engineering and the Environment, University of South Australia, Adelaide
| | - Juan Merif
- Microbiology Department, South Eastern Area Laboratory Service (SEALS), Prince of Wales Hospital, Rand wick
| | - David Andresen
- Department of Microbiology, Children’s Hospital Westmead, Darlinghurst, Australia
| | - Sebastian Van Hal
- Department of Microbiology, Liverpool Hospital, Darlinghurst, Australia
| | - Damien Stark
- Division of Microbiology, St. Vincent’s Hospital, Darlinghurst, Australia
| | - John Ellis
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney
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Wilhelm M, Dirksen U, Bielack SS, Whelan JS, Lewis IJ, Jürgens H, Ferrari S, Sundby Hall K, Cleton-Jansen AM, Stark D. ENCCA WP17-WP7 consensus paper on teenagers and young adults (TYA) with bone sarcomas. Ann Oncol 2014; 25:1500-5. [PMID: 24962703 DOI: 10.1093/annonc/mdu153] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Teenagers and young adults (TYA) cancer contributes substantially to morbidity and mortality in a population with much to offer society. TYA place distinct challenges upon cancer care services, many reporting feeling marginalized and their needs not being met in adult or paediatric cancer services. Bone tumours such as osteosarcoma and Ewing sarcoma, because of their age at presentation and the complexity of their care, are where challenges in managing (TYA) with cancer have often been most readily apparent. Bone sarcomas may be managed by paediatric or medical oncologists, and require fastidious attention to protocol. A lack of recent improvement in survival in TYA with bone tumours may be linked to a lack of specialist care, poor concordance with therapy in some situations and TYA-specific pharmacology. Participation in clinical trials, particularly of young adults, is low, hindering progress. All these requirements may be best met by a concerted effort to create collaborative care between adult and paediatric experts in bone sarcoma, working together to meet TYA patients' needs.
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Affiliation(s)
- M Wilhelm
- Cooperative Osteosarcoma Study Group (COSS), Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum-Stuttgart Olgahospital, Stuttgart
| | - U Dirksen
- Cooperative Ewing Sarcoma Study Group, Pediatric Hematology and Oncology, Hospital Muenster, Westfalian Wilhelms University, Muenster, Germany
| | - S S Bielack
- Cooperative Osteosarcoma Study Group (COSS), Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum-Stuttgart Olgahospital, Stuttgart
| | - J S Whelan
- Teenage and Young Adult Unit, Department of Oncology, University College Hospital, London
| | - I J Lewis
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - H Jürgens
- Cooperative Ewing Sarcoma Study Group, Pediatric Hematology and Oncology, Hospital Muenster, Westfalian Wilhelms University, Muenster, Germany
| | - S Ferrari
- Italian Sarcoma Group (ISG), Chemioterapia, Bone Tumor Center, Istituto Rizzoli, Bologna, Italy
| | - K Sundby Hall
- Scandinavian Sarcoma Group (SSG), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A M Cleton-Jansen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D Stark
- Department of Medical Oncology, St James's Institute of Oncology, St James's University Hospital Leeds, Leeds, UK
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Abstract
Although Blastocystis is one of the most common enteric parasites, there is still much controversy surrounding the pathogenicity and potential treatment options for this parasite. In this review we look at the evidence supporting Blastocystis as an intestinal pathogen as shown by numerous case studies and several in vivo studies and the evidence against. We describe the chronic nature of some infections and show the role of Blastocystis in immunocompromised patients and the relationship between irritable bowel syndrome and Blastocystis infection. There have been several studies that have suggested that pathogenicity may be subtype related. Metronidazole is the most widely accepted treatment for Blastocystis but several cases of treatment failure and resistance have been described. Other treatment options which have been suggested include paromomycin and trimethroprim- sulfamethoxazole.
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Affiliation(s)
- Tamalee Roberts
- Department of Microbiology, St. Vincent's Hospital, Victoria St, Darlinghurst 2010, NSW, Australia ; School of Medical and Molecular Biosciences, University of Technology, Sydney, Ultimo, NSW 2007, Australia
| | - Damien Stark
- Department of Microbiology, St. Vincent's Hospital, Victoria St, Darlinghurst 2010, NSW, Australia
| | - John Harkness
- Department of Microbiology, St. Vincent's Hospital, Victoria St, Darlinghurst 2010, NSW, Australia
| | - John Ellis
- School of Medical and Molecular Biosciences, University of Technology, Sydney, Ultimo, NSW 2007, Australia
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Abstract
This article reports long-term infection and treatment failure in 18 symptomatic individuals infected with Blastocystis spp. Patients were initially treated with either metronidazole, iodoquinol or triple combination therapy consisting of nitazoxanide, furazolidone and secnidazole. Following treatment, resolution of clinical symptoms did not occur and follow-up testing revealed ongoing infection with the same subtype. Patients then underwent secondary treatment with a variety of antimicrobial agents but remained symptomatic with Blastocystis spp. still present in faeces. Sequencing of the SSU rDNA was completed on all isolates and four subtypes were identified in this group: ST1, ST3, ST4 and ST5. This study highlights the lack of efficacy of several commonly used antimicrobial regimens in the treatment of Blastocystis and the chronic nature of some infections. It also demonstrates the need for further research into treatment options for Blastocystis infection.
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Affiliation(s)
- Tamalee Roberts
- i3 Institute, School of Medical and Molecular Sciences, University of Technology, Sydney, Ultimo, NSW, Australia.,Department of Microbiology, SydPath, St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia
| | - John Ellis
- i3 Institute, School of Medical and Molecular Sciences, University of Technology, Sydney, Ultimo, NSW, Australia
| | - John Harkness
- Department of Microbiology, SydPath, St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia
| | - Deborah Marriott
- Department of Microbiology, SydPath, St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia
| | - Damien Stark
- Department of Microbiology, SydPath, St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia
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Affiliation(s)
- D. Stark
- Oncology, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - I. Lewis
- Alderhey Childrens Hospital, Childrens Services, Liverpool, United Kingdom
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Wright C, Coad J, Morgan S, Stark D, Cable M. ‘Just in case’: The fertility information needs of teenagers and young adults with cancer. Eur J Cancer Care (Engl) 2013; 23:189-98. [DOI: 10.1111/ecc.12137] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C.I. Wright
- Faculty of Health & Life Sciences; Coventry University; Coventry UK
| | - J. Coad
- Centre of Children and Families Applied Research, CCFAR; Faculty of Health & Life Sciences; Coventry University; Coventry UK
| | - S. Morgan
- Teenage and Young Adult Cancer Service; Leeds Teaching Hospitals Trust; St James University Hospital; Leeds UK
| | - D. Stark
- The Leeds Institute of Cancer Studies and Pathology; St James's University Hospital Leeds; Leeds UK
- Leeds Institute of Oncology; St James's University Hospital Leeds; Leeds UK
| | - M. Cable
- Faculty of Health and Life Sciences; Coventry University; Coventry UK
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Clark P, Trickett A, Chimenti M, Stark D. Optimization of microbial screening for cord blood. Transfusion 2013; 54:550-9. [PMID: 23889674 DOI: 10.1111/trf.12352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/05/2013] [Accepted: 06/11/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Collection and processing of cord blood (CB) is associated with significant risk of contamination; hence standards mandate microbial screening of the final product. The sensitivity of current methods to evaluate the microbial content of CB is unknown, given the small volume tested and reduced sensitivity of pediatric bottles. Hence, this study was undertaken to evaluate an optimal microbial screening method. STUDY DESIGN AND METHODS CB was collected using a closed system then spiked with organisms at 1 or 10 colony-forming units (CFUs)/mL. Samples were screened using culture bottles (BacT/ALERT, bioMérieux; and BACTEC, Becton Dickinson). Several methods were evaluated with different combinations of inoculated bottles (adult vs. pediatric), sample types (plasma discard, red blood cell [RBC] discard, or final product), and sample volumes. RESULTS Of 94 cord blood units (CBUs) spiked with organisms before screening, 81% tested positive for contamination overall. Screening of CB in pediatric bottles resulted in equivalent detection rates on the BacT/ALERT and BACTEC systems (33% at 1 CFU/mL and 73% at 10 CFUs/mL, respectively). However, the pediatric bottle screen only detected 15% of obligate anaerobes. A combined fraction method showed superior detection (71%) compared to the plasma fraction (27%) and resulted in optimal anaerobic detection. CONCLUSIONS This study demonstrates that the optimal microbial screening method for CB includes testing a combination of discard fractions (plasma and RBCs) in addition to final product using an automated culture system. Inoculating a small sample of final product in a pediatric bottle is suboptimal for microbial detection and may lead to distribution of contaminated CB for transplantation.
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Affiliation(s)
- Pamela Clark
- Sydney Cord Blood Bank, Sydney Children's Hospital, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
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Munasinghe VS, Vella NGF, Ellis JT, Windsor PA, Stark D. Cyst formation and faecal-oral transmission of Dientamoeba fragilis--the missing link in the life cycle of an emerging pathogen. Int J Parasitol 2013; 43:879-83. [PMID: 23872523 DOI: 10.1016/j.ijpara.2013.06.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [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: 05/06/2013] [Revised: 06/23/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
Abstract
Dientamoeba fragilis is a protozoan parasite emerging as a cause of diarrhoea and "irritable-bowel-like" gastrointestinal disease in humans with a propensity for establishing long-term, chronic infections in humans. Although Dientamoeba was discovered over a century ago its life cycle and mode of transmission is not known. No cyst stage has been described and no animal models are presently available for the study of this parasite. Here we describe the establishment of an animal model using laboratory rodents, the fulfilling of Koch's postulates, and the discovery of a new cyst stage in the life cycle of D. fragilis. Our demonstration of long-term parasite carriage by rodents and prolonged shedding of cysts, together with elevated levels of calprotectin in the stool, confirms the capacity of this organism to cause disease and indicates dientamoebiasis should be considered in the differential diagnosis of gastrointestinal diseases such as Inflammatory Bowel Syndrome (IBS). Finally, we suggest that the cyst stage described here is the vehicle that mediates faecal-oral transmission of D. fragilis between hosts.
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Affiliation(s)
- Varuni S Munasinghe
- School of Medical and Molecular Biosciences and the i3 Institute, University of Technology Sydney, Broadway, New South Wales 2007, Australia
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Clark P, Trickett A, Saffo S, Stark D. Effects of cryopreservation on microbial-contaminated cord blood. Transfusion 2013; 54:532-40. [PMID: 23808601 DOI: 10.1111/trf.12323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/12/2013] [Accepted: 05/20/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cord blood units (CBUs) are associated with significant risk of exposure to microbial contamination during collection and processing; however, the survival of bacteria within a CBU is poorly understood. This study aimed to determine whether contaminating organisms in CBU survive the cryopreservation, frozen storage, and subsequent thawing conditions before infusion. STUDY DESIGN AND METHODS A total of 134 CBUs rejected from banking due to known contamination were thawed and rescreened using blood culture bottles (BacT/ALERT, bioMérieux). An additional 61 fresh CBUs were deliberately spiked with a range of microbial organisms and evaluated both before freeze and after thaw. RESULTS Microbial contaminants were detected after thaw in 63% of stored contaminated CBUs and 85% of spiked CBUs. Postthaw organism detection in spiked cord blood (CB) was higher in adult culture bottles (80%) than pediatric culture bottles (61%). Twenty percent of spiked organisms, particularly Bacillus subtilis, Escherichia coli, Clostridium sporogenes, and Propionibacterium acnes, were not detected in prefreeze samples but were detectable after thaw. CONCLUSIONS This study demonstrates that the majority of contaminating organisms isolated in a prefreeze sample of CB have the ability to survive cryopreservation, frozen storage, and thawing. Further, CBUs reported as microbial free may contain microbial contamination, which could result in transplantation of contaminated CB and be potentially deleterious to a patient.
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Affiliation(s)
- Pamela Clark
- Sydney Cord Blood Bank, Sydney Children's Hospital, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; BMT Laboratory, SEALS, Prince of Wales Hospital, Randwick, NSW, Australia; Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, NSW, Australia
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Jarrett N, Scott I, Addington-Hall J, Amir Z, Brearley S, Hodges L, Richardson A, Sharpe M, Stamataki Z, Stark D, Siller C, Ziegler L, Foster C. Informing future research priorities into the psychological and social problems faced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs 2013; 17:510-20. [PMID: 23619278 DOI: 10.1016/j.ejon.2013.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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: 09/07/2012] [Revised: 03/04/2013] [Accepted: 03/08/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE To establish what is known regarding the psychological and social problems faced by adult cancer survivors (people who are living with and beyond a diagnosis of cancer) and identify areas future research should address. METHOD A rapid search of published literature reviews held in electronic data bases was under taken. Inclusion and exclusion criteria, and removal of duplicated papers, reduced the initial number of papers from 4051 to 38. Twenty-two review papers were excluded on grounds of quality and 16 review papers were selected for appraisal. RESULTS The psychological and social problems for cancer survivors are identified as depression, anxiety, distress, fear of recurrence, social support/function, relationships and impact on family, and quality of life. A substantial minority of people surviving cancer experience depression, anxiety, and distress or fear associated with recurrence or follow up. There is some indication that social support is positively associated with better outcomes. Quality of life for survivors of cancer appears generally good for most people, but an important minority experience a reduction in quality of life, especially those with more advanced disease and reduced social and economic resources. The majority of research knowledge is based on women with breast cancer. The longer term implications of cancer survival have not been adequately explored. CONCLUSIONS Focussing well designed research in the identified areas where less is already known about the psychological and social impact of cancer survival is likely to have the greatest impact on the wellbeing of people surviving cancer.
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Affiliation(s)
- N Jarrett
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
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van Laar M, McKinney PA, Parslow RC, Glaser A, Kinsey SE, Lewis IJ, Picton SV, Richards M, Shenton G, Stark D, Norman P, Feltbower RG. Erratum: Cancer incidence among the south Asian and non-south Asian population under 30 years of age in Yorkshire, UK. Br J Cancer 2013. [PMCID: PMC3619078 DOI: 10.1038/bjc.2013.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Fletcher S, Van Hal S, Andresen D, McLaws ML, Stark D, Harkness J, Ellis J. Gastrointestinal pathogen distribution in symptomatic children in Sydney, Australia. J Epidemiol Glob Health 2013; 3:11-21. [PMID: 23856534 PMCID: PMC7320378 DOI: 10.1016/j.jegh.2012.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 11/28/2012] [Accepted: 11/30/2012] [Indexed: 12/14/2022] Open
Abstract
There is limited information on the causes of paediatric diarrhoea in Sydney. This cross-sectional study used clinical and microbiological data to describe the clinical features and pathogens associated with gastrointestinal illnesses for children presenting to two major public hospitals in Sydney with diarrhoea, for the period January 2007-December 2010. Of 825 children who tested positive for an enteric pathogen, 430 medical records were reviewed. Adenovirus, norovirus and rotavirus were identified in 20.8%, 20.3% and 21.6% of reviewed cases, respectively. Younger children were more likely to have adenovirus and norovirus compared with rotavirus (P=0.001). More viruses were detected in winter than in the other three seasons (P=0.001). Rotavirus presented a distinct seasonal pattern with the lowest rates occurring in the warm months and peaking in the cooler months. Adenovirus showed a less consistent monthly trend, and norovirus detection increased in the cooler months (P=0.008). A decline in the number of rotavirus cases was observed after mid-2008. The majority of childhood diarrhoeal illnesses leading to hospital presentations in Sydney are caused by enteric viruses with most infections following clear seasonal patterns. However, a sustained decrease in the incidence of rotavirus infections has been observed over the study period.
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Affiliation(s)
- Stephanie Fletcher
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
| | - Sebastian Van Hal
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
- Department of Microbiology, Liverpool Hospital, Locked Bag 7103, Liverpool NSW 1871, Australia
| | - David Andresen
- Department of Microbiology, Children’s Hospital at Westmead, NSW, University of Sydney, Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Damien Stark
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
- Division of Microbiology, SydPath, St. Vincent’s Hospital, Sydney, NSW, Australia
| | - John Harkness
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
- Division of Microbiology, SydPath, St. Vincent’s Hospital, Sydney, NSW, Australia
| | - John Ellis
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
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