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Zeh P, Young A, Gholap N, Randeva H, Robbins T, Johal K, Patel S, O'Hare JP. Diabetes specialist intervention in general practices in areas of deprivation and ethnic diversity: A qualitative evaluation (QUAL-ECLIPSE). Prim Care Diabetes 2024; 18:37-43. [PMID: 37926590 DOI: 10.1016/j.pcd.2023.10.012] [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: 08/09/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
AIM To assess patients' and healthcare professionals' perspectives of a specialist-led Diabetes Risk-based Assessment Clinic (DIRAC) for people with diabetes at high risk of complications (PWDHRC) in areas of deprivation in Coventry, UK. METHODS A qualitative evaluation of a pilot trial, comprising a specialist team intervention (DIRAC), was undertaken in seven GP practices through observations of weekly virtual or occasional face-to-face patient consultations and monthly interventionists' meetings. Semi-structured interviews were carried out post-intervention, with PWDHRC, primary care clinicians and diabetes specialists (interventionists). Thematic analyses of observations and interviews were undertaken. KEY FINDINGS Over 12 months, 28 DIRAC clinics comprising 154 patient consultations and five interventionists' meetings, were observed. 19 interviews were undertaken, PWDHRC experienced 'culturally-sensitive care from a specialist-led clinic intervention encompassing integrated care. This model of care was recommended at GP practice level, all participants (PWDHRC, primary care clinicians and diabetes specialist interventionists) felt upskilled to deal with complex diabetes care. The EMIS and ECLIPSE technologies utilised during the intervention were perceived to positively contribute to diabetes management of PWDHRC despite reservations around cost and database. CONCLUSION The specialist-led DIRACs were largely appreciated by study participants. These qualitative data support the trial progressing to a full-service evaluation.
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Affiliation(s)
- Peter Zeh
- Centre for Healthcare Research, Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5RW, UK; Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK.
| | - Annie Young
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Nitin Gholap
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Harpal Randeva
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Timothy Robbins
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Kam Johal
- Henley Green Medical Centre, Coventry CV2 1AB, UK
| | - Shweta Patel
- University Hospitals of Leicester NHS Trust, LE5 4PW Leicester, UK
| | - J Paul O'Hare
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
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Jones TH, Dobs AS, Randeva H, Moore W, Parkin JM. Leflutrozole in male obesity-associated hypogonadotropic hypogonadism: Ph 2b double-blind randomised controlled trial. Eur J Endocrinol 2023; 189:297-308. [PMID: 37579053 DOI: 10.1093/ejendo/lvad099] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/27/2023] [Accepted: 05/24/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Assessment of the efficacy and safety/tolerability of the aromatase inhibitor leflutrozole to normalise testosterone in Obesity-associated Hypogonadotropic Hypogonadism (OHH). DESIGN Placebo-controlled, double-blind, RCT, in 70 sites in Europe/USA. METHODS Patient inclusion criteria: men with BMI of 30-50 kg/m2, morning total testosterone (TT) < 10.41 nmol/L, and two androgen deficiency symptoms (at least one of sexual dysfunction). Patients randomised to weekly leflutrozole (0.1/0.3/1.0 mg) or placebo for 24 weeks. Primary endpoint: normalisation of TT levels in ≥75% of patients after 24 weeks. Secondary endpoints (included): time to TT normalisation and change in LH/FSH. Safety was assessed through adverse events and laboratory monitoring. RESULTS AND CONCLUSIONS Of 2103 screened, 271 were randomised, 81 discontinued. Demographic characteristics were similar across groups. Mean BMI was 38.1 kg/m2 and TT 7.97 nmol/L. The primary endpoint was achieved in all leflutrozole-treated groups by 24 weeks with a dose-tiered response; mean TT 15.89; 17.78; 20.35 nmol/L, for leflutrozole 0.1 mg, 0.3 mg, and 1.0 mg groups respectively, vs 8.04 nmol/L for placebo. LH/FSH significantly increased in leflutrozole vs placebo groups. No improvements in body composition or sexual dysfunction were observed. Semen volume/total motile sperm count improved with leflutrozole vs placebo. Treatment-emergent adverse events, more common in leflutrozole-treated groups included, raised haematocrit, hypertension, increased PSA, and headache. Some reduction in lumbar bone density was observed with leflutrozole (mean -1.24%, -1.30%, -2.09%) and 0.66% for 0.1 mg, 0.3 mg, 1.0 mg, and placebo, respectively, without change at the hip. This RCT of leflutrozole in OHH demonstrated normalisation of TT in obese men. FSH/LH and semen parameter changes support that leflutrozole may preserve/improve testicular function. CLINICAL TRIAL REGISTRATION NUMBER NCT02730169.
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Affiliation(s)
- T Hugh Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, United Kingdom
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Adrian S Dobs
- Division of Endocrinology and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Harpal Randeva
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) and the Human Metabolism Research Unit (HMRU), Coventry, United Kingdom
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Kyriakakis N, Giannoudi M, Kumar SS, Seejore K, Dimitriadis GK, Randeva H, Glaser A, Kwok-Williams M, Gerrard G, Loughrey C, Al-Qaissi A, Ajjan R, Lynch J, Murray RD. Evaluation of cardiovascular risk factors in long-term survivors of adult and childhood-onset brain tumours - a pilot study. Endocr Connect 2023:EC-22-0491. [PMID: 37253232 PMCID: PMC10388661 DOI: 10.1530/ec-22-0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Survivors of childhood brain tumours (SCBT) and teenage and young adult cancer survivors have an adverse cardiovascular risk profile, which translates into an increased vascular mortality. Data on cardiovascular risk profile in SCBT are limited and furthermore there are no data in adult-onset brain tumours. PATIENTS AND METHODS Fasting lipids, glucose, insulin, 24-hour blood pressure, and body composition were measured in 36 brain tumours survivors [20 adult-onset (AO); 16 childhood-onset (CO)] and 36 age- and gender-matched controls. RESULTS Compared with controls, patients had elevated total cholesterol (5.3±1.1 Vs. 4.6±1.0mmol/l, p=0.007), LDL-C (3.1±0.8 Vs. 2.7±0.9mmol/l, p=0.011), insulin (13.4±13.1 Vs. 7.6±3.3miu/l, p=0.014) and increased insulin resistance (HOMA-IR 2.90±2.84 Vs. 1.66±0.73, p=0.016). Patients showed adverse body composition, with increased total body fat mass (FM) (24.0±12.2 Vs. 15.7±6.6kg, p<0.001) and truncal FM (13.0±6.7 Vs. 8.2±3.7kg, p<0.001). After stratification by timing of onset, CO survivors showed significantly increased LDL-C, insulin, and HOMA-IR compared with controls. Body composition was characterized by increased total body and truncal FM. Truncal fat mass was increased by 84.1% compared with controls. AO survivors showed similar adverse cardiovascular risk profile, with increased total cholesterol and HOMA-IR. Truncal fat mass was increased by 41.0% compared with matched controls (p=0.029). No difference in mean 24hr BP was noted between patients and controls irrespective of timing of cancer diagnosis. CONCLUSION The phenotype of both CO and AO brain tumour survivors is characterized by an adverse metabolic profile and body composition, putatively placing long-term survivors at increased risk of vascular morbidity and mortality.
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Affiliation(s)
- Nikolaos Kyriakakis
- N Kyriakakis, Endocrinology, LeedsTeaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Marilena Giannoudi
- M Giannoudi, Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Satish S Kumar
- S Kumar, Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Khyatisha Seejore
- K Seejore, Endocrinology, LeedsTeaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Georgios K Dimitriadis
- G Dimitriadis, Endocrinology, King's College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Harpal Randeva
- H Randeva, Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom of Great Britain and Northern Ireland
| | - Adam Glaser
- A Glaser, Pediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Michelle Kwok-Williams
- M Kwok-Williams, Clinical Oncology, Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Georgina Gerrard
- G Gerrard, Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Carmel Loughrey
- C Loughrey, Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Ahmed Al-Qaissi
- A Al-Qaissi, Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Ramzi Ajjan
- R Ajjan, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds Faculty of Medicine and Health, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Julie Lynch
- J Lynch, Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Robert D Murray
- R Murray, Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom of Great Britain and Northern Ireland
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Statham L, Pelling M, Hanson P, Kyrou I, Randeva H, Barber TM. Designer GLP1 poly-agonist peptides in the management of diabesity. Expert Rev Endocrinol Metab 2023; 18:231-240. [PMID: 37089108 DOI: 10.1080/17446651.2023.2204976] [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: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION To date, the 21st Century has witnessed key developments in the management of diabesity (a conflation of obesity and Type 2 Diabetes Mellitus [T2D]), including Glucagon Like Peptide 1 (GLP1) receptor agonist therapies, and recently the 'designer' GLP1 Poly-agonist Peptides (GLP1PPs). AREAS COVERED A PubMed search of published data on the GLP1PP class of therapies was conducted. The gut-brain axis forms complex multi-directional interlinks that include autonomic nervous signaling, components of the gut microbiota (including metabolic by-products and gram-negative cell wall components [e.g. endotoxinaemia]), and incretin hormones that are secreted from the gut in response to the ingestion of nutrients. The development of dual-incretin agonist therapies includes combinations of the GLP1 peptide with Glucose-dependent Insulinotropic Polypeptide (GIP), Glucagon (Gcg), Cholecystokinin (CCK), Peptide YY (PYY), and Glucagon-Like Peptide 2 (GLP2). Triple incretin agonist therapies are also under development. EXPERT OPINION At the dawn of a new era in the therapeutic management of diabesity, the designer GLP1PP class holds great promise, with each novel combination building on a preexisting palimpsest of clinical data and insights. Future innovations of the GLP1PP class will likely enable medically induced weight loss and glycemic control in diabesity to rival or even out-perform those resulting from bariatric surgery.
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Affiliation(s)
- Laura Statham
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Melina Pelling
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Petra Hanson
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Ioannis Kyrou
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, UK
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, Athens, Greece
| | - Harpal Randeva
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Thomas M Barber
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
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Lachlan T, He H, Miller A, Chandan N, Siddiqui S, Beadle R, Wilson D, Petkar S, Randeva H, Osman F. Feasibility of novel unshielded portable magnetocardiography: Insights from the prospective multicenter MAGNETO-SCD trial. Heart Rhythm 2023; 20:475-477. [PMID: 36549632 DOI: 10.1016/j.hrthm.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Thomas Lachlan
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Hejie He
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Nakul Chandan
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Shoaib Siddiqui
- Department of Cardiology, George Eliot Hospital, Nuneaton, United Kingdom
| | - Roger Beadle
- Department of Cardiology, Warwick Hospital, Warwick, United Kingdom
| | - David Wilson
- Department of Cardiology, Worcester Royal Hospital, Worcester, United Kingdom
| | - Sanjiv Petkar
- Department of Cardiology, Wolverhampton Heart Centre, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Harpal Randeva
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Faizel Osman
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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He H, Lachlan T, Chandan N, Lim VG, Kimani P, Ng GA, Ali A, Randeva H, Osman F. Obstructive Sleep Apnoea and Cardiac Arrhythmias (OSCA) trial: a nested cohort study using injectable loop recorders and Holter monitoring in patients with obstructive sleep apnoea. BMJ Open 2023; 13:e070884. [PMID: 36792325 PMCID: PMC9950886 DOI: 10.1136/bmjopen-2022-070884] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is associated with increased cardiovascular mortality despite continuous positive airways pressure (CPAP) therapy. This excess risk may be related to increased arrhythmia risk, especially atrial fibrillation (AF). The true incidence of arrhythmia in patients with OSA is unknown. Implantable loop recorders (ILR) are powerful tools for detecting arrhythmias long-term. Cardiac autonomic function may be important in arrhythmogenesis in these patients but needs further study. We aim to identify the true incidence of arrhythmias (especially AF) using ILRs, assess cardiac autonomic function using Holter monitors in patients with OSA and explore cardiovascular outcomes. METHODS AND ANALYSIS A two-centre (University Hospital Coventry and St. Cross Hospital, Rugby) nested cohort study using Reveal LINQ (Medtronic, UK) ILR to identify precise arrhythmia (atrial/ventricular) incidence in patients with moderate-severe OSA. 200 patients will be randomised 1:1 to standard care alone or standard care+ILR (+Holter monitor at baseline and 12 months). The primary objective is to compare arrhythmia detection over 3 years between the two groups. Cardiac autonomic function will be assessed in the ILR-arm at baseline and 12 months post CPAP. Secondary objectives will explore the mechanisms linking OSA and arrhythmia using cardiac autonomic function parameters based on Holter recordings and circulating biomarkers (high sensitivity Troponin-T, N-terminal pro B-type natriuretic peptide, matrix metalloproteinase-9, fibroblast growth factor 23, high sensitivity C-reactive protein, interleukin-6 and tumour necrosis factor-α) before and after CPAP initiation in the ILR-arm. ETHICS AND DISSEMINATION This study has been approved by the Health Research Authority after examination by the Solihull Research and Ethics Committee. The main ethical considerations was the minimally invasive nature of ILR insertion outside of usual care. Patient advisory groups were consulted with a positive outcome for this type of research. We plan on publishing papers in peer-reviewed journals based on the primary objective and any interesting findings from secondary objectives. We will endeavour to publish all relevant data. TRIAL REGISTRATION NUMBER NCT03866148.
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Affiliation(s)
- Hejie He
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Thomas Lachlan
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- University of Warwick Warwick Medical School, Coventry, UK
| | - Nakul Chandan
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ven Gee Lim
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Peter Kimani
- Warwick Medical School, University of Warwick Faculty of Medicine, Coventry, UK
| | - G Andre Ng
- Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Asad Ali
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Faizel Osman
- University of Warwick Warwick Medical School, Coventry, UK
- R&D Institute of Cardiometabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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García-Lorenzo B, Gorostiza A, González N, Larrañaga I, Mateo-Abad M, Ortega-Gil A, Bloemeke J, Groene O, Vergara I, Mar J, Lim Choi Keung SN, Arvanitis TN, Kaye R, Dahary Halevy E, Nahir B, Arndt F, Dichmann Sorknæs A, Juul NK, Lilja M, Sherman MH, Laleci Erturkmen GB, Yuksel M, Robbins T, Kyrou I, Randeva H, Maguire R, McCann L, Miller M, Moore M, Connaghan J, Fullaondo A, Verdoy D, de Manuel Keenoy E. Assessment of the Effectiveness, Socio-Economic Impact and Implementation of a Digital Solution for Patients with Advanced Chronic Diseases: The ADLIFE Study Protocol. Int J Environ Res Public Health 2023; 20:3152. [PMID: 36833849 PMCID: PMC9966680 DOI: 10.3390/ijerph20043152] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach.
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Affiliation(s)
- Borja García-Lorenzo
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Ania Gorostiza
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Nerea González
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
- Osakidetza Basque Health Service, Barrualde-Galdakao, Integrated Health Organisation, 48960 Galdakao, Spain
| | - Igor Larrañaga
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Maider Mateo-Abad
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
- Biodonostia Health Research Institute, Paseo Dr. Begiristain s/n, 20014 Donostia, Basque Country, Spain
| | - Ana Ortega-Gil
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | | | - Oliver Groene
- OptiMedis, Burchardstrasse 17, 20095 Hamburg, Germany
| | - Itziar Vergara
- Biodonostia Health Research Institute, Paseo Dr. Begiristain s/n, 20014 Donostia, Basque Country, Spain
| | - Javier Mar
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
- Unidad de Investigación AP-OSIs, Hospital Alto Deba, 20500 Arrasate-Mondragón, Gipuzkoa, Spain
- Instituto de Investigación Sanitaria Biodonostia, 20014 San Sebastián, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 48960 Galdakao, Spain
- Unidad de Gestión Sanitaria, Hospital Alto Deba, 20500 Arrasate-Mondragón, Gipuzkoa, Spain
| | - Sarah N. Lim Choi Keung
- School of Engineering, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
| | - Theodoros N. Arvanitis
- School of Engineering, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Rachelle Kaye
- Assuta Medical Centre Ashdod, Ashdod 7747629, Israel
| | | | - Baraka Nahir
- Assuta Medical Centre Ashdod, Ashdod 7747629, Israel
- Maccabi Healthcare Services Southern Region, Omer 8496500, Israel
| | - Fritz Arndt
- Gesunder Werra-Meißner-Kreis GmbH, 37269 Eschwege, Germany
| | - Anne Dichmann Sorknæs
- Internal Medical & Emergency Department M/FAM, OUH, Svendvorg Hospital, Baagøes Allé 15, Indgang 51, 5700 Svendborg, Denmark
| | - Natassia Kamilla Juul
- Internal Medical & Emergency Department M/FAM, OUH, Svendvorg Hospital, Baagøes Allé 15, Indgang 51, 5700 Svendborg, Denmark
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, 901 87 Umeå, Sweden
| | - Marie Holm Sherman
- R&D Project Office, Region Jämtland Härjedalen, 831 30 Östersund, Sweden
| | | | - Mustafa Yuksel
- SRDC, ODTU Teknokent Silikon Blok Kat: 1 No: 16 Cankaya, Ankara 06800, Turkey
| | - Tim Robbins
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Ioannis Kyrou
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Harpal Randeva
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Roma Maguire
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Lisa McCann
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Morven Miller
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Margaret Moore
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - John Connaghan
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Dolores Verdoy
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Esteban de Manuel Keenoy
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
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Denton F, Waddell A, Kite C, Hesketh K, Atkinson L, Cocks M, Jones H, Randeva H, Davenport N, Powell R, Clark C, Kyrou I, Harwood AE, McGregor G. Remote maintenance cardiac rehabilitation (MAINTAIN): A protocol for a randomised feasibility study. Digit Health 2023; 9:20552076231152176. [PMID: 36818155 PMCID: PMC9936404 DOI: 10.1177/20552076231152176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023] Open
Abstract
Background Long-term adherence to exercise is often poor for people with coronary heart disease (CHD) who have completed supervised, centre-based cardiac rehabilitation. The aim of this study is to assess the feasibility of a remotely prescribed, delivered and monitored cardiac rehabilitation intervention using a wearable device to support long-term adherence to exercise and physical activity during maintenance of cardiac rehabilitation. Methods After completing cardiac rehabilitation, 30 participants with CHD, will be randomised (1:1) to an intervention (n = 15) or a usual care group (n = 15) in a 12-month feasibility randomised controlled trial (RCT). The intervention will comprise of an exercise consultation, personalised exercise prescription delivered via a wearable activity monitor using biometric feedback, regular monitoring via check-ins, and feedback text-messages for 6-months. Participants will be assessed at baseline (following completion of cardiac rehabilitation) and at three-, six-, and 12-months post-randomisation. The primary outcome will be feasibility, including assessment of eligibility, recruitment, adherence, and acceptability. Secondary outcomes will include exercise capacity, physical activity behaviours, cardiovascular disease risk and quality of life. Semi-structured interviews will be conducted at three-, six-, and 12-months post-randomisation (and with those who drop-out) to explore the acceptability of the study intervention and procedures. A questionnaire will be offered to those who decline participation. Discussion The MAINTAIN study will evaluate the feasibility of conducting a future definitive multi-centre RCT testing a remotely prescribed and monitored long-term mHealth maintenance exercise programme, versus usual care, for people with CHD who have completed cardiac rehabilitation. Trial registration number ClinicalTrials.gov, NCT05292287. Registered on 22/03/2022.
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Affiliation(s)
- Francesca Denton
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Francesca Denton, Institute of Health and Wellbeing, Coventry University, Coventry, CV1 2DS, UK.
| | - Alexander Waddell
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Chris Kite
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- School of Public Health Studies, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Katie Hesketh
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lou Atkinson
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Matthew Cocks
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Helen Jones
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Harpal Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nathan Davenport
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Richard Powell
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Cain Clark
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ioannis Kyrou
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, UK
- Laboratory of Dietetics and Quality of Life, School of Food and Nutritional Sciences, Department of Food Science & Human Nutrition, Agricultural University of Athens, Athens, Greece
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy E Harwood
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Gordon McGregor
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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9
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Liarakos AL, Tran P, Keegan M, Robbins T, Chaudhuri N, Murthy N, Randeva H, Gholap NN. Real-world evaluation of glucose-lowering therapies and the use of weight-adjusted variable rate intravenous insulin infusion in the management of hyperglycaemia in patients with acute coronary syndrome (REGULATE-ACS). Int J Cardiol 2023; 370:26-34. [PMID: 36441073 DOI: 10.1016/j.ijcard.2022.10.158] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Admission hyperglycaemia in acute coronary syndromes (ACS) is a strong independent predictor of adverse clinical outcomes post-ACS. We examined the safety, efficacy, and feasibility of a modified, weight-adjusted variable rate intravenous insulin infusion (VRIII) and evaluated current practice of prescribing novel cardio-protective glucose-lowering therapies in patients presenting with acute hyperglycaemia across the ACS spectrum. METHODS REGULATE-ACS was an observational single-centre study of consecutive patients admitted with acute hyperglycaemia post-ACS between 2020 and 2021. Following updated local guidance on a modified VRIII, we evaluated its safety and efficacy in glycaemic control, cardio-metabolic complications including hypoglycaemia (blood glucose <3 mmol/L) and 30-day mortality. We also determined the prescription of glucose-lowering therapies pre-discharge. RESULTS Out of 107 patients, mean age was 64.9 ± 12.2 years, 82% had known diabetes, and 15% newly diagnosed diabetes. 86.9% (n = 93) had an admission glucose ≥11 mmol/L. In patients treated with VRIII (n = 63/93, 67.7%), glucose improved from 17.5 to 9.0 mmol/L (IQR 7.1-12.1), which was 3 mmol/L lower (p = 0.03) than in patients not treated with VRIII (n = 30/93, 32.3%) where median glucose reduced from 12.6 to 12 mmol/L (IQR 8.6-13.9). No significant hypoglycaemia, arrhythmia or worsening pulmonary oedema associated with VRIII was found. Novel glucose-lowering therapies were initiated in 20/71 (28.2%) and 3/15 (20.0%) of patients with prior and newly diagnosed diabetes, respectively. CONCLUSION This real-world analysis provides further support of efficacy, safety, and feasibility of a modified, weight-adjusted VRIII in managing acute hyperglycaemia in ACS. Despite established cardio-protective benefits of novel glucose-lowering therapies, <1/3 of eligible patients received such agents pre-discharge, demanding further research and awareness.
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Affiliation(s)
- Alexandros Leonidas Liarakos
- Diabetes and Endocrinology, Clifford Bridge Road, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
| | - Patrick Tran
- Cardiology, Clifford Bridge Road, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
| | - Michelle Keegan
- Diabetes and Endocrinology, Clifford Bridge Road, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
| | - Tim Robbins
- Diabetes and Endocrinology, Clifford Bridge Road, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
| | - Nadia Chaudhuri
- Diabetes and Endocrinology, Clifford Bridge Road, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
| | - Narasimha Murthy
- Diabetes and Endocrinology, Clifford Bridge Road, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
| | - Harpal Randeva
- Diabetes and Endocrinology, Clifford Bridge Road, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
| | - Nitin Narayan Gholap
- Diabetes and Endocrinology, Clifford Bridge Road, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom.
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10
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Gadelha MR, Gordon MB, Doknic M, Mezősi E, Tóth M, Randeva H, Marmon T, Jochelson T, Luo R, Monahan M, Madan A, Ferrara-Cook C, Struthers RS, Krasner A. ACROBAT Edge: Safety and efficacy of switching injected SRLs to oral paltusotine in patients with acromegaly. J Clin Endocrinol Metab 2022; 108:e148-e159. [PMID: 36353760 PMCID: PMC10099171 DOI: 10.1210/clinem/dgac643] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
CONTEXT Paltusotine is a once-daily, oral, non-peptide small-molecule somatostatin receptor type 2 (SST2) agonist in clinical development for treatment of acromegaly. OBJECTIVE To evaluate change in IGF-I levels in patients switched from octreotide LAR or lanreotide depot monotherapy to paltusotine. DESIGN Phase 2, open-label, prospective, multicenter, multinational, non-randomized, single-arm exploratory study in which dosage up-titrations were performed in a double-blinded manner. SETTING 26 global sites. PARTICIPANTS Patients with acromegaly switched to paltusotine from injected SRL-based therapy. INTERVENTIONS Patients received 13-week treatment with once-daily oral paltusotine (10-40 mg/day). MAIN OUTCOME MEASURES Primary endpoint was change from baseline to week 13 in IGF-I for patients who switched from long-acting octreotide or lanreotide monotherapy to paltusotine (Group 1). All patients underwent a 4-week paltusotine washout at end of treatment period (weeks 13-17). IGF-I, GH, patient reported outcome, and safety data were collected. RESULTS Forty-seven patients enrolled. In Group 1 (n = 25), IGF-I and GH showed no significant change between SRL baseline and end of paltusotine treatment at week 13 (median change in IGF-I = -0.03×upper limit of normal [ULN], P = 0.6285; GH = -0.05 ng/mL, P = 0.6285). IGF-I and GH rose significantly in the 4 weeks after withdrawing paltusotine (median change in IGF-I = 0.55×ULN, P < 0.0001 [median increase 39%]; GH = 0.72 ng/mL, P < 0.0001 [109.1% increase]). No patients discontinued due to adverse events; no treatment-related serious adverse events were reported. CONCLUSIONS These results suggest once daily, oral paltusotine is effective in maintaining IGF-I values in patients with acromegaly who switched from injected SRLs. Paltusotine was well tolerated with a safety profile consistent with other SRLs.
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Affiliation(s)
- Monica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division-Medical School and Hospital Universitario Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Division of Endocrinology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Mirjana Doknic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Emese Mezősi
- University of Pécs Medical School, Pécs, Hungary
| | | | - Harpal Randeva
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Tonya Marmon
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
| | | | - Rosa Luo
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
| | | | - Ajay Madan
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
| | | | | | - Alan Krasner
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
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Thadani P, Chaudhury N, Murthy N, Rao R, Randeva H, Weickert M, Gholap N. Cushing’s Syndrome - A medical emergency and diagnostic challenge. EJEA 2022. [DOI: 10.1530/endoabs.86.p260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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12
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Hanson P, Randeva H, Cuthbertson DJ, O'Hare PJ, Parsons N, Chatha K, Reidy G, Weickert MO, Barber TM. The DAPA-DIET study: Metabolic response to Dapagliflozin combined with dietary carbohydrate restriction in patients with Type 2 Diabetes Mellitus and Obesity-A longitudinal cohort study. Endocrinol Diabetes Metab 2022; 5:e381. [PMID: 36266774 PMCID: PMC9659664 DOI: 10.1002/edm2.381] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The cardio-renal benefits of sodium glucose-like transporter 2 inhibitor (SGLT2i) therapies have been demonstrated in patients with and without type 2 diabetes. However, no studies have explored the long-term metabolic effects of SGLT2i, combined with dietary carbohydrate restriction. Our primary objective was to describe long-term changes in weight, energy expenditure, appetite and body composition after 12 months of Dapagliflozin therapy, with carbohydrate restriction, in people with type 2 diabetes and obesity. Our secondary objective was to assess changes in adiponectin and leptin. METHOD This was a 12-month cohort study in a secondary care setting. Participants (n = 18) with type 2 diabetes (T2D) and class 3 obesity underwent baseline indirect calorimetry for determination of 24-h energy expenditure, body composition, fasting serum leptin and adiponectin levels, and appetitive assessments. Following initiation of Dapagliflozin (and dietary carbohydrate restriction), measurements were repeated at monthly intervals up to 12 months. RESULTS Mean starting weight of participants was 129.4 kg (SD 25.9), mean BMI 46.1 kg/m2 (SD 8.3) and mean HbA1c 53.9 mmol/mol (14.1). Seventeen participants completed the study; after 12 months of Dapagliflozin and dietary carbohydrate restriction, mean weight loss was 8.1 kg (SD 11.3 kg; p = .009). This was mediated by reduced fat mass (mean loss, 9.9 kg; SD 10.4 kg; p = .002) associated with reduced serum leptin at 12 months (mean reduction 11,254 pg/ml; SD 16,075; p = .011). There were no significant changes in self-reported appetite, 24-h energy expenditure or serum adiponectin during follow-up. CONCLUSION In this study, combined Dapagliflozin therapy and carbohydrate restriction in patients with T2D and obesity resulted in a significant reduction of body weight and fat mass at 12 months without any discernible changes in energy expenditure or appetite. These results offer a scientific and clinical rationale to conduct an exploratory trial investigating the effects of a low carbohydrate diet combined with SGLT2 inhibitors in patients with T2D.
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Affiliation(s)
- Petra Hanson
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Harpal Randeva
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Dan J. Cuthbertson
- Institute of Cardiovascular and Metabolic MedicineUniversity of LiverpoolLiverpoolUK,Department of EndocrinologyLiverpool University Hospital NHS Foundation TrustLiverpoolUK
| | - Paul J. O'Hare
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Nick Parsons
- Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Kamaljit Chatha
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Biochemistry and Immunology DepartmentUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Gemma Reidy
- Biochemistry and Immunology DepartmentUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Martin O. Weickert
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Thomas M. Barber
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
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13
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Hanson P, Summers C, Panesar A, Liarakos A, Oduro-Donkor D, Oshodi Whyte D, Hailston L, Randeva H, Menon V, de la Fosse M, Kaura A, Shuttlewood E, Loveder M, Poole D, Barber T. Implementation of a digital health tool for patients awaiting input from a specialist weight management team (Preprint). JMIR Hum Factors 2022; 10:e41256. [DOI: 10.2196/41256] [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] [Received: 07/20/2022] [Revised: 01/19/2023] [Accepted: 02/26/2023] [Indexed: 03/01/2023] Open
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14
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Hanson P, Parmar D, Deo P, Whyteoshodi D, Gotts C, O'Hare PJ, Randeva H, Barber TM. Insights into optimising education for patients living with diabetes mellitus: A model for the post‐pandemic era, informed by survey data. Lifestyle Medicine 2022. [DOI: 10.1002/lim2.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Petra Hanson
- Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK
- NIHR CRF Human Metabolism Research Unit University Hospitals Coventry and Warwickshire Coventry UK
| | - Dilan Parmar
- Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK
| | - Pranay Deo
- Department of Health Psychology University of the West of England Bristol UK
| | - Daniella Whyteoshodi
- Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK
- NIHR CRF Human Metabolism Research Unit University Hospitals Coventry and Warwickshire Coventry UK
| | - Charlotte Gotts
- Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK
| | - Paul J. O'Hare
- Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK
- NIHR CRF Human Metabolism Research Unit University Hospitals Coventry and Warwickshire Coventry UK
| | - Harpal Randeva
- Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK
- NIHR CRF Human Metabolism Research Unit University Hospitals Coventry and Warwickshire Coventry UK
- Aston Medical School Aston University Birmingham UK
| | - Thomas M. Barber
- Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK
- NIHR CRF Human Metabolism Research Unit University Hospitals Coventry and Warwickshire Coventry UK
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Pournik O, Ahmad B, Lim Choi Keung SN, Khan O, Despotou G, Consoli A, Ayadi J, Gilardi L, Laleci Erturkmen GB, Yuksel M, Gencturk M, Gappa H, Breidenbach M, Mohamad Y, Velasco CA, Cramaiuc O, Ciobanu C, Gómez Jiménez E, Avendaño Céspedes A, Alcantud Córcoles R, Cortés Zamora EB, Abizanda P, Steinhoff A, Schmidt-Barzynski W, Robbins T, Kyrou I, Randeva H, Ferrazzini L, Arvanitis TN. CAREPATH: Developing Digital Integrated Care Solutions for Multimorbid Patients with Dementia. Stud Health Technol Inform 2022; 295:487-490. [PMID: 35773917 DOI: 10.3233/shti220771] [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] [Indexed: 06/15/2023]
Abstract
CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients' independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.
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Affiliation(s)
- Omid Pournik
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Bilal Ahmad
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | - Omar Khan
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - George Despotou
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | | | | | | | - Mustafa Yuksel
- Software Research Development and Consultancy Cooperation, Ankara, Turkey
| | - Mert Gencturk
- Software Research Development and Consultancy Cooperation, Ankara, Turkey
| | - Henrike Gappa
- Fraunhofer Institute for Applied Information Technology FIT, Germany
| | | | - Yehya Mohamad
- Fraunhofer Institute for Applied Information Technology FIT, Germany
| | - Carlos A Velasco
- Fraunhofer Institute for Applied Information Technology FIT, Germany
| | | | | | - Elena Gómez Jiménez
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
| | - Almudena Avendaño Céspedes
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
- CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
| | - Rubén Alcantud Córcoles
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
| | - Elisa Belén Cortés Zamora
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
- CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Abizanda
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
- CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Spain
| | | | | | - Timothy Robbins
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ioannis Kyrou
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Theodoros N Arvanitis
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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16
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Robbins T, Hopper A, Brophy J, Pearson E, Suthantirakumar R, Vankad M, Igharo N, Baitule S, Clark CCT, Arvanitis TN, Sankar S, Kyrou I, Randeva H. Digitally enabled flash glucose monitoring for inpatients with COVID-19: Feasibility and pilot implementation in a teaching NHS Hospital in the UK. Digit Health 2022; 8:20552076211059350. [PMID: 35024157 PMCID: PMC8744149 DOI: 10.1177/20552076211059350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 placed significant challenges on healthcare systems. People with diabetes are at high risk of severe COVID-19 with poor outcomes. We describe the first reported use of inpatient digital flash glucose monitoring devices in a UK NHS hospital to support management of people with diabetes hospitalized for COVID-19. METHODS Inpatients at University Hospitals Coventry & Warwickshire (UHCW) NHS Trust with COVID-19 and diabetes were considered for digitally enabled flash glucose monitoring during their hospitalization. Glucose monitoring data were analysed, and potential associations were explored between relevant parameters, including time in hypoglycaemia, hyperglycaemia, and in range, glycated haemoglobin (HbA1c), average glucose, body mass index (BMI), and length of stay. RESULTS During this pilot, digital flash glucose monitoring devices were offered to 25 inpatients, of whom 20 (type 2/type 1: 19/1; mean age: 70.6 years; mean HbA1c: 68.2 mmol/mol; mean BMI: 28.2 kg/m2) accepted and used these (80% uptake). In total, over 2788 h of flash glucose monitoring were recorded for these inpatients with COVID-19 and diabetes. Length of stay was not associated with any of the studied variables (all p-values >0.05). Percentage of time in hyperglycaemia exhibited significant associations with both percentage of time in hypoglycaemia and percentage of time in range, as well as with HbA1c (all p-values <0.05). The average glucose was significantly associated with percentage of time in hypoglycaemia, percentage of time in range, and HbA1c (all p-values <0.05). DISCUSSION We report the first pilot inpatient use of digital flash glucose monitors in an NHS hospital to support care of inpatients with diabetes and COVID-19. Overall, there are strong arguments for the inpatient use of these devices in the COVID-19 setting, and the findings of this pilot demonstrate feasibility of this digitally enabled approach and support wider use for inpatients with diabetes and COVID-19.
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Affiliation(s)
- Tim Robbins
- University Hospitals Coventry & Warwickshire NHS Trust,
Coventry, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Adam Hopper
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jack Brophy
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Elle Pearson
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Natalie Igharo
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Sud Baitule
- University Hospitals Coventry & Warwickshire NHS Trust,
Coventry, UK
| | | | | | - Sailesh Sankar
- University Hospitals Coventry & Warwickshire NHS Trust,
Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ioannis Kyrou
- University Hospitals Coventry & Warwickshire NHS Trust,
Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Coventry University, UK
- Aston Medical Research Institute, Aston Medical School, College of
Health and Life Sciences, Aston University, Birmingham, UK
- * Ioannis Kyrou and Harpal Randeva have contributed
equally to this work and are joint senior co-authors
| | - Harpal Randeva
- University Hospitals Coventry & Warwickshire NHS Trust,
Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Aston Medical Research Institute, Aston Medical School, College of
Health and Life Sciences, Aston University, Birmingham, UK
- * Ioannis Kyrou and Harpal Randeva have contributed
equally to this work and are joint senior co-authors
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17
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Khan U, Borg A, Beltechi R, Mehta H, Robbins T, Randeva H, Machenahalli P. Non-Hodgkin Lymphoma Causing Hypopituitarism Can Imaging Help Diagnosis and Management? Eur J Case Rep Intern Med 2021; 8:002980. [PMID: 35059332 PMCID: PMC8765684 DOI: 10.12890/2021_002980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 11/05/2022] Open
Abstract
Non-Hodgkin lymphomas of the hypothalamus and pituitary are rare. They usually remain clinically silent until onset of compressive features affecting surrounding structures. When symptomatic, patients most commonly present with diabetes insipidus, headaches, ophthalmoplegia and/or bilateral hemianopia. We report a case of a 67-year-old Caucasian female with a history of B-cell lymphoma in complete remission. She presented with left oculomotor nerve palsy and was subsequently found to have a sellar/suprasellar mass lesion on MRI. Alongside hypocortisolism and hypogonadotropic hypogonadism, she developed transient diabetes insipidus during her illness. Her clinical course was characterized by rapid intracranial progression of the sellar mass. MR spectroscopy suggested a diagnosis of lymphoma. Diagnostic biopsy confirmed high-grade diffuse large B-cell CNS lymphoma; this changed the definitive management from surgical excision to chemotherapy. Despite treatment, she succumbed to her illness within 7 months of initial presentation. This case highlights the aggressive nature of CNS lymphomas and the need for a high index of suspicion in an unusual presentation of sellar/suprasellar mass lesions.
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Affiliation(s)
- Uzma Khan
- Department of Endocrinology & Diabetes, University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - Anton Borg
- Department of Haematology, South Warwickshire NHS Foundation Trust, UK
| | - Radu Beltechi
- Department of Neurosurgery, University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - Hiten Mehta
- Department of Clinical Radiology, University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - Timothy Robbins
- Department of Endocrinology & Diabetes, University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - Harpal Randeva
- Department of Endocrinology & Diabetes, University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - Pratibha Machenahalli
- Department of Endocrinology & Diabetes, University Hospitals Coventry & Warwickshire NHS Trust, UK
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18
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Tran P, Marshall L, Patchett I, Salim H, Yusuf S, Panikker S, Kuehl M, Osman F, Banerjee P, Randeva H, Dhanjal T. Real-world evaluation of followup strategies after ICD therapies in patients with VT (REFINE-VT). Br J Cardiol 2021; 28:48. [PMID: 35747065 PMCID: PMC9063697 DOI: 10.5837/bjc.2021.048] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Implantable cardiac defibrillators (ICDs) can prevent sudden cardiac death, but the risk of recurrent ventricular arrhythmia (VA) and ICD shocks persist. Strategies to minimise such risks include medication optimisation, device programming and ventricular tachycardia (VT) ablation. Whether the choice of these interventions at follow-up are influenced by factors such as the type of arrhythmia or ICD therapy remains unclear. To investigate this, we evaluated ICD follow-up strategies in a real-world population with primary and secondary prevention ICDs. REFINE-VT (Real-world Evaluation of Follow-up strategies after Implantable cardiac-defibrillator therapies in patients with Ventricular Tachycardia) is an observational study of 514 ICD recipients recruited between 2018 and 2019. We found that 77 patients (15%) suffered significant VA and/or ICD therapies, of whom 26% experienced a second event; 31% received no intervention. We observed an inconsistent approach to the choice of strategies across different types of arrhythmias and ICD therapies. Odds of intervening were significantly higher if ICD shock was detected compared with anti-tachycardia pacing (odds ratio [OR] 8.4, 95% confidence interval [CI] 1.7 to 39.6, p=0.007). Even in patients with two events, the rate of escalation of antiarrhythmics or referral for VT ablation were as low as patients with single events. This is the first contemporary study evaluating how strategies that reduce the risk of recurrent ICD events are executed in a real-world population. Significant inconsistencies in the choice of interventions exist, supporting the need for a multi-disciplinary approach to provide evidence-based care to this population.
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Affiliation(s)
- Patrick Tran
- Cardiology Registrar University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Leeann Marshall
- Senior Cardiac Physiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Ian Patchett
- Senior Cardiac Physiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Handi Salim
- Cardiology Registrar University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Shamil Yusuf
- Consultant Electrophysiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Sandeep Panikker
- Consultant Electrophysiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Michael Kuehl
- Consultant Cardiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Faizel Osman
- Consultant Electrophysiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Prithwish Banerjee
- Consultant Cardiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Harpal Randeva
- Director of Research & Development University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Tarvinder Dhanjal
- Consultant Electrophysiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
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19
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Chaudhury N, Thadani P, Awala O, Randeva H, Correa P, Machenahalli P, Gholap N. Case report: pituitary metastasis and Its diagnostic complexity. EJEA 2021. [DOI: 10.1530/endoabs.77.p229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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20
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Robbins T, Kyrou I, Clark C, Sharma K, Laird S, Berry L, Morgan N, Patel K, Sankar S, Randeva H. Healthcare Staff Perceptions Following Inoculation with the BNT162b2 mRNA COVID-19 Vaccine at University Hospitals Coventry & Warwickshire NHS Trust. Int J Environ Res Public Health 2021; 18:ijerph18179378. [PMID: 34501970 PMCID: PMC8430614 DOI: 10.3390/ijerph18179378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/02/2021] [Accepted: 08/07/2021] [Indexed: 12/25/2022]
Abstract
Background: COVID-19 vaccination programmes offer hope for a potential end to the acute phase of the COVID-19 pandemic. We present perceptions following from a cohort of healthcare staff at the UK NHS hospital, which first initiated the BNT162b2 mRNA COVID-19 (“Pfizer”) vaccination program. Methods: A paper-based survey regarding perceptions on the BNT162b2 mRNA COVID-19 vaccine was distributed to all healthcare workers at the University Hospitals Coventry & Warwickshire NHS Trust following receipt of the first vaccine dose. Results: 535 healthcare workers completed the survey, with a 40.9% response rate. Staff felt privileged to receive a COVID-19 vaccine. Staff reported that they had minimised contact with patients with confirmed or suspected COVID-19. Reported changes to activity following vaccination both at work and outside work were guarded. Statistically significant differences were noted between information sources used by staff groups and between groups of different ethnic backgrounds to inform decisions to receive vaccination. Conclusions: NHS staff felt privileged to receive the COVID-19 vaccine, and felt that their actions would promote uptake in the wider population. Concerns regarding risks and side effects existed, but were minimal. This research can be used to help inform strategies driving wider vaccine uptake amongst healthcare staff and the public.
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Affiliation(s)
- Tim Robbins
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
- Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Ioannis Kyrou
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
- Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Aston Medical Research Institute, Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5FB, UK
| | - Cain Clark
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
- Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5FB, UK
| | - Kavi Sharma
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
| | - Steven Laird
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
- Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Lisa Berry
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
| | - Nina Morgan
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
- Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5FB, UK
| | - Kiran Patel
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
- Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5FB, UK
| | - Sailesh Sankar
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
- Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Harpal Randeva
- COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; (T.R.); (I.K.); (C.C.); (K.S.); (S.L.); (L.B.); (N.M.); (K.P.); (S.S.)
- Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Correspondence:
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21
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Chaudhury N, Thadani P, Awala O, Randeva H, Correa P, Machenahalli P, Gholap N. Case Report: Pituitary metastasis and its diagnostic complexity. EJEA 2021. [DOI: 10.1530/endoabs.75.p09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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22
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Robbins T, Kyrou I, Vankad M, Suthantirakumar R, Igharo N, Patel K, Randeva H, Sankar S. Differential perceptions regarding personal protective equipment use during the COVID-19 pandemic by NHS healthcare professionals based on ethnicity, sex and professional experience. Infect Prev Pract 2021; 3:100141. [PMID: 34316583 PMCID: PMC8195686 DOI: 10.1016/j.infpip.2021.100141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/08/2021] [Indexed: 01/19/2023] Open
Abstract
Objectives To capture perceptions regarding personal protective equipment (PPE) among healthcare professionals during the COVID-19 pandemic, including staff subgroups at high risk for severe COVID-19, such as black and minority ethnic (BAME) groups. Design Electronically distributed survey with semi-quantitative analysis. Survey distributed at a major academic NHS tertiary referral centre in the West Midlands with a diverse medical workforce to medically qualified staff who completed COVID-19 redeployment training. (N=121; 47% female; 49% of BAME background; 26% international medical graduates). Results All demographic groups reported overall good awareness of when and how to use PPE during COVID-19 pandemic. Statistically significant differences in the perceptions regarding PPE use during COVID-19 were noted between BAME vs non-BAME staff, international vs UK medical graduates, and male vs female participants, as well as between professionals at different stages of their career. The differences related to perceptions around availability, degree of protection provided, perceived inconvenience, ability to raise concerns about availability, confidence in sharing underlying health conditions with managers and the impact of full PPE in emergency situations causing delay patient care. Conclusions Amongst medically qualified staff, significant differences exist in the perceptions relating to the, availability and effectiveness of PPE during the COVID-19 pandemic depending on country of training, ethnic background and sex. GAFREC Study Approval Study ID GF0392.
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Affiliation(s)
- Tim Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Ioannis Kyrou
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Maariyah Vankad
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Risheka Suthantirakumar
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Natalie Igharo
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Kiran Patel
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Harpal Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Sailesh Sankar
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
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23
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Tso S, Moiz H, Satchwell F, Hari T, Dhariwal S, Barlow R, Forbat E, Blee IC, Tan YT, Thind C, Ilchyshyn A, Randeva H, Kwok MM, Tso ACY, Barber TM. Erythroderma (exfoliative dermatitis). Part 2: energy homeostasis and dietetic management strategies. Clin Exp Dermatol 2021; 46:1011-1015. [PMID: 33817816 DOI: 10.1111/ced.14667] [Citation(s) in RCA: 2] [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: 12/31/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
Erythroderma (exfoliative dermatitis) is associated with important metabolic changes that include an enhancement in energy expenditure. The key components to total energy expenditure (TEE) include basal metabolic rate (~68% of TEE), physical activity (~22% of TEE) and thermic effect of food (~10% of TEE). In the erythrodermic state, there are likely multiple contributors to the increase in basal metabolic rate, such as 'caloric drain' resulting from increased evaporation of water from enhanced transepidermal water loss, increased activity of the cardiovascular system (including high-output cardiac failure), increased nonshivering thermogenesis and hormonal changes such as hypercortisolaemia. A change in the patient's level of physical activity and appetite as a result of ill health status may further impact on their TEE and energy consumption. In Part 2 of this two-part concise review, we explore the key constituents of energy homeostasis and the potential mechanisms influencing energy homeostasis in erythroderma, and suggest much-needed dietetic management strategies for this important condition.
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Affiliation(s)
- S Tso
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - H Moiz
- Department of Public Health, University of Warwick, Coventry, UK
| | - F Satchwell
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - T Hari
- University of Buckingham Medical School, Buckingham, UK
| | - S Dhariwal
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - R Barlow
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - E Forbat
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - I C Blee
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK.,Centre for Host Microbiome Interactions King's College London, London, UK
| | - Y T Tan
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - C Thind
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - A Ilchyshyn
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - H Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Warwick, UK
| | - M M Kwok
- Department of Anesthetics, Westmead Hospital, Sydney, NSW, Australia
| | - A C Y Tso
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore
| | - T M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Warwick, UK
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24
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Gadelha MR, Gordon MB, Doknic M, Mezősi E, Tóth M, Randeva H, Marmon T, Luo R, Monahan M, Madan A, Ferrara-Cook C, Struthers S, Krasner A. Safety and Efficacy of Switching Injected Peptide Long-Acting Somatostatin Receptor Ligands to Once Daily Oral Paltusotine: ACROBAT Edge Phase 2 Study. J Endocr Soc 2021. [PMCID: PMC8090738 DOI: 10.1210/jendso/bvab048.1073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Patients with acromegaly not cured by surgery are often initially treated with injected peptide long-acting somatostatin receptor ligands (SRLs). Non-peptide small molecules can also activate the somatostatin receptor and do so with a high degree of precision for the target therapeutic receptor subtype. Paltusotine (formerly CRN00808) is a small molecule somatostatin type 2 (SST2) receptor agonist with high oral bioavailability (70%) and pharmacokinetic profile suitable for once daily dosing. In healthy volunteers, paltusotine has been shown to lower growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels. We hypothesized that patients with acromegaly could switch from injected SRLs to once daily oral paltusotine while maintaining baseline IGF-1 levels. ACROBAT Edge (NCT03789656) was a single-arm study designed to evaluate the safety and efficacy of switching from injected SRLs to paltusotine in patients with acromegaly. The primary analysis population consisted of those who had not achieved normal IGF-1 levels despite stable therapy with long-acting octreotide or lanreotide. Eligible patients received their last injection of SRL 4 weeks prior to switching to once daily oral paltusotine monotherapy for a 13-week treatment period. The starting dose of 10 mg per day was uptitrated in 10 mg increments at specified study visits to a maximal dose of 40 mg per day based on protocol specified study drug toleration and IGF-1 criteria. The primary endpoint was change in IGF-1 from baseline to the completion of the 13-week treatment period. Statistical testing was based on non-parametric Wilcoxon Sign Rank test of whether the median change is different from zero. In addition, the rise in IGF-1 during a 4-week washout period was used to provide supportive evidence of efficacy. Twenty-five patients were enrolled in the primary analysis group, three patients discontinued from the study for non-study drug related reasons, two during the treatment period and one during the washout period after completing treatment. The primary endpoint was achieved as paltusotine treatment resulted in no significant change in IGF-1 levels at week 13 compared to baseline [change in IGF-1 =-0.034 (-0.107, 0.107), median (IQR), p>0.6]. Of the 23 patients who completed the dosing period, 20 (87%) achieved IGF-1 levels at the end of treatment that were within 20% of baseline or lower. Median IGF-1 values rose significantly after paltusotine washout (p<0.0001). The most common treatment-emergent adverse events (>10%) included: headache, arthralgia, fatigue, peripheral swelling, paresthesia and hyperhidrosis. There were no discontinuations due to adverse events and no treatment related serious adverse events. These results suggest that patients with acromegaly treated with injected SRLs can switch to oral paltusotine while maintaining IGF-1 and that paltusotine appeared to be well tolerated.
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Affiliation(s)
- Monica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division--Medical School and Hospital Universitario Clementino Fraga Filho--Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Emese Mezősi
- University of Pécs Medical School, Pécs, Hungary
| | | | - Harpal Randeva
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | - Rosa Luo
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
| | | | - Ajay Madan
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
| | | | | | - Alan Krasner
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
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25
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Tso S, Satchwell F, Moiz H, Hari T, Dhariwal S, Barlow R, Forbat E, Randeva H, Tan YT, Ilchyshyn A, Kwok MM, Barber TM, Thind C, Tso ACY. Erythroderma (exfoliative dermatitis). Part 1: underlying causes, clinical presentation and pathogenesis. Clin Exp Dermatol 2021; 46:1001-1010. [PMID: 33639006 DOI: 10.1111/ced.14625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022]
Abstract
Erythroderma (exfoliative dermatitis), first described by Von Hebra in 1868, manifests as a cutaneous inflammatory state, with associated skin barrier and metabolic dysfunctions. The annual incidence of erythroderma is estimated to be 1-2 per 100 000 population in Europe with a male preponderance. Erythroderma may present at birth, or may develop acutely or insidiously (due to progression of an underlying primary pathology, including malignancy). Although there is a broad range of diseases that associate with erythroderma, the vast majority of cases result from pre-existing and chronic dermatoses. In the first part of this two-part concise review, we explore the underlying causes, clinical presentation, pathogenesis and investigation of erythroderma, and suggest potential treatment targets for erythroderma with unknown causes.
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Affiliation(s)
- S Tso
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - F Satchwell
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - H Moiz
- Department of Public Health, University of Warwick, Coventry, UK
| | - T Hari
- University of Buckingham Medical School, Buckingham, UK
| | - S Dhariwal
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - R Barlow
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - E Forbat
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Department of Dermatology, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - H Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Y T Tan
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - A Ilchyshyn
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M M Kwok
- Anaesthetics, Westmead Hospital, Sydney, Australia
| | - T M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - C Thind
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - A C Y Tso
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore
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Robbins T, Sankaranarayanan S, Randeva H, Keung SNLC, Arvanitis TN. Association between glycosylated haemoglobin and outcomes for patients discharged from hospital with diabetes: A health informatics approach. Digit Health 2021; 7:20552076211007661. [PMID: 33948220 PMCID: PMC8054217 DOI: 10.1177/20552076211007661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/13/2021] [Indexed: 11/16/2022] Open
Abstract
Aims/Objectives Extensive research considers associations between inpatient glycaemic control and outcomes during hospital admission; this cautions against overly tight glycaemic targets. Little research considers glycaemic control following hospital discharge. This is despite a clear understanding that people with diabetes are at increased risk of negative outcomes, following discharge. We evaluate absolute and relative Hba1c values, and frequency of Hba1c monitoring, on readmission and mortality rates for people discharged from hospital with diabetes. Methods All discharges (n = 46,357) with diabetes from a major tertiary referral centre over 3 years were extracted, including biochemistry data. We conducted an evaluation of association between Hba1c, mortality and readmission, statistical significance and standardised Cohen's D effect size calculations. Results 399 patients had a Hba1c performed during their admission. 3,138 patients had a Hba1c within 1 year of discharge. Mean average Hba1c for readmissions was 57.82 vs 60.39 for not readmitted (p = 0.009, Cohen's D 0.28). Mean average number of days to Hba1c testing in readmitted was 97 vs 113 for those not readmitted (p = 0.00006, Cohen's D 0.39). Further evaluation of mortality outcomes, cohorts of T1DM and T2DM and association of relative change in Hba1c was performed. Conclusions Lower Hba1c values following discharge from hospital are significantly associated with increased risk of readmission, as is a shorter duration until testing. Similar patterns observed for mortality. Findings particularly prominent for T1DM. Further research needed to consider underlying causation and design of appropriate risk stratification models.
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Affiliation(s)
- Tim Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | - Harpal Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
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Robbins T, Baitule S, Kyrou I, Ray P, Morgan N, Berry L, Randeva H. SARS-CoV-2 infection despite vaccination: an under-reported COVID-19 cohort. Clin Med (Lond) 2021; 21:e243. [PMID: 33762401 DOI: 10.7861/clinmed.let.21.2.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tim Robbins
- NIHR clinical lecturer, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
| | - Sudhanshu Baitule
- Clinical fellow, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ioannis Kyrou
- Clinical lecturer and endocrinologist, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, Warwick Medical School, Coventry, UK and Aston Medical School, Birmingham, UK
| | - Pijush Ray
- Group clinical director medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nina Morgan
- Chief nursing officer, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Lisa Berry
- Clinical scientist virology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- Director of research and development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, Warwick Medical School, Coventry, UK and Aston Medical School, Birmingham, UK
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Robbins T, Berry L, Wells F, Randeva H, Laird S. Healthcare staff perceptions towards influenza and potential COVID-19 vaccination in the 2020 pandemic context. J Hosp Infect 2021; 112:45-48. [PMID: 33746009 PMCID: PMC7973053 DOI: 10.1016/j.jhin.2021.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/10/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic generated renewed focus on infectious disease transmission in healthcare settings. This study aimed to evaluate staff perceptions towards influenza vaccination in the COVID-19 context. All healthcare workers within a major UK tertiary referral hospital were invited to answer a survey conducted from September 2nd to 13th, 2020. In all, 593 responses were received across a spectrum of roles; 44% reported they were more likely to get an influenza vaccine this year due to COVID-19; however, 10% felt that an influenza vaccine was less important due to social distancing. Additional questions evaluated intention to receive COVID-19 vaccination. There were substantial differences of opinion between staff groups.
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Affiliation(s)
- T Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - L Berry
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - F Wells
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - H Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - S Laird
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK.
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Robbins T, Kyrou I, Laird S, Morgan N, Anderson N, Imray C, Patel K, Sankar S, Randeva H, Jones C. Healthcare staff perceptions and misconceptions regarding antibody testing in the United Kingdom: implications for the next steps for antibody screening. J Hosp Infect 2020; 111:102-106. [PMID: 33309938 PMCID: PMC7834281 DOI: 10.1016/j.jhin.2020.11.019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Healthcare workers have been at increased risk of exposure, infection and serious complications from COVID-19. Antibody testing has been used to identify staff members who have been previously infected by SARS-CoV-2, and has been rolled out rapidly in the United Kingdom. A number of comment and editorial articles have been published that raise concerns about antibody testing in this context. We present perceptions of National Health Service (NHS) healthcare workers in relation to SARS-CoV-2 antibody testing. METHODS An electronic survey regarding perceptions towards SARS-CoV-2 antibody testing was distributed to all healthcare workers at a major NHS tertiary hospital following implementation of antibody testing. RESULTS In total, 560 healthcare workers completed the survey (80% female; 25% of Black and Minority Ethnic background; 58% from frontline clinical staff). Exploring whether they previously had COVID-19 was the primary reported reason for choosing to undergo antibody testing (85.2%). In case of a positive antibody test, 72% reported that they would feel relieved, whilst 48% felt that they would be happier to work in a patient-facing area. Moreover, 12% responded that a positive test would mean "social distancing is less important", with 34% of the responders indicating that in this case they would be both less likely to catch COVID-19 and happier to visit friends/relatives. CONCLUSIONS NHS staff members primarily seek out SARS-CoV-2 antibody testing for an appropriate reason. Based on our findings and given the lack of definite data regarding the extent of immunity protection from a positive SARS-CoV-2 antibody test, significant concerns may be raised regarding the reported interpretation by healthcare workers of positive antibody test results. This needs to be further explored and addressed to protect NHS staff and patients.
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Affiliation(s)
- T Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK.
| | - I Kyrou
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - S Laird
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - N Morgan
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - N Anderson
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - C Imray
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - K Patel
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - S Sankar
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - H Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - C Jones
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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Mukherjee T, Robbins T, Lim Choi Keung SN, Sankar S, Randeva H, Arvanitis TN. A systematic review considering risk factors for mortality of patients discharged from hospital with a diagnosis of diabetes. J Diabetes Complications 2020; 34:107705. [PMID: 32861561 DOI: 10.1016/j.jdiacomp.2020.107705] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 11/23/2022]
Abstract
AIM To identify known risk factors for mortality for adult patients, discharged from hospital with diabetes. METHOD The systematic review was based on the PRISMA protocol. Studies were identified through EMBASE & MEDLINE databases. The inclusion criteria were papers that were published over the last 6 years, in English language, and focused on risk factors of mortality in adult patients with diabetes, after they were discharged from hospitals. This was followed by data extraction "with quality assessment and semi-quantitative synthesis according to PRISMA guidelines". RESULTS There were 35 studies identified, considering risk factors relating to mortality for patients, discharged from hospital with diabetes. These studies are distributed internationally. 48 distinct statistically significant risk factors for mortality can be identified. Risk factors can be grouped into the following categories; demographic, socioeconomic, lifestyle, patient medical, inpatient stay, medication related, laboratory results, and gylcaemic status. These risk factors can be further divided into risk factors identified in generalized populations of patients with diabetes, compared to specific sub-populations of people with diabetes. CONCLUSION A relatively small number of studies have considered risk factors relating to mortality for patients, discharged from hospital with a diagnosis of diabetes. Mortality is an important outcome, when considering discharge from hospital with diabetes. However, there has only been limited consideration within the research literature.
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Affiliation(s)
- Teesta Mukherjee
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Tim Robbins
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, United Kingdom; University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
| | - Sarah N Lim Choi Keung
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Sailesh Sankar
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom; Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Harpal Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom; Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Theodoros N Arvanitis
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
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Lachlan T, He H, Sharma K, Khan J, Rajappan K, Morley-Davies A, Patwala A, Randeva H, Osman F. MAGNETO cardiography parameters to predict future Sudden Cardiac Death (MAGNETO-SCD) or ventricular events from implantable cardioverter defibrillators: study protocol, design and rationale. BMJ Open 2020; 10:e038804. [PMID: 33040013 PMCID: PMC7552867 DOI: 10.1136/bmjopen-2020-038804] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Predicting sudden cardiac death (SCD) is challenging as current risk predictors have significant limitations. Evaluating magnetocardiogram (MCG) parameters could be of great value and we plan to assess the capability of a new mobile unshielded MCG device in predicting SCD and ventricular arrhythmias (VA) in patients undergoing implantable cardioverter defibrillator (ICD) implantation. METHODS AND ANALYSIS A prospective multicentre (University Hospitals Coventry and Warwickshire (UHCW) National Health Service (NHS) Trust/University Hospital North Midlands NHS Trust, UK) observational study evaluating the VitalScan MCG (Creavo Medical Technologies, UK) to predict future VA risk; 270 patients meeting criteria for primary or secondary prevention ICDs (ischaemic or non-ischaemic aetiology) are being recruited. The first patient was recruited September 2019 and the study will be completed at final participant follow-up. The primary endpoint is appropriate ICD therapy for VA, secondary endpoint is SCD. Previous trials using MCG identified late QRS signals/QRS fragmentation as potential indicators of SCD in small samples using large shielded expensive MCG devices that were difficult to use clinically. It is hoped the MAGNETO-SCD trial will show this new MCG device can provide real world risk stratification for SCD/VA risk. The trial has recruited 25 patients (13 with secondary prevention indication) from a single site (UHCW) with recruitment starting at the second site in March 2020. ETHICS AND DISSEMINATION Research Ethics Committee, Yorkshire and Humber Sheffield Research Ethics Committee UK (Ref: 19/YH/0143) and Health Research Authority (IRAS reference 254466, EDGE ID: 123146) approval received on 17/07/2019. The Medicines and Healthcare products Regulatory Agency approval received 11/07/2019. Results will be disseminated via a peer-reviewed publication and presentation at international conferences. TRIAL REGISTRATION NUMBERS ClinicalTrials.gov Registry (NCT04352816) and EU Clinical Trials Registry (EudraCT2019-002994-78).
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Affiliation(s)
- Thomas Lachlan
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hejie He
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kavi Sharma
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jamal Khan
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kim Rajappan
- Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian Morley-Davies
- Cardiology, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Ashish Patwala
- Cardiology, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Harpal Randeva
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Faizel Osman
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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Patel J, Robbins T, Randeva H, de Boer R, Sankar S, Brake S, Patel K. Rising to the challenge: Qualitative assessment of medical student perceptions responding to the COVID-19 pandemic. Clin Med (Lond) 2020; 20:e244-e247. [PMID: 33037028 DOI: 10.7861/clinmed.2020-0219] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medical students internationally have volunteered and stepped up to support frontline clinical teams during the COVID-19 pandemic. We know very little about the motivation of those volunteering, or their concerns in deploying to a new role. We aim to establish the reasons that medical students volunteered in one Trust and understand to their concerns. METHODS Structured survey, thematic analysis and categorisation of volunteer student perceptions. RESULTS Medical students volunteered for broadly four reasons: to make a contribution, to learn, to benefit from remuneration and for an activity during the national lockdown. There were disparate concerns; however, the most common involved availability of personal protective equipment, uncertainty as to expectations and becoming infected. CONCLUSIONS We must recognise and applaud the motivations of our future workforce who have stepped up to support the NHS at a time of unprecedented demand. The experiences and learning gained during this period will undoubtedly shape their future medical training and careers.
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Affiliation(s)
- Jayamala Patel
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,*joint first authors
| | - Tim Robbins
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and University of Warwick, Coventry, UK.,*joint first authors
| | - Harpal Randeva
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and University of Warwick, Coventry, UK
| | - Richard de Boer
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Sailesh Sankar
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, University of Warwick, Coventry, UK and Health Education England (West Midlands), Edgbaston, UK
| | | | - Kiran Patel
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and University of Warwick, Coventry, UK
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33
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Tsoli M, Kaltsas G, Angelousi A, Alexandraki K, Randeva H, Kassi E. Managing Ipilimumab-Induced Hypophysitis: Challenges and Current Therapeutic Strategies. Cancer Manag Res 2020; 12:9551-9561. [PMID: 33061641 PMCID: PMC7537807 DOI: 10.2147/cmar.s224791] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
Over the past years, progress has been made in cancer immunotherapy following the development of immune checkpoint inhibitors (ICI) that have been proved effective in the management of many malignancies. Ipilimumab, a monoclonal antibody against cytotoxic T-lymphocyte antigen-4 (CTLA-4), has been approved for the treatment of advanced melanoma but has been associated with the development of several endocrine immune-related adverse events (irAEs). Hypophysitis is the most common endocrine irAE related to ipilimumab with a reported incidence ranging from 1.8% to 17%. The mechanism underlying ipilimumab-induced hypophysitis implicates immune, inflammatory and genetic factors, but there are still some points that are not well understood and remain to be elucidated. The diagnosis is based mainly on clinical, biochemical and imaging data. The majority of patients display multiple hormone deficiencies that may recover or persist for a prolonged period of time with corticotroph deficiency usually being permanent. Immune-related hypopituitarism is treated with replacement of deficient hormones while in severe forms of hypophysitis treatment with high-dose glucocorticoids may be required. Proper evaluation and registration of patients in clinical trials and further investigation are needed to precisely clarify the pathophysiology of the ICI-related hypophysitis, define predictive factors and ameliorate the management and outcome of the disease.
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Affiliation(s)
- Marina Tsoli
- First Department of Propaedeutic and Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kaltsas
- First Department of Propaedeutic and Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Angelousi
- First Department of Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Krystallenia Alexandraki
- First Department of Propaedeutic and Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Harpal Randeva
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Eva Kassi
- First Department of Propaedeutic and Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Jackisch L, Murphy AM, Kumar S, Randeva H, Tripathi G, McTernan PG. Tunicamycin-Induced Endoplasmic Reticulum Stress Mediates Mitochondrial Dysfunction in Human Adipocytes. J Clin Endocrinol Metab 2020; 105:5837767. [PMID: 32413131 DOI: 10.1210/clinem/dgaa258] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/24/2019] [Accepted: 05/12/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT Dysfunctional endoplasmic reticulum (ER) and mitochondria are known to contribute to the pathology of metabolic disease. This damage may occur, in part, as a consequence of ER-mitochondria cross-talk in conditions of nutrient excess such as obesity. To date, insight into this dynamic relationship has not been characterized in adipose tissue. Therefore, this study investigated whether ER stress contributes to the development of mitochondrial inefficiency in human adipocytes from lean and obese participants. METHODS Human differentiated adipocytes from Chub-S7 cell line and primary abdominal subcutaneous adipocytes from lean and obese participants were treated with tunicamycin to induce ER stress. Key parameters of mitochondrial function were assessed, including mitochondrial respiration, membrane potential (MMP), and dynamics. RESULTS ER stress led to increased respiratory capacity in a model adipocyte system (Chub-S7 adipocytes) in a concentration and time dependent manner (24 h: 23%↑; 48 h: 68%↑, P < 0.001; 72 h: 136%↑, P < 0.001). This corresponded with mitochondrial inefficiency and diminished MMP, highlighting the formation of dysfunctional mitochondria. Morphological analysis revealed reorganization of mitochondrial network, specifically mitochondrial fragmentation. Furthermore, p-DRP1, a key protein in fission, significantly increased (P < 0.001). Additionally, adipocytes from obese subjects displayed lower basal respiration (49%↓, P < 0.01) and were unresponsive to tunicamycin in contrast to their lean counterparts, demonstrating inefficient mitochondrial oxidative capacity. CONCLUSION These human data suggest that adipocyte mitochondrial inefficiency is driven by ER stress and exacerbated in obesity. Nutrient excess-induced ER stress leads to mitochondrial dysfunction that may therefore shift lipid deposition ectopically and thus have further implications on the development of related metabolic disorders.
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Affiliation(s)
- Laura Jackisch
- Warwick Medical School, University of Warwick, UHCW, Coventry, UK
| | - Alice M Murphy
- Department of Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Sudhesh Kumar
- Warwick Medical School, University of Warwick, UHCW, Coventry, UK
| | - Harpal Randeva
- Warwick Medical School, University of Warwick, UHCW, Coventry, UK
| | - Gyanendra Tripathi
- Human Sciences Research Centre, College of Life and Natural Sciences, University of Derby, Derby, UK
| | - Philip G McTernan
- Department of Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham, UK
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Robbins T, Lim Choi Keung SN, Sankar S, Randeva H, Arvanitis TN. Application of standardised effect sizes to hospital discharge outcomes for people with diabetes. BMC Med Inform Decis Mak 2020; 20:150. [PMID: 32635913 PMCID: PMC7339522 DOI: 10.1186/s12911-020-01169-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 06/25/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with diabetes are at an increased risk of readmission and mortality when discharged from hospital. Existing research identifies statistically significant risk factors that are thought to underpin these outcomes. Increasingly, these risk factors are being used to create risk prediction models, and target risk modifying interventions. These risk factors are typically reported in the literature accompanied by unstandardized effect sizes, which makes comparisons difficult. We demonstrate an assessment of variation between standardised effect sizes for such risk factors across care outcomes and patient cohorts. Such an approach will support development of more rigorous risk stratification tools and better targeting of intervention measures. METHODS Data was extracted from the electronic health record of a major tertiary referral centre, over a 3-year period, for all patients discharged from hospital with a concurrent diagnosis of diabetes mellitus. Risk factors selected for extraction were pre-specified according to a systematic review of the research literature. Standardised effect sizes were calculated for all statistically significant risk factors, and compared across patient cohorts and both readmission & mortality outcome measures. RESULTS Data was extracted for 46,357 distinct admissions patients, creating a large dataset of approximately 10,281,400 data points. The calculation of standardized effect size measures allowed direct comparison. Effect sizes were noted to be larger for mortality compared to readmission, as well as for being larger for surgical and type 1 diabetes cohorts of patients. CONCLUSIONS The calculation of standardised effect sizes is an important step in evaluating risk factors for healthcare events. This will improve our understanding of risk and support the development of more effective risk stratification tools to support patients to make better informed decisions at discharge from hospital.
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Affiliation(s)
- Tim Robbins
- Institute of Digital Healthcare, International Digital Laboratory, WMG, University of Warwick, Coventry, CV4 7AL, UK. .,Warwickshire Institute for the Study of Diabetes, Endocrinology & Metabolism, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Sarah N Lim Choi Keung
- Institute of Digital Healthcare, International Digital Laboratory, WMG, University of Warwick, Coventry, CV4 7AL, UK
| | - Sailesh Sankar
- Warwickshire Institute for the Study of Diabetes, Endocrinology & Metabolism, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Harpal Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology & Metabolism, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Theodoros N Arvanitis
- Institute of Digital Healthcare, International Digital Laboratory, WMG, University of Warwick, Coventry, CV4 7AL, UK
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Affiliation(s)
- Tim Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, UK.,Institute of Digital Healthcare, WMG, University of Warwick, UK
| | - Sarah Hudson
- Bristol Heart Institute, United Hospitals Bristol NHS Foundation Trust, UK
| | - Pijush Ray
- University Hospitals Coventry & Warwickshire NHS Trust, UK.,Warwick Medical School, University of Warwick, UK
| | - Sailesh Sankar
- University Hospitals Coventry & Warwickshire NHS Trust, UK.,Warwick Medical School, University of Warwick, UK
| | - Kiran Patel
- University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - Harpal Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, UK.,Warwick Medical School, University of Warwick, UK
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McAloon CJ, Hyndman S, Ansell V, O'Hare P, Randeva H, Osman F. Body composition in heart failure and the impact of cardiac resynchronisation therapy: a proof-of-concept study. Open Heart 2020; 7:e001105. [PMID: 32153788 PMCID: PMC7046974 DOI: 10.1136/openhrt-2019-001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 11/06/2022] Open
Abstract
Aims Body composition (BC) is known to alter in heart failure. Cardiac resynchronisation therapy (CRT) improves left ventricular geometry but the impact on BC is unknown. Our aim was to evaluate BC in these patients before and after CRT implantation. Methods Prospective proof-of-concept pilot study of heart failure patients undergoing CRT between September 2014 and December 2015. Assessments performed pre-CRT and post-CRT (6 weeks and 6 months) were: BC parameters (using air-displacement plethysmography), New York Heart Failure classification for assessing symptom severity, echocardiography to assess left ventricular geometry, electrocardiography, Minnesota Heart Failure Questionnaire and N-terminal probrain natriuretic peptide (NT-pro-BNP). Repeated measures analysis of variance was performed to assess relative change over time and potential correlations. Results Twenty-five patients were recruited; mean-age (±SD) was 73.4±10.0 years, 23 males, 18 CRT defibrillators (remainder CRT pacemakers), 16 had ischaemic aetiology, 6 diabetics, 17 with left bundle-branch morphology on ECG and 10 had atrial fibrillation. Significant inverse correlations were observed in the first 6 weeks following CRT between fat mass and left ventricular end-diastolic volume (r=−0.69, p<0.01) and NT-pro-BNP and fat mass (r=0.41, p=0.05). No significant differences were noted over 6 months. There was an observed trend towards reduced fat mass in the first 6 weeks post-CRT implant driven by non-responders. There was no significant difference between responders and non-responders in BC over 6 months. Conclusion This is the first study to observe interplay between BC and cardiac geometry/function following CRT; a trend in overall fat mass reduction was noted following CRT and merits further study.
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Affiliation(s)
- Christopher J McAloon
- Cardiology, University Hospital Coventry, Coventry, UK.,University of Warwick Warwick Medical School, Coventry, UK
| | | | | | - Paul O'Hare
- University of Warwick Warwick Medical School, Coventry, UK
| | - Harpal Randeva
- University of Warwick Warwick Medical School, Coventry, UK
| | - Faizel Osman
- Cardiology, University Hospital Coventry, Coventry, UK.,University of Warwick Warwick Medical School, Coventry, UK
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de Aguiar Greca SC, Kyrou I, Pink R, Randeva H, Grammatopoulos D, Silva E, Karteris E. Involvement of the Endocrine-Disrupting Chemical Bisphenol A (BPA) in Human Placentation. J Clin Med 2020; 9:jcm9020405. [PMID: 32028606 PMCID: PMC7074564 DOI: 10.3390/jcm9020405] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/26/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Endocrine-disrupting chemicals (EDCs) are environmental chemicals/toxicants that humans are exposed to, interfering with the action of multiple hormones. Bisphenol A (BPA) is classified as an EDC with xenoestrogenic activity with potentially adverse effects in reproduction. Currently, a significant knowledge gap remains regarding the complete spectrum of BPA-induced effects on the human placenta. As such, the present study examined the effects of physiologically relevant doses of BPA in vitro. Methods: qRT-PCR, Western blotting, immunofluorescence, ELISA, microarray analyses, and bioinformatics have been employed to study the effects of BPA using nonsyncytialised (non-ST) and syncytialised (ST) BeWo cells. Results: Treatment with 3 nM BPA led to an increase in cell number and altered the phosphorylation status of p38, an effect mediated primarily via the membrane-bound estrogen receptor (GPR30). Nonbiased microarray analysis identified 1195 and 477 genes that were differentially regulated in non-ST BeWo cells, whereas in ST BeWo cells, 309 and 158 genes had altered expression when treated with 3 and 10 nM, respectively. Enriched pathway analyses in non-ST BeWo identified a leptin and insulin overlap (3 nM), methylation pathways (10 nM), and differentiation of white and brown adipocytes (common). In the ST model, most significantly enriched were the nuclear factor erythroid 2-related factor 2 (NRF2) pathway (3 nM) and mir-124 predicted interactions with cell cycle and differentiation (10 nM). Conclusion: Collectively, our data offer a new insight regarding BPA effects at the placental level, and provide a potential link with metabolic changes that can have an impact on the developing fetus.
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Affiliation(s)
| | - Ioannis Kyrou
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B4 7ET, UK;
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Institute of Precision Diagnostics and Translational Medicine, UHCW NHS Trust, Coventry CV4 7AL, UK; (H.R.); (D.G.)
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Ryan Pink
- Dept of Bio. & Med. Sci., Oxford Brookes University, Oxford OX3 0BP, UK;
| | - Harpal Randeva
- Institute of Precision Diagnostics and Translational Medicine, UHCW NHS Trust, Coventry CV4 7AL, UK; (H.R.); (D.G.)
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Dimitris Grammatopoulos
- Institute of Precision Diagnostics and Translational Medicine, UHCW NHS Trust, Coventry CV4 7AL, UK; (H.R.); (D.G.)
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Elisabete Silva
- College of Health and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK;
- Correspondence: (E.S.); (E.K.)
| | - Emmanouil Karteris
- College of Health and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK;
- Correspondence: (E.S.); (E.K.)
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Abstract
CONTEXT Although most sellar lesions are related to pituitary adenomas, the region gives rise to a variety of neoplasms that can be associated with substantial morbidity and/or mortality. DESIGN Information from reviews and guidelines of relevant societies dealing with such neoplasms, as well as articles that have provided new developments that made important contributions to their pathogenesis and treatment up to 2018, were obtained: public indexes such as PubMed/MEDLINE were used with the relevant search items. RESULTS Sellar neoplasms have a worse outcome than pituitary adenomas that is related not only to their natural history but also to side effects of therapies and evolving endocrine and/or hypothalamic deficiencies. Recent imaging advances have established the radiological fingerprint of some of these neoplasms, and several chromosomal aberrations have also been identified. Although established approaches along with new surgical and radiotherapeutic approaches remain the main treatment modalities, recent evidence has provided insight into their molecular pathogenesis involving, other than chemotherapy, treatments with targeted agents as in gliomas and craniopharyngiomas bearing BRAF mutations. Development of predictive markers of recurrences may also identify high-risk patients, including proliferative markers and expression of the progesterone receptor in meningiomas, and lead to less aggressive surgery. Owing to the rarity and complexity of these neoplasms, patients should be managed in dedicated centers. CONCLUSIONS The diagnosis and management of sellar neoplasms necessitate a multidisciplinary approach. Following evolving recent advances in their diagnosis and therapy, such a multidisciplinary approach needs to be extended to establish evidence-based diagnostic and management plans.
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Affiliation(s)
- Gregory A Kaltsas
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
- WISDEM Centre, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Dionysia Kolomodi
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Harpal Randeva
- WISDEM Centre, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Ashley Grossman
- Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
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Angelousi A, Kassi E, Ansari-Nasiri N, Randeva H, Kaltsas G, Chrousos G. Clock genes and cancer development in particular in endocrine tissues. Endocr Relat Cancer 2019; 26:R305-R317. [PMID: 30959483 DOI: 10.1530/erc-19-0094] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 12/24/2022]
Abstract
Circadian rhythms at a central and peripheral level are operated by transcriptional/translational feedback loops involving a set of genes called 'clock genes' that have been implicated in the development of several diseases, including malignancies. Dysregulation of the Clock system can influence cancer susceptibility by regulating DNA damage and repair mechanisms, as well as apoptosis. A number of oncogenic pathways can be dysregulated via clock genes' epigenetic alterations, including hypermethylation of clock genes' promoters or variants of clock genes. Clock gene disruption has been studied in breast, lung and prostate cancer, and haematological malignancies. However, it is still not entirely clear whether clock gene disruption is the cause or the consequence of tumourigenesis and data in endocrine neoplasms are scarce. Recent findings suggest that clock genes are implicated in benign and malignant adrenocortical neoplasias. They have been also associated with follicular and papillary thyroid carcinomas and parathyroid adenomas, as well as pituitary adenomas and craniopharyngiomas. Dysregulation of clock genes is also encountered in ovarian and testicular tumours and may also be related with their susceptibility to chemotherapeutic agents. The most common clock genes that are implicated in endocrine neoplasms are PER1, CRY1; in most cases their expression is downregulated in tumoural compared to normal tissues. Although there is still a lot to be done for the better understanding of the role of clock genes in endocrine tumourigenenesis, existing evidence could guide research and help identify novel therapeutic targets aiming mainly at the peripheral components of the clock gene system.
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Affiliation(s)
- Anna Angelousi
- Endocrine Unit, 1st Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eva Kassi
- Endocrine Unit, 1st Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Narjes Ansari-Nasiri
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Harpal Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Gregory Kaltsas
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Chrousos
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Alexandraki KI, Pizanias M, Uri I, Thomas D, Page T, Kolomodi D, Low CS, Adesanya O, Tsoli M, Gross DJ, Randeva H, Srirajaskanthan R, Grozinsky-Glasberg S, Kaltsas G, Weickert MO. The prognosis and management of neuroendocrine neoplasms-related metastatic bone disease: lessons from clinical practice. Endocrine 2019; 64:690-701. [PMID: 30635793 DOI: 10.1007/s12020-019-01838-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/02/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To study the evolution and optimal management of metastatic bone disease (mBD) in patients with neuroendocrine neoplasms (NENs). METHODS Seventy-four patients were recruited from four NEN centers in this observational multicenter study. RESULTS Pancreas and small bowel were the most common primaries (30 and 27%, respectively). Almost all gastrointestinal (GI)-NENs were grades 1 and 2, whereas bronchopulmonary-thymic were atypical carcinoids. Thirty-two (43%) patients had synchronous metastatic bone disease (mBD) and three patients reported bone-specific symptoms; metachronous mBD developed at a median of 35 (range: 4-395) months. Thirty-six (86%) of patients with metachronous mBD had stage IV disease at diagnosis. Somatostatin receptor functional imaging and computed tomography were the modalities mostly used for mBD identification. Fifty-two patients received assessable bone-related therapy (bisphosphonates, denosumab, local radiotherapy, and radionuclide treatment). Improvement in mBD was seen in 5, stable disease in 22, and deterioration in 25 patients. The presence of synchronous mBD and the negative outcome of bone-related therapy negatively affected overall survival (OS). In the multivariate analysis, the stronger predictor of OS was the outcome of bone-related therapy (HR: 4.753; 95% CI: 1.589-14.213). Bisphosphonates therapy was the mostly used bone-specific treatment but its monthly administration did not affect OS. At last follow-up, 39 patients were alive with OS 50 (14-463) months. CONCLUSIONS Early investigation for mBD offers a prognostic marker of patients with NENs, since synchronous mBD has a negative impact on survival. The outcome of bone-related therapy affects OS but the monthly administration of bisphosphonates did not show a benefit over less intense schemes.
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Affiliation(s)
- Krystallenia I Alexandraki
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece.
| | - Michail Pizanias
- Institute of Liver Studies, King's College Hospital, London, SE5 9RS, UK
| | - Inbal Uri
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Dimitrios Thomas
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
| | - Tristan Page
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Denise Kolomodi
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
| | - Chen Sheng Low
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Olu Adesanya
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Marina Tsoli
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
| | - David J Gross
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Harpal Randeva
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Coventry University, Centre for Applied Biological & Exercise Science, Coventry, UK
- Clinical Sciences Research Laboratories, Division of Translational Medicine, Warwick Medical School, University Hospital, University of Warwick, CV4 7AL, Coventry, UK
| | | | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Gregory Kaltsas
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Martin O Weickert
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Coventry University, Centre for Applied Biological & Exercise Science, Coventry, UK
- Clinical Sciences Research Laboratories, Division of Translational Medicine, Warwick Medical School, University Hospital, University of Warwick, CV4 7AL, Coventry, UK
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Robbins TD, Lim Choi Keung SN, Sankar S, Randeva H, Arvanitis TN. Risk factors for readmission of inpatients with diabetes: A systematic review. J Diabetes Complications 2019; 33:398-405. [PMID: 30878296 DOI: 10.1016/j.jdiacomp.2019.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 11/02/2018] [Revised: 01/04/2019] [Accepted: 01/22/2019] [Indexed: 12/16/2022]
Abstract
AIM We have limited understanding of which risk factors contribute to increased readmission rates amongst people discharged from hospital with diabetes. We aim to complete the first review of its kind, to identify, in a systematic way, known risk factors for hospital readmission amongst people with diabetes, in order to better understand this costly complication. METHOD The review was prospectively registered in the PROSPERO database. Risk factors were identified through systematic review of literature in PubMed, EMBASE & SCOPUS databases, performed independently by two authors prior to data extraction, with quality assessment and semi-quantitative synthesis according to PRISMA guidelines. RESULTS Eighty-three studies were selected for inclusion, predominantly from the United States, and utilising retrospective analysis of local or regional data sets. 76 distinct statistically significant risk factors were identified across 48 studies. The most commonly identified risk factors were; co-morbidity burden, age, race and insurance type. Few studies conducted power calculations; unstandardized effect sizes were calculated for the majority of statistically significant risk factors. CONCLUSION This review is important in assessing the current state of the literature and in supporting development of interventions to reduce readmission risk. Furthermore, it provides an important foundation for development of rigorous, pre-specified risk prediction models.
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Affiliation(s)
- Tim D Robbins
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, United Kingdom; Warwickshire Institute for the Study of Diabetes, Endocrinology & Metabolism, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - S N Lim Choi Keung
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - S Sankar
- Warwickshire Institute for the Study of Diabetes, Endocrinology & Metabolism, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
| | - H Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology & Metabolism, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
| | - T N Arvanitis
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, United Kingdom
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Kite C, Lahart IM, Afzal I, Broom DR, Randeva H, Kyrou I, Brown JE. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Syst Rev 2019; 8:51. [PMID: 30755271 PMCID: PMC6371542 DOI: 10.1186/s13643-019-0962-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Typically, management of PCOS focuses on lifestyle changes (exercise and diet), aiming to alleviate symptoms, and lower the associated risk of type 2 diabetes and cardiovascular disease. Our objective was to analyse evidence on the effectiveness of exercise in the management of PCOS, when compared to (i) usual care, (ii) diet alone, and (iii) exercise combined with diet, and also exercise combined with diet, compared to (i) control or usual care and (ii) diet alone. METHODS Relevant databases were searched (June 2017) with no time limit for trial inclusion. Eligible trials employed a randomised or quasi-randomised design to measure the chronic effects of exercise, or exercise and diet in women with PCOS. RESULTS Searches returned 2390 articles; of those, 27 papers from 18 trials were included. Results are presented as mean difference (MD) and 95% confidence intervals (95% CI). Compared with control, exercise had a statistical effect on change from baseline fasting insulin (MD - 2.44 μIU/mL, 95% CIs - 4.24 to - 0.64; very low-quality evidence), HOMA-IR (- 0.57, - 0.99 to - 0.14; very low-quality evidence), total cholesterol (- 5.88 mg/dL, - 9.92 to - 1.83; low-quality evidence), LDL cholesterol (- 7.39 mg/dL, - 9.83 to - 4.95; low-quality evidence), and triglycerides (- 4.78 mg/dL, - 7.52 to - 2.05; low-quality evidence). Exercise also improved VO2 max (3.84 ml/kg/min, 2.87 to 4.81), waist circumference (- 2.62 cm, - 4.13 to - 1.11), and body fat percentage (- 1.39%, - 2.61 to - 0.18) when compared with usual care. No effect was found for change value systolic/diastolic blood pressure, fasting glucose, HDL cholesterol (all low-quality evidence), or waist-to-hip ratio. Many favourable change score findings were supported by post-intervention value analyses: fasting insulin (- 2.11 μIU/mL, - 3.49 to - 0.73), total cholesterol (- 6.66 mg/dL, - 11.14 to - 2.17), LDL cholesterol (- 6.91 mg/dL, - 12.02 to - 1.80), and VO2 max (5.01 ml/kg/min, 3.48 to 6.54). Statistically lower BMI (- 1.02 kg/m2, - 1.81 to - 0.23) and resting heart rate (- 3.26 beats/min - 4.93 to - 1.59) were also revealed in post-intervention analysis. Subgroup analyses revealed the greatest improvements in overweight/obese participants, and more outcomes improved when interventions were supervised, aerobic in nature, or of a shorter duration. Based on limited data, we found no differences for any outcome between the effects of exercise and diet combined, and diet alone. It was not possible to compare exercise vs diet or exercise and diet combined vs diet. CONCLUSION Statistically beneficial effects of exercise were found for a range of metabolic, anthropometric, and cardiorespiratory fitness-related outcomes. However, caution should be adopted when interpreting these findings since many outcomes present modest effects and wide CIs, and statistical effects in many analyses are sensitive to the addition/removal of individual trials. Future work should focus on rigorously designed, well-reported trials that make comparisons involving both exercise and diet. SYSTEMATIC REVIEW REGISTRATION This systematic review was prospectively registered on the Prospero International Prospective Register of Systematic Reviews ( CRD42017062576 ).
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Affiliation(s)
- Chris Kite
- School of Life and Health Sciences, Cell and Tissue Biomedical Research Group, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.,Centre for Active Living, University Centre Shrewsbury, University of Chester, Guildhall, Frankwell Quay, Shrewsbury, SY3 8HQ, UK
| | - Ian M Lahart
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK
| | - Islam Afzal
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK
| | - David R Broom
- Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Harpal Randeva
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK.,Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.,Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - Ioannis Kyrou
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK.,Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.,Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - James E Brown
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK. .,School of Life and Health Sciences, Cell and Tissue Biomedical Research Group, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.
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Daskalakis K, Tsoli M, Srirajaskanthan R, Chatzellis E, Alexandraki K, Angelousi A, Pizanias M, Randeva H, Kaltsas G, Weickert MO. Lung Metastases in Patients with Well-Differentiated Gastroenteropancreatic Neuroendocrine Neoplasms: An Appraisal of the Validity of Thoracic Imaging Surveillance. Neuroendocrinology 2019; 108:308-316. [PMID: 30673674 DOI: 10.1159/000497183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To evaluate the impact of lung metastases (LM) on overall survival (OS) in well-differentiated (WD) stage IV gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) patients along with developing surveillance strategies for thoracic imaging. METHODS Thirty-four patients with LM, from 3 centres, were identified (22 small intestine/12 pancreatic; 17 grade 1/15 grade 2/2 of unknown grade). For comparison, we used 106 stage IV WD, grade 1 and 2 GEP-NEN patients with metastatic disease confined in the abdomen. RESULTS LM prevalence was 4.9% (34/692). Eleven patients (32%) presented with synchronous LM whereas 23 (68%) developed metachronous LM at a median of 25 months (range 1-150 months). Patients with metachronous LM had already established liver and/or para-aortic lymph node metastases. Eighteen of 23 patients (78%) with metachronous LM exhibited concomitant progression in the abdomen. Median OS of WD GEP-NEN patients with LM was shorter than for those with stage IV disease without extra-abdominal metastases (56 [95% CI 40.6-71.6] vs. 122.7 [95% CI 70.7-174.8] months; log-rank p = 0.001). Among patients with progressive stage IV disease, the subset of patients with LM exhibited shorter OS (log-rank p = 0.005). LM were also confirmed as an independent prognostic factor for survival in multivariable analysis (HR 0.18; 95% CI 0.07-0.45; p < 0.0001). CONCLUSION LM, although relatively rare in patients with WD stage IV GEP-NENs, may impact patients' outcome. The development of metachronous LM is associated with concomitant disease progression in established abdominal metastases in most patients. These patient-related parameters could be utilized for a stratified surveillance approach, mainly reserving thoracic imaging for GEP-NEN patients with progressive disease in the abdomen.
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Affiliation(s)
- Kosmas Daskalakis
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,
- 1st Department of Propaupedic Internal Medicine, Endocrine Oncology Unit, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece,
| | - Marina Tsoli
- 1st Department of Propaupedic Internal Medicine, Endocrine Oncology Unit, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Raj Srirajaskanthan
- Department of Gastroenterology, King's College Hospital, London, SE5 9RS, Neuroendocrine Tumour Unit, KHP ENETS Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Eleftherios Chatzellis
- 1st Department of Propaupedic Internal Medicine, Endocrine Oncology Unit, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Krystallenia Alexandraki
- 1st Department of Propaupedic Internal Medicine, Endocrine Oncology Unit, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Angelousi
- 1st Department of Propaupedic Internal Medicine, Endocrine Oncology Unit, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Pizanias
- Department of Liver Transplantation, Hepatobiliary Pancreatic Surgery, King's Healthcare Partners, King's College Hospital, NHS FT, Institute of Liver Studies, Denmark Hill, London, United Kingdom
| | - Harpal Randeva
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, United Kingdom
- Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, United Kingdom
| | - Gregory Kaltsas
- 1st Department of Propaupedic Internal Medicine, Endocrine Oncology Unit, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, United Kingdom
- Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, United Kingdom
| | - Martin O Weickert
- The ARDEN NET Centre, European Neuroendocrine Tumour Society (ENETS) Centre of Excellence (CoE), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, United Kingdom
- Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, United Kingdom
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McAloon CJ, Barwari T, Hu J, Hamborg T, Nevill A, Hyndman S, Ansell V, Musa A, Jones J, Goodby J, Banerjee P, O'Hare P, Mayr M, Randeva H, Osman F. Characterisation of circulating biomarkers before and after cardiac resynchronisation therapy and their role in predicting CRT response: the COVERT-HF study. Open Heart 2018; 5:e000899. [PMID: 30364565 PMCID: PMC6196945 DOI: 10.1136/openhrt-2018-000899] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/05/2018] [Accepted: 09/20/2018] [Indexed: 11/17/2022] Open
Abstract
Aims Cardiac resynchronisation therapy (CRT) is effective treatment for selected patients with heart failure (HF) but has ~30% non-response rate. We evaluated whether specific biomarkers can predict outcome. Methods A prospective single-centre pilot study of consecutive unselected patients undergoing CRT for HF between November 2013 and December 2015 evaluating cardiac extracellular matrix biomarkers and micro-ribonucleic acid (miRNA) expression before and after CRT assessing ability to predict functional response and survival. Each underwent three assessments (pre-implant, 6 weeks and 6 months postimplant) including: New York Heart Association (NYHA) class, echocardiography, electrocardiography, 6 min walk test (6MWT), Minnesota Living with Heart Failure Questionnaire (MLHFQ) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). Plasma markers of cardiac fibrosis assessed were: N-terminal pro-peptides of collagen I and III, collagen I C-terminal telopeptides (CTx) and matrix metalloproteinases (MMP-2 and MMP-9) as well as a panel of miRNAs (miRNA-21, miRNA-30d, miRNA-122, miRNA-133a, miRNA-210 and miRNA-486). Results A total of 52 patients were recruited; mean age (±SD) was 72.4±9.4 years; male=43 (82.7%), ischaemic aetiology=30 (57.7%), mean QRS duration=166.4±23.5 ms, left bundle branch block (LBBB) morphology = 39 (75.0%), mean NYHA=2.7±0.6, 6MWT=238.8±130.6 m, MLHFQ=46.4±21.3 and left ventricular ejection fraction (LVEF)=24.3%±8.0%. Mean follow-up=1.7±0.3 and 5.8±0.7 months. There were 27 (55.1%) functional responders (3 no definable 6-month response; 2 missed assessments and 1 long-term lead displacement). No marker predicted response, however, CTx and LBBB trended most towards predicting functional response. Conclusion No specific biomarkers reached significance for predicting functional response to CRT. CTx showed a trend towards predicting response and warrants further study. Trial registration number NCT02541773.
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Affiliation(s)
- Christopher J McAloon
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Temo Barwari
- King's British Heart Foundation Centre, King's College London, London, UK
| | - Jimiao Hu
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Thomas Hamborg
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alan Nevill
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Samantha Hyndman
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Valerie Ansell
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Anntoniette Musa
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Julie Jones
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Julie Goodby
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK.,Faculty of Health and Life Sciences, University of Coventry, Coventry, UK
| | - Paul O'Hare
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Manuel Mayr
- King's British Heart Foundation Centre, King's College London, London, UK
| | - Harpal Randeva
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
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46
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Robbins T, Lim Choi Keung SN, Sankar S, Randeva H, Arvanitis TN. Diabetes and the direct secondary use of electronic health records: Using routinely collected and stored data to drive research and understanding. Digit Health 2018; 4:2055207618804650. [PMID: 30305917 PMCID: PMC6176528 DOI: 10.1177/2055207618804650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Electronic health records provide an unparalleled opportunity for the use of
patient data that is routinely collected and stored, in order to drive
research and develop an epidemiological understanding of disease. Diabetes,
in particular, stands to benefit, being a data-rich, chronic-disease state.
This article aims to provide an understanding of the extent to which the
healthcare sector is using routinely collected and stored data to inform
research and epidemiological understanding of diabetes mellitus. Methods Narrative literature review of articles, published in both the medical- and
engineering-based informatics literature. Results There has been a significant increase in the number of papers published,
which utilise electronic health records as a direct data source for diabetes
research. These articles consider a diverse range of research questions.
Internationally, the secondary use of electronic health records, as a
research tool, is most prominent in the USA. The barriers most commonly
described in research studies include missing values and misclassification,
alongside challenges of establishing the generalisability of results. Discussion Electronic health record research is an important and expanding area of
healthcare research. Much of the research output remains in the form of
conference abstracts and proceedings, rather than journal articles. There is
enormous opportunity within the United Kingdom to develop these research
methodologies, due to national patient identifiers. Such a healthcare
context may enable UK researchers to overcome many of the barriers
encountered elsewhere and thus to truly unlock the potential of electronic
health records.
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Affiliation(s)
- Tim Robbins
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Sailesh Sankar
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Angelousi A, Kassi E, Nasiri-Ansari N, Weickert MO, Randeva H, Kaltsas G. Clock genes alterations and endocrine disorders. Eur J Clin Invest 2018; 48:e12927. [PMID: 29577261 DOI: 10.1111/eci.12927] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 12/13/2017] [Accepted: 03/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Various endocrine signals oscillate over the 24-hour period and so does the responsiveness of target tissues. These daily oscillations do not occur solely in response to external stimuli but are also under the control of an intrinsic circadian clock. DESIGN We searched the PubMed database to identify studies describing the associations of clock genes with endocrine diseases. RESULTS Various human single nucleotide polymorphisms of brain and muscle ARNT-like 1 (BMAL1) and Circadian Locomotor Output Cycles Kaput (CLOCK) genes exhibited significant associations with type 2 diabetes mellitus. ARNTL2 gene expression and upregulation of BMAL1 and PER1 were associated with the development of type 1 diabetes mellitus. Thyroid hormones modulated PER2 expression in a tissue-specific way, whereas BMAL1 regulated the expression of type 2 iodothyronine deiodinase in specific tissues. Adrenal gland and adrenal adenoma expressed PER1, PER2, CRY2, CLOCK and BMAL1 genes. Adrenal sensitivity to adrenocorticotrophin was also affected by circadian oscillations. A significant correlation between the expression of propio-melanocorticotrophin and PER 2, as well as between prolactin and CLOCK, was found in corticotroph and lactosomatotroph cells, respectively, in the pituitary. Clock genes and especially BMAL1 showed an important role in fertility, whereas oestradiol and androgens exhibited tissue-specific effects on clock gene expression. Metabolic disorders were also associated with circadian dysregulation according to studies in shift workers. CONCLUSIONS Clock genes are associated with various endocrine disorders through complex mechanisms. However, data on humans are scarce. Moreover, clock genes exhibit a tissue-specific expression representing an additional level of regulation. Their specific role in endocrine disorders and their potential implications remain to be further clarified.
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Affiliation(s)
- Anna Angelousi
- Department of Pathophysiology, Endocrine Unit, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eva Kassi
- Department of Biochemistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Narjes Nasiri-Ansari
- Department of Biochemistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Martin O Weickert
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Applied Biological & Exercise Sciences, Coventry University, Coventry, UK
| | - Harpal Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Applied Biological & Exercise Sciences, Coventry University, Coventry, UK
| | - Gregory Kaltsas
- 1st Department of Propaedeutic Internal Medicine, Medical School, Laikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
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48
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Jackisch L, Kumsaiyai W, Moore JD, Al-Daghri N, Kyrou I, Barber TM, Randeva H, Kumar S, Tripathi G, McTernan PG. Differential expression of Lp-PLA2 in obesity and type 2 diabetes and the influence of lipids. Diabetologia 2018; 61:1155-1166. [PMID: 29427237 PMCID: PMC6449000 DOI: 10.1007/s00125-018-4558-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 07/27/2017] [Accepted: 01/03/2018] [Indexed: 12/31/2022]
Abstract
AIMS/HYPOTHESIS Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a circulatory macrophage-derived factor that increases with obesity and leads to a higher risk of cardiovascular disease (CVD). Despite this, its role in adipose tissue and the adipocyte is unknown. Therefore, the aims of this study were to clarify the expression of Lp-PLA2 in relation to different adipose tissue depots and type 2 diabetes, and ascertain whether markers of obesity and type 2 diabetes correlate with circulating Lp-PLA2. A final aim was to evaluate the effect of cholesterol on cellular Lp-PLA2 in an in vitro adipocyte model. METHODS Analysis of anthropometric and biochemical variables from a cohort of lean (age 44.4 ± 6.2 years; BMI 22.15 ± 1.8 kg/m2, n = 23), overweight (age 45.4 ± 12.3 years; BMI 26.99 ± 1.5 kg/m2, n = 24), obese (age 49.0 ± 9.1 years; BMI 33.74 ± 3.3 kg/m2, n = 32) and type 2 diabetic women (age 53.0 ± 6.13 years; BMI 35.08 ± 8.6 kg/m2, n = 35), as part of an ethically approved study. Gene and protein expression of PLA2 and its isoforms were assessed in adipose tissue samples, with serum analysis undertaken to assess circulating Lp-PLA2 and its association with cardiometabolic risk markers. A human adipocyte cell model, Chub-S7, was used to address the intracellular change in Lp-PLA2 in adipocytes. RESULTS Lp-PLA2 and calcium-independent PLA2 (iPLA2) isoforms were altered by adiposity, as shown by microarray analysis (p < 0.05). Type 2 diabetes status was also observed to significantly alter gene and protein levels of Lp-PLA2 in abdominal subcutaneous (AbdSc) (p < 0.01), but not omental, adipose tissue. Furthermore, multivariate stepwise regression analysis of circulating Lp-PLA2 and metabolic markers revealed that the greatest predictor of Lp-PLA2 in non-diabetic individuals was LDL-cholesterol (p = 0.004). Additionally, in people with type 2 diabetes, oxidised LDL (oxLDL), triacylglycerols and HDL-cholesterol appeared important predictors, accounting for 59.7% of the variance (p < 0.001). Subsequent in vitro studies determined human adipocytes to be a source of Lp-PLA2, as confirmed by mRNA expression, protein levels and immunochemistry. Further in vitro experiments revealed that treatment with LDL-cholesterol or oxLDL resulted in significant upregulation of Lp-PLA2, while inhibition of Lp-PLA2 reduced oxLDL production by 19.8% (p < 0.05). CONCLUSIONS/INTERPRETATION Our study suggests adipose tissue and adipocytes are active sources of Lp-PLA2, with differential regulation by fat depot and metabolic state. Moreover, levels of circulating Lp-PLA2 appear to be influenced by unfavourable lipid profiles in type 2 diabetes, which may occur in part through regulation of LDL-cholesterol and oxLDL metabolism in adipocytes.
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Affiliation(s)
- Laura Jackisch
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Warunee Kumsaiyai
- Department of Medical Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Jonathan D Moore
- Warwick Systems Biology Centre, University of Warwick, Coventry, UK
| | - Nasser Al-Daghri
- Biomarkers Research Program, Biochemistry Department, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, King Saud University, Riyadh, Saudi Arabia
| | - Ioannis Kyrou
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
| | - Thomas M Barber
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Human Metabolism Research Unit, Warwickshire Institute for the Study of Diabetes, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sudhesh Kumar
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gyanendra Tripathi
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
- Department of Biomedical Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK.
| | - Philip G McTernan
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
- College of Science and Technology, Department of Biosciences, Nottingham Trent University, Clifton, Nottingham, NG1 8NS, UK.
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49
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Kahal H, Kyrou I, Uthman O, Brown A, Johnson S, Wall P, Metcalfe A, Tahrani A, Randeva H. The Prevalence of Obstructive Sleep Apnoea in women with Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis. EJEA 2017. [DOI: 10.1530/endoabs.50.p339] [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] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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50
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McAloon CJ, Ali D, Hamborg T, Banerjee P, O'Hare P, Randeva H, Osman F. Extracellular cardiac matrix biomarkers in patients with reduced ejection fraction heart failure as predictors of response to cardiac resynchronisation therapy: a systematic review. Open Heart 2017; 4:e000639. [PMID: 28878953 PMCID: PMC5574440 DOI: 10.1136/openhrt-2017-000639] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/26/2017] [Accepted: 07/13/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Cardiac resynchronisation therapy (CRT) is an effective therapy for selected patients with heart failure (HF); however, a significant non-response rate exists. We examined current evidence on extracellular cardiac matrix (ECM) biomarkers in predicting response following CRT. METHODS Complete literature review of PubMed, Ovid SP MEDLINE, Cochrane Library and TRIP, reference lists, international cardiology conferences and ongoing studies between December 1999 and December 2015 conducted according to prospectively registered study selection and analysis criteria (PROSPERO:CRD42016025864) was performed. All observational and randomised control trials (RCT) were included if they tested prespecified ECM biomarkers' ability to predict CRT response. Risk of bias assessment and data extraction determined pooling of included studies was not feasible due to heterogeneity of the selected studies. RESULTS A total of 217 studies were screened; six (five prospective cohort and one RCT substudy) were included in analysis with 415 participants in total. Study sizes varied (n=55-260), cohort characteristics contrasted (male: 67.8%-83.6%, ischaemic aetiology: 40.2%-70.3%) and CRT response definitions differed (three clinical/functional, three echocardiographic). Consistent observation in all ECM biomarker behaviour before and after CRT implantation was not observed between studies. Lower type I and type III collagen synthesis biomarkers (N-terminal propeptides of type I and III procollagens) expression demonstrated replicated ability to predict reverse left ventricular remodelling. CONCLUSION Collagen synthesis biomarkers offer the most potential as ECM biomarkers for predicting CRT response. Heterogeneity between these studies was large and limited the ability to pool and compare results numerically. Use of different response definitions was one of the biggest challenges.
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Affiliation(s)
- Christopher J McAloon
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Danish Ali
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Thomas Hamborg
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Life Sciences, Coventry University, Coventry, UK
| | - Paul O'Hare
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Harpal Randeva
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
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