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Abdelgawad N, Wasserman S, Abdelwahab MT, Davis A, Stek C, Wiesner L, Black J, Meintjes G, Wilkinson RJ, Denti P. Linezolid Population Pharmacokinetic Model in Plasma and Cerebrospinal Fluid Among Patients With Tuberculosis Meningitis. J Infect Dis 2024; 229:1200-1208. [PMID: 37740554 PMCID: PMC11011161 DOI: 10.1093/infdis/jiad413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Linezolid is evaluated in novel treatment regimens for tuberculous meningitis (TBM). Linezolid pharmacokinetics have not been characterized in this population, particularly in cerebrospinal fluid (CSF), as well as, following its co-administration with high-dose rifampicin. We aimed to characterize linezolid plasma and CSF pharmacokinetics in adults with TBM. METHODS In the LASER-TBM pharmacokinetic substudy, the intervention groups received high-dose rifampicin (35 mg/kg) plus 1200 mg/day of linezolid for 28 days, which was then reduced to 600 mg/day. Plasma sampling was done on day 3 (intensive) and day 28 (sparse). A lumbar CSF sample was obtained on both visits. RESULTS Thirty participants contributed 247 plasma and 28 CSF observations. Their median age and weight were 40 years (range, 27-56) and 58 kg (range, 30-96). Plasma pharmacokinetics was described by a 1-compartment model with first-order absorption and saturable elimination. Maximal clearance was 7.25 L/h, and the Michaelis-Menten constant was 27.2 mg/L. Rifampicin cotreatment duration did not affect linezolid pharmacokinetics. CSF-plasma partitioning correlated with CSF total protein up to 1.2 g/L, where the partition coefficient reached a maximal value of 37%. The plasma-CSF equilibration half-life was ∼3.5 hours. CONCLUSIONS Linezolid was readily detected in CSF despite high-dose rifampicin coadministration. These findings support continued clinical evaluation of linezolid plus high-dose rifampicin for the treatment of TBM in adults. Clinical Trials Registration. ClinicalTrials.gov (NCT03927313).
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Affiliation(s)
- Noha Abdelgawad
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - Sean Wasserman
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
- Institute for Infection and Immunity, St George's University of London, United Kingdom
| | - Mahmoud Tareq Abdelwahab
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - Angharad Davis
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
- The Francis Crick Institute, London, United Kingdom
- Faculty of Life Sciences, University College London, United Kingdom
| | - Cari Stek
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - John Black
- Department of Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Graeme Meintjes
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
- Department of Medicine, University of Cape Town, South Africa
| | - Robert J Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, South Africa
- The Francis Crick Institute, London, United Kingdom
- Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
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Inada-Kim M, Chmiel FP, Boniface M, Burns D, Pocock H, Black J, Deakin C. Validation of oxygen saturations measured in the community by emergency medical services as a marker of clinical deterioration in patients with confirmed COVID-19: a retrospective cohort study. BMJ Open 2024; 14:e067378. [PMID: 38167289 PMCID: PMC10773313 DOI: 10.1136/bmjopen-2022-067378] [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: 08/11/2022] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES To evaluate oxygen saturation and vital signs measured in the community by emergency medical services (EMS) as clinical markers of COVID-19-positive patient deterioration. DESIGN A retrospective data analysis. SETTING Patients were conveyed by EMS to two hospitals in Hampshire, UK, between 1 March 2020 and 31 July 2020. PARTICIPANTS A total of 1080 patients aged ≥18 years with a COVID-19 diagnosis were conveyed by EMS to the hospital. PRIMARY AND SECONDARY OUTCOME MEASURES The primary study outcome was admission to the intensive care unit (ICU) within 30 days of conveyance, with a secondary outcome representing mortality within 30 days of conveyance. Receiver operating characteristic (ROC) analysis was performed to evaluate, in a retrospective fashion, the efficacy of different variables in predicting patient outcomes. RESULTS Vital signs measured by EMS staff at the first point of contact in the community correlated with patient 30-day ICU admission and mortality. Oxygen saturation was comparably predictive of 30-day ICU admission (area under ROC (AUROC) 0.753; 95% CI 0.668 to 0.826) to the National Early Warning Score 2 (AUROC 0.731; 95% CI 0.655 to 0.800), followed by temperature (AUROC 0.720; 95% CI 0.640 to 0.793) and respiration rate (AUROC 0.672; 95% CI 0.586 to 0.756). CONCLUSIONS Initial oxygen saturation measurements (on air) for confirmed COVID-19 patients conveyed by EMS correlated with short-term patient outcomes, demonstrating an AUROC of 0.753 (95% CI 0.668 to 0.826) in predicting 30-day ICU admission. We found that the threshold of 93% oxygen saturation is prognostic of adverse events and of value for clinician decision-making with sensitivity (74.2% CI 0.642 to 0.840) and specificity (70.6% CI 0.678 to 0.734).
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Affiliation(s)
- Matthew Inada-Kim
- Department of Acute Medicine, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - Francis P Chmiel
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Michael Boniface
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Daniel Burns
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Helen Pocock
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - John Black
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charles Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
- Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Dickson L, Le Roux SR, Mitrani L, Hill J, Jassat W, Cox H, Mlisana K, Black J, Loveday M, Grant A, Kielmann K, Ndjeka N, Moshabela M, Nicol M. Organisation of care for people receiving drug-resistant tuberculosis treatment in South Africa: a mixed methods study. BMJ Open 2023; 13:e067121. [PMID: 37977868 PMCID: PMC10660906 DOI: 10.1136/bmjopen-2022-067121] [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: 03/03/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES Treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is increasingly transitioning from hospital-centred to community-based care. A national policy for decentralised programmatic MDR/RR-TB care was adopted in South Africa in 2011. We explored variations in the implementation of care models in response to this change in policy, and the implications of these variations for people affected by MDR/RR-TB. DESIGN A mixed methods study was done of patient movements between healthcare facilities, reconstructed from laboratory records. Facility visits and staff interviews were used to determine reasons for movements. PARTICIPANTS AND SETTING People identified with MDR/RR-TB from 13 high-burden districts within South Africa. OUTCOME MEASURES Geospatial movement patterns were used to identify organisational models. Reasons for patient movement and implications of different organisational models for people affected by MDR/RR-TB and the health system were determined. RESULTS Among 191 participants, six dominant geospatial movement patterns were identified, which varied in average hospital stay (0-281 days), average patient distance travelled (12-198 km) and number of health facilities involved in care (1-5 facilities). More centralised models were associated with longer delays to treatment initiation and lengthy hospitalisation. Decentralised models facilitated family-centred care and were associated with reduced time to treatment and hospitalisation duration. Responsiveness to the needs of people affected by MDR/RR-TB and health system constraints was achieved through implementation of flexible models, or the implementation of multiple models in a district. CONCLUSIONS Understanding how models for organising care have evolved may assist policy implementers to tailor implementation to promote particular patterns of care organisation or encourage flexibility, based on patient needs and local health system resources. Our approach can contribute towards the development of a health systems typology for understanding how policy-driven models of service delivery are implemented in the context of variable resources.
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Affiliation(s)
- Lindy Dickson
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Sacha Roxanne Le Roux
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Leila Mitrani
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Jeremy Hill
- TB Centre, London School of Hygiene &Tropical Medicine, London, UK
| | - Waasila Jassat
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Helen Cox
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Institute for Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research, University of Cape Town, Cape Town, South Africa
| | - Koleka Mlisana
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
| | - John Black
- Division of Infectious Diseases, University of Cape Town, Cape Town, South Africa
| | - Marian Loveday
- South African Medical Research Council, Durban, South Africa
| | - Alison Grant
- TB Centre, London School of Hygiene &Tropical Medicine, London, UK
- Africa Health Research Institute, Somkhele, South Africa
| | - Karina Kielmann
- Institute of Tropical Medicine, Antwerp, Belgium
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Norbert Ndjeka
- National Tuberculosis Control Programme, National Department of Health, Pretoria, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
| | - Mark Nicol
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Marshall Centre for Infectious DIsease Research and Training, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
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Abdelgawad N, Wasserman S, Abdelwahab MT, Davis A, Stek C, Wiesner L, Black J, Meintjes G, Wilkinson RJ, Denti P. Linezolid population pharmacokinetic model in plasma and cerebrospinal fluid among patients with tuberculosis meningitis. medRxiv 2023:2023.04.06.23288230. [PMID: 37066148 PMCID: PMC10104225 DOI: 10.1101/2023.04.06.23288230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Linezolid is being evaluated in novel treatment regimens for tuberculous meningitis (TBM). The pharmacokinetics of linezolid have not been characterized in this population, particularly in cerebrospinal fluid (CSF) where exposures may be affected by changes in protein concentration and rifampicin co-administration. Methods This was a sub-study of a phase 2 clinical trial of intensified antibiotic therapy for adults with HIV-associated TBM. Participants in the intervention groups received high-dose rifampicin (35 mg/kg) plus linezolid 1200 mg daily for 28 days followed by 600 mg daily until day 56. Plasma was intensively sampled, and lumbar CSF was collected at a single timepoint in a randomly allocated sampling window, within 3 days after enrolment. Sparse plasma and CSF samples were also obtained on day 28. Linezolid concentrations were analyzed using non-linear mixed effects modelling. Results 30 participants contributed 247 plasma and 28 CSF linezolid observations. Plasma PK was best described by a one-compartment model with first-order absorption and saturable elimination. The typical value of maximal clearance was 7.25 L/h. Duration of rifampicin co-treatment (compared on day 3 versus day 28) did not affect linezolid pharmacokinetics. Partitioning between plasma and CSF correlated with CSF total protein concentration up to 1.2 g/L where the partition coefficient reached a maximal value of 37%. The equilibration half-life between plasma and CSF was estimated at ∼3.5 hours. Conclusion Linezolid was readily detected in CSF despite co-administration of the potent inducer rifampicin at high doses. These findings support continued clinical evaluation of linezolid plus high-dose rifampicin for the treatment of TBM in adults.
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Verboven L, Callens S, Black J, Maartens G, Dooley KE, Potgieter S, Cartuyvels R, Laukens K, Warren RM, Van Rie A. A machine-learning based model for automated recommendation of individualized treatment of rifampicin-resistant tuberculosis. Res Sq 2023:rs.3.rs-2525765. [PMID: 36824956 PMCID: PMC9949242 DOI: 10.21203/rs.3.rs-2525765/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background Rifampicin resistant tuberculosis remains a global health problem with almost half a million new cases annually. In high-income countries patients empirically start a standardized treatment regimen, followed by an individualized regimen guided by drug susceptibility test (DST) results. In most settings, DST information is not available or is limited to isoniazid and fluoroquinolones. Whole genome sequencing could more accurately guide individualized treatment as the full drug resistance profile is obtained with a single test. Whole genome sequencing has not reached its full potential for patient care, in part due to the complexity of translating a resistance profile into the most effective individualized regimen. Methods We developed a treatment recommender clinical decision support system (CDSS) and an accompanying web application for user-friendly recommendation of the optimal individualized treatment regimen to a clinician. Results Following expert stakeholder meetings and literature review, nine drug features and 14 treatment regimen features were identified and quantified. Using machine learning, a model was developed to predict the optimal treatment regimen based on a training set of 3895 treatment regimen-expert feedback pairs. The acceptability of the treatment recommender CDSS was assessed as part of a clinical trial and in a routine care setting. Within the clinical trial setting, all patients received the CDSS recommended treatment. In 8 of 20 cases, the initial recommendation was recomputed because of stock out, clinical contra-indication or toxicity. In routine care setting, physicians rejected the treatment recommendation in 7 out of 15 cases because it deviated from the national TB treatment guidelines. A survey indicated that the treatment recommender CDSS is easy to use and useful in clinical practice but requires digital infrastructure support and training. Conclusions Our findings suggest that global implementation of the novel treatment recommender CDSS holds the potential to improve treatment outcomes of rifampicin resistant tuberculosis.
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Affiliation(s)
| | | | - John Black
- University of Cape Town and Livingstone Hospital
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Le Roux SR, Jassat W, Dickson L, Mitrani L, Cox H, Mlisana K, Black J, Loveday M, Grant AD, Moshabela M, Kielmann K, Nicol MP. The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa. BMJ Glob Health 2022; 7:bmjgh-2022-008907. [PMID: 36593649 PMCID: PMC9743276 DOI: 10.1136/bmjgh-2022-008907] [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: 02/24/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions. DESIGN Interviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency. RESULTS All champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. 'Disease-centred' champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while 'patient-centred' champions promoted pathways of care that would optimise patients' recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context. CONCLUSION Policymakers can learn from champions' experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives.
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Affiliation(s)
- Sacha Roxanne Le Roux
- Division of Medical Microbiology,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Waasila Jassat
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Lindy Dickson
- Division of Medical Microbiology,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Leila Mitrani
- Division of Medical Microbiology,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Helen Cox
- Division of Medical Microbiology,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Institute for Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Koleka Mlisana
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - John Black
- Division of Infectious Diseases, Department of Medicine, University of Cape Town, Cape Town, South Africa,Department of Infectious Diseases, Livingstone Hospital, Port Elizabeth, South Africa
| | - Marian Loveday
- South Africa HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK,Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Karina Kielmann
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium,Institute of Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Mark P Nicol
- Division of Medical Microbiology,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Infection and Immunity, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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Davis AG, Wasserman S, Stek C, Maxebengula M, Liang CJ, Stegmann S, Koekemoer S, Jackson A, Kadernani Y, Bremer M, Daroowala R, Aziz S, Goliath R, Sai LL, Sihoyiya T, Denti P, Lai RP, Crede T, Naude J, Szymanski P, Vallie Y, Banderker IA, Moosa MS, Raubenheimer P, Candy S, Offiah C, Wahl G, Vorster I, Maartens G, Black J, Meintjes G, Wilkinson RJ. A phase 2A trial of the safety and tolerability of increased dose rifampicin and adjunctive linezolid, with or without aspirin, for HIV-associated tuberculous meningitis (The LASER-TBM Trial). Clin Infect Dis 2022; 76:1412-1422. [PMID: 36482216 PMCID: PMC10110270 DOI: 10.1093/cid/ciac932] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/12/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Drug regimens which include intensified antibiotics alongside effective anti-inflammatory therapies may improve outcomes in Tuberculous Meningitis (TBM). Safety data on their use in combination and in the context of HIV is needed to inform clinical trial design. METHODS We conducted a phase 2 open-label parallel-design RCT to assess safety of high-dose rifampicin, linezolid and high-dose aspirin in HIV-associated TBM. Participants were randomised (1.4:1:1) to three treatment arms (arm 1, standard of care (SOC); arm 2 SOC + additional rifampicin (up to 35mg/kg/day)) + linezolid 1200mg/day reducing after 28/7 to 600mg/day; arm 3, as per arm 2 + aspirin 1000mg/day) for 56 days, when the primary outcome of adverse events of special interest (AESI) or death was assessed. RESULTS 52 participants with HIV-associated TBM were randomised. 59% had mild disease (MRC Grade 1) vs 39% (Grade 2) vs 2% (Grade 3). 33% had microbiologically-confirmed TBM; 41% 'possible', 25% 'probable'. AESI or death occurred in 10/16 (63%) (arm 3) vs 4/14 (29%) (arm 2) vs 6/20 (30%) (arm 1) (p = 0.083). The cumulative proportion of AESI or death (Kaplan-Meier) demonstrated worse outcomes in arm 3 vs arm 1 (p = 0.04), however only one event in arm 3 was attributable to aspirin and was mild. There was no difference in efficacy (modified Rankin scale) at day 56 between arms. CONCLUSIONS High-dose rifampicin and adjunctive linezolid can safely be added to SOC in HIV-associated TBM. Larger studies are required to evaluate whether potential toxicity associated with these interventions, particularly high-dose aspirin, is outweighed by mortality or morbidity benefit.
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Affiliation(s)
- Angharad G Davis
- The Francis Crick Institute, Midland Road, London, NW1 1AT, United Kingdom.,Faculty of Life Sciences, University College London, WC1E 6BT, United Kingdom.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa.,Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Cari Stek
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa.,Department of Infectious Diseases, Imperial College London, W12 0NN, United Kingdom
| | - Mpumi Maxebengula
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - C Jason Liang
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Maryland, USA
| | - Stephani Stegmann
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Sonya Koekemoer
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Amanda Jackson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Yakub Kadernani
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Marise Bremer
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Remy Daroowala
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa.,Department of Infectious Diseases, Imperial College London, W12 0NN, United Kingdom
| | - Saalikha Aziz
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Louise Lai Sai
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Thandi Sihoyiya
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Paolo Denti
- The Francis Crick Institute, Midland Road, London, NW1 1AT, United Kingdom.,Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Rachel Pj Lai
- The Francis Crick Institute, Midland Road, London, NW1 1AT, United Kingdom.,Department of Infectious Diseases, Imperial College London, W12 0NN, United Kingdom
| | - Thomas Crede
- Mitchells Plain Hospital, 8 A Z Berman Drive, Lentegeur, Cape Town, 7785, South Africa
| | - Jonathan Naude
- Mitchells Plain Hospital, 8 A Z Berman Drive, Lentegeur, Cape Town, 7785, South Africa
| | - Patryk Szymanski
- Mitchells Plain Hospital, 8 A Z Berman Drive, Lentegeur, Cape Town, 7785, South Africa
| | - Yakoob Vallie
- New Somerset Hospital, Portswood Rd, Green Point, Cape Town, 8051, South Africa
| | | | - Muhammed S Moosa
- New Somerset Hospital, Portswood Rd, Green Point, Cape Town, 8051, South Africa
| | - Peter Raubenheimer
- Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Sally Candy
- Division of Diagnostic Radiology, University of Cape Town, Groote Schuur Hospital, Observatory 7925, Republic of South Africa
| | - Curtis Offiah
- Department of Neuroradiology, Imaging Department, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, E1 1BB, United Kingdom
| | - Gerda Wahl
- Department of Medicine, Walter Sisulu University, Mthatha 5117, Republic of South Africa
| | - Isak Vorster
- Division of Diagnostic Radiology, University of Cape Town, Groote Schuur Hospital, Observatory 7925, Republic of South Africa
| | - Gary Maartens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa.,Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - John Black
- Department of Medicine, Walter Sisulu University, Mthatha 5117, Republic of South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa.,Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Robert J Wilkinson
- The Francis Crick Institute, Midland Road, London, NW1 1AT, United Kingdom.,Faculty of Life Sciences, University College London, WC1E 6BT, United Kingdom.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa.,Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa.,Department of Infectious Diseases, Imperial College London, W12 0NN, United Kingdom
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Ben-Joseph R, Saad R, Black J, Dabrowski E, Taylor B, Gallucci S, Somers V. CardioVascular Burden Of Narcolepsy Disease (CV-BOND): A Real-World Evidence Study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.419] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moore H, Zheng A, Cairns A, Lillaney P, Black J. Enhancement of a Machine Learning Algorithm to Alert Sleep Clinicians of Patients at Risk for Narcolepsy, Using Nocturnal Polysomnography in General Sleep Medicine Clinics. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.429] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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Saad R, Somers V, Parks G, Pushkarna D, Fazeli M, Black J. Determinants of adherence/persistence to positive airway pressure therapy in patients with obstructive sleep apnoea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.658] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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11
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Upadhyay A, Lengden M, Enemali G, Stewart G, Johnstone W, Wilson D, Humphries G, Benoy T, Black J, Chighine A, Fisher E, Zhang R, Liu C, Polydorides N, Tsekenis A, Wright P, Kliment J, Nilsson J, Feng Y, Archilla V, Rodríguez-Carmona J, Sánchez-Valdepeñas J, Beltran M, Polo V, Armstrong I, Mauchline I, Walsh D, Johnson M, Bauldreay J, McCann H. Tomographic imaging of carbon dioxide in the exhaust plume of large commercial aero-engines. Appl Opt 2022; 61:8540-8552. [PMID: 36256172 DOI: 10.1364/ao.467828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
We report here the first implementation of chemically specific imaging in the exhaust plume of a gas turbine typical of those used for propulsion in commercial aircraft. The method used is chemical species tomography (CST) and the target species is CO2, absorbing in the near-infrared at 1999.4 nm. A total of 126 beams propagate transverse to the plume axis, along 7 m paths in a coplanar geometry, to probe a central region of diameter ≈1.5m. The CO2 absorption spectrum is measured using tunable diode laser spectroscopy with wavelength modulation, using the second harmonic to first harmonic (2f/1f) ratio method. The engine is operated over the full range of thrust, while data are recorded in a quasi-simultaneous mode at frame rates of 1.25 and 0.3125 Hz. Various data inversion methodologies are considered and presented for image reconstruction. At all thrust levels a persistent ring structure of high CO2 concentration is observed in the central region of the measurement plane, with a raised region in the middle of the plume assumed to be due to the engine's boat tail. With its potential to target various exhaust species, the CST method outlined here offers a new approach to turbine combustion research, turbine engine development, and aviation fuel research and development.
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Mashau RC, Meiring ST, Quan VC, Nel J, Greene GS, Garcia A, Menezes C, Reddy DL, Venter M, Stacey S, Madua M, Boretti L, Harrison TS, Meintjes G, Shroufi A, Trivino-Duran L, Black J, Govender NP. Outcomes of flucytosine-containing combination treatment for cryptococcal meningitis in a South African national access programme: a cross-sectional observational study. Lancet Infect Dis 2022; 22:1365-1373. [PMID: 35750065 DOI: 10.1016/s1473-3099(22)00234-1] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although flucytosine is a key component of WHO-recommended induction treatment for HIV-associated cryptococcal meningitis, this antifungal agent is not widely available in low-income and middle-income countries due to limited production and cost. In 2018, a national flucytosine access programme was initiated in South Africa. We aimed to determine the effectiveness of flucytosine-containing induction regimens in routine care to motivate for the urgent registration of flucytosine and its inclusion in treatment guidelines. METHODS In this cross-sectional study, we compared outcomes of adults aged 18 years and older with incident laboratory-confirmed cryptococcal meningitis treated with or without flucytosine-containing regimens at 19 sentinel hospitals in South Africa. A case of cryptococcosis was defined as illness in an adult with: (1) positive cerebrospinal fluid (CSF) India ink microscopy; (2) a positive CSF cryptococcal antigen test; or (3) culture of Cryptococcus neoformans or Cryptococcus gattii from CSF or any other specimen. We excluded patients without a case report form, those with an unknown or negative HIV serology result, those with a recurrent episode, and those who did not receive antifungal treatment in hospital. We assessed cumulative in-hospital mortality at 14 days and 30 days and calculated the overall crude in-hospital case-fatality ratio. We used random-effects logistic regression to examine the association between treatment group and in-hospital mortality. FINDINGS From July 1, 2018, to March 31, 2020, 10 668 individuals were diagnosed with laboratory-confirmed cryptococcal meningitis, 7787 cases diagnosed at non-enhanced surveillance sites and 567 cases from eight enhanced surveillance sites with no access to flucytosine were excluded. Of 2314 adults with a first episode of cryptococcosis diagnosed at 19 facilities with access to flucytosine, 1996 had a case report form and of these, 1539 received induction antifungal treatment and were confirmed HIV-seropositive first-episode cases. Of 1539 patients who received antifungal therapy, 596 (38·7%) individuals received a flucytosine-containing regimen and 943 (61·3%) received another regimen. The median age was 36 years (IQR 32-43) and 906 (58·9%) participants were male and 633 (41·1%) were female. The crude in-hospital case-fatality ratio was 23·9% (95% CI 20·0-27·0; 143 of 596) in those treated with flucytosine-containing regimens and 37·2% (95% CI 34·0-40·0; 351 of 943) in those treated with other regimens. Patients admitted to non-academic hospitals (adjusted odds ratio [aOR] 1·95 [95% CI 1·53-2·48]; p<0·0001) and those who were antiretroviral treatment-experienced (aOR 1·30 [1·02-1·67]; p=0·033) were more likely to receive flucytosine. After adjusting for relevant confounders, flucytosine treatment was associated with a 53% reduction in mortality (aOR 0·47 [95% CI 0·35-0·64]; p<0·0001). Among survivors, the median length of hospital admission in the flucytosine group was 11 days (IQR 8-15) versus 17 days (13-21) in the comparison group (p=0·0010). INTERPRETATION In-hospital mortality among patients treated with a flucytosine-containing regimen was comparable to reduced mortality reported in patients receiving a flucytosine-containing regimen in a recent multicentre African clinical trial. Flucytosine-based treatment can be delivered in routine care in a middle-income country with a substantial survival benefit. FUNDING National Institute for Communicable Diseases, a Division of the National Health Laboratory Service. TRANSLATION For the Zulu translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Rudzani C Mashau
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
| | - Susan T Meiring
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vanessa C Quan
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Jeremy Nel
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Infectious Diseases, Department of Medicine, Helen Joseph Hospital, Johannesburg, South Africa
| | - Greg S Greene
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Andrea Garcia
- Clinton Health Access Initiative, Pretoria, South Africa
| | - Colin Menezes
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Denasha L Reddy
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Michelle Venter
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Sarah Stacey
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Matamela Madua
- Department of Medicine, Rob Ferreira Hospital, Mbombela, South Africa
| | - Lia Boretti
- Division of Infectious Diseases and HIV Medicine, Livingstone Hospital, Gqeberha, South Africa
| | - Thomas S Harrison
- Institute of Infection and Immunity, St George's University of London, London, UK; Clinical Academic Group in Infection and Immunity, St George's University Hospitals NHS Foundation Trust, London, UK; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Graeme Meintjes
- Department of Medicine, Wellcome Centre for Infectious Diseases Research in Africa and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Amir Shroufi
- Medecins Sans Frontieres/Doctors Without Borders, Johannesburg, South Africa
| | - Laura Trivino-Duran
- Medecins Sans Frontieres/Doctors Without Borders, Johannesburg, South Africa
| | - John Black
- Division of Infectious Diseases and HIV Medicine, Livingstone Hospital, Gqeberha, South Africa
| | - Nelesh P Govender
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Institute of Infection and Immunity, St George's University of London, London, UK; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK; Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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13
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Lobl M, Georgesen C, Black J, Lum M, Lauer S, Whitley M, Wysong A. 821 ALK expression in metastatic cutaneous squamous cell carcinoma: A pilot study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Black J, Cox M, Chung W, Lowe M, Barber J, Dennison AR, Bagul A, Yang B. O083 A proof of principle study of cell targeted delivery of sirna guided by innate repair receptor epor/βcr highly expressed by injured tubular epithelial cells in porcine kidneys subjected to extended cold ischaemia times. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction
Small interfering RNA (siRNA) has been used in biological models for disease modification. Whilst challenges remain with targeted cell delivery, caspase-3, an executing enzyme of apoptosis and inflammation, plays a crucial role in acute kidney injury. Using caspase-3 siRNA or erythropoietin derived peptide CHBP, we have demonstrated renoprotection against ischaemia-reperfusion injury in isolated kidney preservation, and further applied the conjugate of both.
Methods
Porcine kidneys (n = 3) subjected to 10 minutes of warm ischemia were retrieved and perfused with 500 mL hyperosmolar citrate. In comparison with the control (Kidney 1) caspase-3 siRNAHBSP (Kidney 2) or CHBP (Kidney 3) conjugate was administered into the kidney and autologous blood and stored for 22 hours in ice. Organs were then preserved by normothermic perfusion (NP) for 3 hours using clinical-grade cardiopulmonary bypass. Functional parameters were recorded, and kidney biopsies were taken at time zero (pre-perfusion) and hourly intervals following NP.
Results
Preliminary findings showed increased arterial flow rate and urine output together with neutralised perfusate pH in the kidneys (2 and 3) receiving both conjugates compared to the control.
Conclusion
Improved physiological outcomes in kidneys subjected to the novel agent treatment suggest protective effects against ischaemia. We hypothesise outcomes should be transferrable to human kidneys, which may facilitate the use of marginal kidneys following prolonged ischaemia, otherwise deemed unsuitable for transplantation. Renal histological and molecular studies of the effect of the agent are underway.
Take-home message
Despite a small sample, this pilot proof of principle study suggests that caspase-3 inhibitors may have a role in limiting the detrimental effects of ischaemia on renal tissues subjected to prolonged cold ischaemic times. It is hoped that this may be beneficial if replicated in the human kidney model at increasing the deceased donor organ pool by enabling use of marginal kidneys subjected to prolonged ischaemic times.
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Affiliation(s)
- J Black
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - M Cox
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - W Chung
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - M Lowe
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - J Barber
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - AR Dennison
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - A Bagul
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - B Yang
- Leicester General Hospital, University Hospitals of Leicester , UK
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15
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Spies R, Potter M, Govender S, Kirk L, Rauch S, Black J. SARS-CoV-2 infection in public hospital medical doctors in an Eastern Cape metro. S Afr J Infect Dis 2022; 37:335. [PMID: 35399560 PMCID: PMC8991316 DOI: 10.4102/sajid.v37i1.335] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ruan Spies
- Department of Medicine, Port Elizabeth Hospital Complex, Gqeberha, South Africa
| | - Matthew Potter
- Department of Medicine, Port Elizabeth Hospital Complex, Gqeberha, South Africa
| | - Sudarshan Govender
- Department of Medicine, Port Elizabeth Hospital Complex, Gqeberha, South Africa
| | - Luke Kirk
- Department of Medicine, Port Elizabeth Hospital Complex, Gqeberha, South Africa
| | - Simon Rauch
- Department of Medicine, Port Elizabeth Hospital Complex, Gqeberha, South Africa
| | - John Black
- Department of Infectious Diseases, Livingstone Hospital, Gqeberha, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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16
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Verboven L, Calders T, Callens S, Black J, Maartens G, Dooley KE, Potgieter S, Warren RM, Laukens K, Van Rie A. A treatment recommender clinical decision support system for personalized medicine: method development and proof-of-concept for drug resistant tuberculosis. BMC Med Inform Decis Mak 2022; 22:56. [PMID: 35236355 PMCID: PMC8892778 DOI: 10.1186/s12911-022-01790-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/22/2022] [Indexed: 12/28/2022] Open
Abstract
Background Personalized medicine tailors care based on the patient’s or pathogen’s genotypic and phenotypic characteristics. An automated Clinical Decision Support System (CDSS) could help translate the genotypic and phenotypic characteristics into optimal treatment and thus facilitate implementation of individualized treatment by less experienced physicians.
Methods We developed a hybrid knowledge- and data-driven treatment recommender CDSS. Stakeholders and experts first define the knowledge base by identifying and quantifying drug and regimen features for the prototype model input. In an iterative manner, feedback from experts is harvested to generate model training datasets, machine learning methods are applied to identify complex relations and patterns in the data, and model performance is assessed by estimating the precision at one, mean reciprocal rank and mean average precision. Once the model performance no longer iteratively increases, a validation dataset is used to assess model overfitting. Results We applied the novel methodology to develop a treatment recommender CDSS for individualized treatment of drug resistant tuberculosis as a proof of concept. Using input from stakeholders and three rounds of expert feedback on a dataset of 355 patients with 129 unique drug resistance profiles, the model had a 95% precision at 1 indicating that the highest ranked treatment regimen was considered appropriate by the experts in 95% of cases. Use of a validation data set however suggested substantial model overfitting, with a reduction in precision at 1 to 78%. Conclusion Our novel and flexible hybrid knowledge- and data-driven treatment recommender CDSS is a first step towards the automation of individualized treatment for personalized medicine. Further research should assess its value in fields other than drug resistant tuberculosis, develop solid statistical approaches to assess model performance, and evaluate their accuracy in real-life clinical settings.
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Affiliation(s)
- Lennert Verboven
- Torch Consortium FAMPOP Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. .,ADReM Data Lab, Department of Computer Science, University of Antwerp, Antwerp, Belgium.
| | - Toon Calders
- ADReM Data Lab, Department of Computer Science, University of Antwerp, Antwerp, Belgium
| | - Steven Callens
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgium
| | - John Black
- Department of Internal Medicine, University of Cape Town and Livingstone Hospital, Port Elizabeth, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kelly E Dooley
- Divisions of Clinical Pharmacology and Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samantha Potgieter
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Robin M Warren
- Division of Molecular Biology and Human Genetics, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Kris Laukens
- ADReM Data Lab, Department of Computer Science, University of Antwerp, Antwerp, Belgium
| | - Annelies Van Rie
- Torch Consortium FAMPOP Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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17
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Esmail A, Oelofse S, Lombard C, Perumal R, Mbuthini L, Goolam Mahomed A, Variava E, Black J, Oluboyo P, Gwentshu N, Ngam E, Ackerman T, Marais L, Mottay L, Meier S, Pooran A, Tomasicchio M, Te Riele J, Derendinger B, Ndjeka N, Maartens G, Warren R, Martinson N, Dheda K. An All-Oral 6-Month Regimen for Multidrug-Resistant TB (the NExT Study): A Multicenter, Randomized Controlled Trial. Am J Respir Crit Care Med 2022; 205:1214-1227. [PMID: 35175905 DOI: 10.1164/rccm.202107-1779oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale/objectives: Improving treatment outcomes, reducing drug toxicity, avoiding injectable agents, and shortening the treatment duration to 6-months (approximating that of rifampicin-susceptible tuberculosis) remains an aspirational goal for the treatment of multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB). METHODS We conducted a multicentre randomised controlled trial in adults with MDR/RR-TB (i.e. without resistance to fluoroquinolones or aminoglycosides). Participants were randomly assigned (1:1 ratio) to a ~6-month all-oral regimen that included levofloxacin, bedaquiline and linezolid, or the standard-of-care ≥ 9-month WHO-approved injectable-based regimen. The primary endpoint was a favourable WHO-defined treatment outcome 24 months after treatment initiation. MAIN RESULTS 93 of 111 participants randomised were included in the modified intention-to-treat analysis; 51 (55%) were HIV co-infected (median CD4 count 158 cells/mL). Participants in the intervention arm were 2.2 times more likely to experience a favourable 24-month outcome than participants in the standard-of-care arm [RR 2.2 (1.2-4.1); p=0.006]. Toxicity-related drug substitution occurred more frequently in the standard-of-care arm [(65·9% (29/44) versus 36·7% (18/49), p= 0·001)]; 79.3% (23/29) due to kanamycin (mainly hearing loss; replaced by bedaquiline) in the standard-of-care arm, and 83·3% (15/18) due to linezolid (mainly anaemia) in the interventional arm. Culture conversion was significantly better in the intervention arm [HR 2.6 (1.4-4.9); p= 0.003] after censoring those with bedaquiline replacement in the standard-of-care arm. CONCLUSIONS An all-oral 6-month levofloxacin, bedaquiline and linezolid-containing MDR/RR-TB regimen was associated with significantly improved 24-month treatment outcomes compared with traditional injectable-containing regimens. However, drug toxicity occurred frequently in both arms. These findings inform strategies to develop future regimens for MDR/RR-TB. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02454205.
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Affiliation(s)
- Aliasgar Esmail
- University of Cape Town, 37716, Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, Rondebosch, South Africa.,University of Cape Town, 37716, South African MRC Centre for the Study of Antimicrobial Resistance, Cape Town, South Africa
| | - Suzette Oelofse
- University of Cape Town, 37716, Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, Cape Town, South Africa.,University of Cape Town, 37716, South African MRC Centre for the Study of Antimicrobial Resistance, Cape Town, South Africa
| | - Carl Lombard
- South African Medical Research Council, 59097, Biostatistics Unit, Cape Town, South Africa.,University of Stellenbosch, 26697, Division of Epidemiology and Biostatistics, Department of Global Health, Cape Town, South Africa
| | - Rubeshan Perumal
- University of Cape Town, 37716, Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, Cape Town, South Africa.,University of Cape Town, 37716, South African MRC Centre for the Study of Antimicrobial Resistance, Cape Town, South Africa
| | - Linda Mbuthini
- University of Cape Town, 37716, Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, Cape Town, South Africa
| | - Akhter Goolam Mahomed
- Sefako Makgatho Health Sciences University, 37715, Department of Intensive Care, Medunsa Campus, Pretoria, South Africa
| | - Ebrahim Variava
- University of the Witwatersrand, 37707, Department of Internal Medicine, Johannesburg, South Africa.,North West Department of Health, 108195, Perinatal HIV Research Unit, Mahikeng, South Africa
| | - John Black
- Walter Sisulu University and Livingstone Tertiary Hospital, Department of Internal Medicine, Mthatha, South Africa
| | - Patrick Oluboyo
- Walter Sisulu University and Nelson Mandela Academic Hospital, Head of Pulmonology, Department of Medicine, Mthatha, South Africa
| | | | - Eric Ngam
- Don Makenzie Hospital, Durban, South Africa
| | - Tertius Ackerman
- University of Stellenbosch, 26697, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for TB Research/Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Lynelle Mottay
- University of Cape Town, 37716, Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, Cape Town, South Africa.,University of Cape Town, 37716, South African MRC Centre for the Study of Antimicrobial Resistance, Cape Town, South Africa
| | - Stuart Meier
- University of Cape Town, 37716, Centre for Lung Infection and Immunity , Division of Pulmonology, Department of Medicine and UCT Lung Institute, Cape Town, South Africa.,University of Cape Town, 37716, South African MRC Centre for the Study of Antimicrobial Resistance, Cape Town, South Africa
| | - Anil Pooran
- University of Cape Town, 37716, Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, Cape Town, South Africa.,University of Cape Town, 37716, South African MRC Centre for the Study of Antimicrobial Resistance, Cape Town, South Africa
| | - Michele Tomasicchio
- University of Cape Town, 37716, Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, Cape Town, South Africa.,University of Cape Town, 37716, South African MRC/UCT Centre for the Study of Antimicrobial Resistance, Cape Town, South Africa
| | | | - Brigitta Derendinger
- University of Stellenbosch, 26697, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, Cape Town, South Africa
| | - Norbert Ndjeka
- National Department of Health, Drug Resistant TB Directorate, Pretoria, South Africa
| | - Gary Maartens
- University of Cape Town, 37716, Division of Clinical Pharmacology, Department of Medicine, Cape Town, South Africa
| | - Robin Warren
- University of Stellenbosch, 26697, 13DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for TB Research/Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Neil Martinson
- University of the Witwatersrand, 37707, Perinatal HIV Research Unit (PHRU), Johannesburg, South Africa.,Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States
| | - Keertan Dheda
- University of Cape Town, Centre for Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, Cape Town, South Africa.,University of Cape Town, 37716, South African MRC Centre for the Study of Antimicrobial Resistance, Cape Town, South Africa.,London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, 218289, London, United Kingdom of Great Britain and Northern Ireland;
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18
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van den Berg K, Glatt TN, Vermeulen M, Little F, Swanevelder R, Barrett C, Court R, Bremer M, Nyoni C, Swarts A, Mmenu C, Crede T, Kritzinger G, Naude J, Szymanski P, Cowley J, Moyo-Gwete T, Moore PL, Black J, Singh J, Bhiman JN, Baijnath P, Mody P, Malherbe J, Potgieter S, van Vuuren C, Maasdorp S, Wilkinson RJ, Louw VJ, Wasserman S. Convalescent plasma in the treatment of moderate to severe COVID-19 pneumonia: a randomized controlled trial (PROTECT-Patient Trial). Sci Rep 2022; 12:2552. [PMID: 35169169 PMCID: PMC8847351 DOI: 10.1038/s41598-022-06221-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
There is a need for effective therapy for COVID-19 pneumonia. Convalescent plasma has antiviral activity and early observational studies suggested benefit in reducing COVID-19 severity. We investigated the safety and efficacy of convalescent plasma in hospitalized patients with COVID-19 in a population with a high HIV prevalence and where few therapeutic options were available. We performed a double-blinded, multicenter, randomized controlled trial in one private and three public sector hospitals in South Africa. Adult participants with COVID-19 pneumonia requiring non-invasive oxygen were randomized 1:1 to receive a single transfusion of 200 mL of either convalescent plasma or 0.9% saline solution. The primary outcome measure was hospital discharge and/or improvement of ≥ 2 points on the World Health Organisation Blueprint Ordinal Scale for Clinical Improvement by day 28 of enrolment. The trial was stopped early for futility by the Data and Safety Monitoring Board. 103 participants, including 21 HIV positive individuals, were randomized at the time of premature trial termination: 52 in the convalescent plasma and 51 in the placebo group. The primary outcome occurred in 31 participants in the convalescent plasma group and and 32 participants in the placebo group (relative risk 1.03 (95% CI 0.77 to 1.38). Two grade 1 transfusion-related adverse events occurred. Participants who improved clinically received convalescent plasma with a higher median anti-SARS-CoV-2 neutralizing antibody titre compared with those who did not (298 versus 205 AU/mL). Our study contributes additional evidence for recommendations against the use of convalescent plasma for COVID-19 pneumonia. Safety and feasibility in this population supports future investigation for other indications.
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Affiliation(s)
- Karin van den Berg
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa.
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa.
- Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa.
| | - Tanya Nadia Glatt
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Marion Vermeulen
- Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
- Operations Division, Operations Testing Department, South African National Blood Service, Roodepoort, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Observatory, South Africa
| | - Ronel Swanevelder
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Claire Barrett
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
| | - Richard Court
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - Marise Bremer
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - Cynthia Nyoni
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Avril Swarts
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Cordelia Mmenu
- Operations Division, Operations Testing Department, South African National Blood Service, Roodepoort, South Africa
| | - Thomas Crede
- Mitchells Plain Hospital and the University of Cape Town's Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Gerdien Kritzinger
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Jonathan Naude
- Mitchells Plain Hospital and the University of Cape Town's Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Patryk Szymanski
- Mitchells Plain Hospital and the University of Cape Town's Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - James Cowley
- Operations Division, Processing Department, South African National Blood Service, Roodepoort, South Africa
| | - Thandeka Moyo-Gwete
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Penny L Moore
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John Black
- Department of Medicine, Walter Sisulu University, Livingstone Hospital, Gqeberha, South Africa
| | - Jaimendra Singh
- Capital Haematology Hospital and Bone Marrow Transplant Unit, Durban, South Africa
| | - Jinal N Bhiman
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Priyesh Mody
- Life Westville Hospital, Westville, South Africa
| | - Jacques Malherbe
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
| | - Samantha Potgieter
- Division of Infectious Diseases, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - Cloete van Vuuren
- 3 Military Hospital and Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - Shaun Maasdorp
- Pulmonology and Critical Care, Universitas Academic Hospital and Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Francis Crick Institute, London, NW1 1AT, UK
- Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Observatory, South Africa
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19
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Inkster T, Wilson G, Black J, Mallon J, Connor M, Weinbren M. Cupriavidus spp and other waterborne organisms in healthcare water systems across the United Kingdom. J Hosp Infect 2022; 123:80-86. [PMID: 35181399 DOI: 10.1016/j.jhin.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cupriavidus pauculus is a rare clinical pathogen with cases having been linked to contaminated hospital water systems. An outbreak of three cases of C. pauculus and other waterborne organisms was reported in a Glasgow hospital in 2018. AIMS The aim of this study was to determine whether Cupriavidus spp are present in hospital water systems elsewhere in Scotland and the UK and to ascertain the optimal laboratory methodology for detection. We also sought to establish where in the water system these organisms are detected and whether a selective media could be developed for isolation. In addition, we tested water samples for the presence of other Gram negative waterborne organisms. METHODS Water samples were received from ten UK NHS hospitals and from various parts of the water system. Isolates were plated on to TSA and Pseudomonas Isolation Agar and further identified using MALDI-TOF and 16S PCR FINDINGS: Cupriavidus spp. were detected in four of ten hospitals tested and all five isolates were from the periphery of the water system. All hospitals had evidence of other OPPPs. Cupriavidus spp. were identified using TSA, with some isolates growing on Pseudomonas isolation agar; as such they may be inadvertently be detected when testing water specifically for Pseudomonas aeruginosa. CONCLUSION This study demonstrates that isolation of Cupriavidus spp. was not unique to the Glasgow incident, these bacteria being present in hospital water systems elsewhere in the UK. We therefore recommend water testing in response to clinical cases. Consideration should also be given to water testing following bacteraemias due to other rare and unusual water borne pathogens.
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Affiliation(s)
- T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK; NHS Assure, National Services Scotland, Edinburgh, UK.
| | - G Wilson
- Department of Microbiology, Glasgow Royal Infirmary, Glasgow, UK
| | - J Black
- Department of Microbiology, Glasgow Royal Infirmary, Glasgow, UK
| | - J Mallon
- Department of Microbiology, Glasgow Royal Infirmary, Glasgow, UK
| | - M Connor
- Department of Microbiology, Dumfries and Galloway Hospital, UK
| | - M Weinbren
- NHS Assure, National Services Scotland, Edinburgh, UK
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20
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Feldman C, Dlamini S, Richards GA, Black J, Butler ILC, Cutland C, Hefer E, Hodkinson B, Kok A, Manga P, Meiring S, Molaudzi M, Moosa MYS, Parker S, Peter J, van Vuuren C, Verburgh E, Watermeyer G. A comprehensive overview of pneumococcal vaccination recommendations for adults in South Africa, 2022. J Thorac Dis 2022; 14:4150-4172. [DOI: 10.21037/jtd-22-287] [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: 03/03/2022] [Accepted: 07/28/2022] [Indexed: 11/06/2022]
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21
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Hansoti B, Mishra A, Rao A, Chimoyi L, Redd AD, Reynolds SJ, Stead DF, Black J, Maharaj R, Hahn E, Mda P, Mvandaba N, Nyanisa Y, Chen V, Clark K, Ryan S, Quinn TC. The geography of emergency department-based HIV testing in South Africa: Can patients link to care? EClinicalMedicine 2021; 40:101091. [PMID: 34746712 PMCID: PMC8548925 DOI: 10.1016/j.eclinm.2021.101091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Emergency Departments (EDs) can serve as clinical sites for identification of new HIV infections and their entry into care. We examined if HIV-positive patients who present to EDs in South Africa are able to successfully link to care. METHODS We conducted a one-year longitudinal prospective cohort study in four hospitals across the Eastern Cape, South Africa, with participants followed between July 2016 and July 2018. All adult, non-critical patients presenting to the ED were systematically approached, asked about their HIV status, and, if unknown, offered a point-of-care (POC) HIV test. All HIV-positive patients were further consented to participate in a follow-up study to assess subsequent linkage to care and distance from "home" to ED. Linkage to care was defined as self-reported linkage (telephonic) or evidence of repeated CD4/viral load testing in the National Health Laboratory System (NHLS) at either the 6- or 12-months post index ED visit. FINDINGS A total of 983 HIV-positive patients consented to participate in the study. In the 12 months following their ED visit, 34·1% of patients demonstrated linkage to care (335/983), 23·8% did not link to care (234/983), and 42·1% (414/983) were lost to follow-up. Though not statistically significant, a high percentage of young men (27/50, 54%) and those presenting with a trauma-related complaints (100/205, 48.8%) did not link to care. A considerable proportion of patients (105/454, 23·2%,) resided 50 or more kilometers from their index ED sites, though there was not a significant difference in linkage to care rate between those who lived closer or further from the ED. INTERPRETATION We have shown that strategies to improve linkage to care from the ED should consider the high rates of poor linkage among young men and those presenting to the ED with trauma. Furthermore, innovative linkage to care solutions will need to account for the unique geographical consideration of this population, given that many ED patients will need to continue care at a site distant from the diagnosis site. FUNDING This research was supported by the South African Medical Research Council, the Division of Intramural Research, the National Institute of Allergy and Infectious Diseases, National Institutes of Health, and the Johns Hopkins Center for Global Health.
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Affiliation(s)
- Bhakti Hansoti
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
- Corresponding author.
| | - Anant Mishra
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Aditi Rao
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, 29 Queens Rd, Parktown, Johannesburg, 2194, South Africa
| | - Andrew D. Redd
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr #7A03, Bethesda, MD 20892, USA
| | - Steven J. Reynolds
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr #7A03, Bethesda, MD 20892, USA
- Department of Family Medicine and Health Sciences, Faculty of Medicine, University of Cape Town, Anzio Rd, Cape Town 7925, South Africa
| | - David F. Stead
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Medicine, Frere and Cecilia Makiwane Hospitals, Amalinda Main Rd, Braelyn, East London 5201, South Africa
| | - John Black
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Medicine, Livingstone Hospital, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
| | - Roshen Maharaj
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Emergency Medicine, Livingstone Hospital, Port Elizabeth, South Africa, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
| | - Elizabeth Hahn
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Pamela Mda
- Nelson Mandela Hospital Clinical Research Unit, Sisson St, Fort Gale, Mthatha 5100, South Africa
| | - Nomzamo Mvandaba
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Yandisa Nyanisa
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Victoria Chen
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Katie Clark
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Sofia Ryan
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Thomas C. Quinn
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr #7A03, Bethesda, MD 20892, USA
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22
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Mitrani L, Dickson-Hall L, Le Roux S, Hill J, Loveday M, Grant AD, Kielmann K, Mlisana K, Moshabela M, Nicol MP, Black J, Cox H. Diverse clinical and social circumstances: developing patient-centred care for DR-TB patients in South Africa. Public Health Action 2021; 11:120-125. [PMID: 34567987 PMCID: PMC8455019 DOI: 10.5588/pha.20.0083] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the medical, socio-economic and geographical profiles of patients with rifampicin-resistant TB (RR-TB) and the implications for the provision of patient-centred care. SETTING Thirteen districts across three South African provinces. DESIGN This descriptive study examined laboratory and healthcare facility records of 194 patients diagnosed with RR-TB in the third quarter of 2016. RESULTS The median age was 35 years; 120/194 (62%) of patients were male. Previous TB treatment was documented in 122/194 (63%) patients and 56/194 (29%) had a record of fluoroquinolone and/or second-line injectable resistance. Of 134 (69%) HIV-positive patients, viral loads were available for 68/134 (51%) (36/68 [53%] had viral loads of >1000 copies/ml) and CD4 counts were available for 92/134 (69%) (20/92 [22%] had CD4 <50 cells/mm3). Patients presented with varying other comorbidities, including hypertension (13/194, 7%) and mental health conditions (11/194, 6%). Of 194 patients, 44 (23%) were reported to be employed. Other socio-economic challenges included substance abuse (17/194, 9%) and ill family members (17/194, 9%). Respectively 13% and 42% of patients were estimated to travel more than 20 km to reach their diagnosing and treatment-initiating healthcare facility. CONCLUSIONS RR-TB patients had diverse medical and social challenges highlighting the need for integrated, differentiated and patient-centred healthcare to better address specific needs and underlying vulnerabilities of individual patients.
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Affiliation(s)
- L Mitrani
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - L Dickson-Hall
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - S Le Roux
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - J Hill
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - M Loveday
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - A D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Africa Health Research Institute, School of Laboratory Medicine & Medical Sciences, College of Health Sciences and School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - K Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK
| | - K Mlisana
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - M Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - M P Nicol
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - J Black
- Livingstone Hospital, Eastern Cape Department of Health, Port Elizabeth, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - H Cox
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
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Karna R, Hans B, Murone J, Black J. Cranial nerve palsies, SIADH and atrial fibrillation: a diagnostic challenge. BMJ Case Rep 2021; 14:e244807. [PMID: 34521742 PMCID: PMC8442043 DOI: 10.1136/bcr-2021-244807] [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] [Accepted: 08/31/2021] [Indexed: 11/03/2022] Open
Abstract
We recently encountered a 79-year-old Caucasian man who presented with blurring of vision and facial muscle weakness. The patient also had hyponatraemia, atrial fibrillation with rapid ventricular response and underlying Brugada type II pattern. Urine and serum osmolality were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). It was only after extensive imaging and workup that we were able to tie together these three different presentations of Lyme disease-cranial nerve palsies, SIADH and atrial fibrillation and treat them accordingly. To the best of our knowledge, only eight cases of SIADH in patients with Lyme neuroborreliosis have been reported in the literature. Although our patient did not have a history of arrhythmias, case findings suggest that underlying Brugada type II morphology could have been the predisposing factor, and Lyme disease the trigger.
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Affiliation(s)
- Rahul Karna
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Bandhul Hans
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Julie Murone
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - John Black
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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24
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Roberts JS, Hahn EA, Black J, Maharaj R, Farley JE, Redd AD, Reynolds SJ, Quinn TC, Hansoti B. Determining the prevalence of tuberculosis in emergency departments in the Eastern Cape region of South Africa and the utility of the World Health Organization tuberculosis screening tool. S Afr Med J 2021; 111:872-878. [PMID: 34949252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND South Africa (SA) faces a significant tuberculosis (TB) burden complicated by high rates of HIV-TB co-infection. In SA, emergency departments (EDs) play an important role in screening for TB. OBJECTIVES To determine the prevalence of TB in the ED and the effectiveness of the World Health Organization (WHO) TB screening tool. METHODS This was a cross-sectional observational study, conducted in the ED at Livingstone Hospital, Port Elizabeth, from 4 June to 15 July 2018. All patients aged >18 years and able to consent were administered the WHO TB screening questions and underwent a point-of-care HIV test and demographic data collection. Patients were followed up for 1 year and tracked in the National Health Laboratory Service database to determine TB status using laboratory testing. RESULTS Over the study period, 790 patients were enrolled. Overall, 121 patients (15.3%) were TB-positive, with 46 (38.0%) diagnosed after presenting to the ED and 75 (62.0%) with a previous TB history determined by self-report or confirmed laboratory testing. A greater proportion of the TB-positive patients were HIV-positive (49.6%) compared with the TB-negative population (24.8%). TB-positive individuals were more likely to present to the ED with a chief complaint of shortness of breath (SoB) (18.2%) compared with the TB-negative population (10.5%). Overall, the WHO TB screening tool had poor sensitivity (46.5%) and specificity (62.5%) for identifying TB-positive patients in the ED. A multiple logistic regression analysis, controlled for age and sex, showed HIV status (odds ratio (OR) 2.81; p<0.001) and SoB (OR 2.19; p<0.05) to be significant predictors of TB positivity. Adding positive HIV status and a presenting complaint of SoB increased sensitivity to 78.3%. CONCLUSIONS EDs in SA face a high burden of TB. While WHO screening guidelines identify some of these patients, including routine HIV testing in the ED could significantly affect the number of TB diagnoses made.
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Affiliation(s)
- J S Roberts
- Johns Hopkins School of Medicine, Baltimore, Md, USA.
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25
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Jassat W, Cohen C, Tempia S, Masha M, Goldstein S, Kufa T, Murangandi P, Savulescu D, Walaza S, Bam JL, Davies MA, Prozesky HW, Naude J, Mnguni AT, Lawrence CA, Mathema HT, Zamparini J, Black J, Mehta R, Parker A, Chikobvu P, Dawood H, Muvhango N, Strydom R, Adelekan T, Mdlovu B, Moodley N, Namavhandu EL, Rheeder P, Venturas J, Magula N, Blumberg L. Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study. Lancet HIV 2021; 8:e554-e567. [PMID: 34363789 PMCID: PMC8336996 DOI: 10.1016/s2352-3018(21)00151-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022]
Abstract
Background The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15–49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19. Methods In this cohort study, we used data submitted to DATCOV, a national active hospital surveillance system for COVID-19 hospital admissions, for patients admitted to hospital with laboratory-confirmed SARS-CoV-2 infection between March 5, 2020, and March 27, 2021. Age, sex, race or ethnicity, and comorbidities (hypertension, diabetes, chronic cardiac disease, chronic pulmonary disease and asthma, chronic renal disease, malignancy in the past 5 years, HIV, and past and current tuberculosis) were considered as risk factors for COVID-19-related in-hospital mortality. COVID-19 in-hospital mortality, the main outcome, was defined as a death related to COVID-19 that occurred during the hospital stay and excluded deaths that occurred because of other causes or after discharge from hospital; therefore, only patients with a known in-hospital outcome (died or discharged alive) were included. Chained equation multiple imputation was used to account for missing data and random-effects multivariable logistic regression models were used to assess the role of HIV status and underlying comorbidities on COVID-19 in-hospital mortality. Findings Among the 219 265 individuals admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and known in-hospital outcome data, 51 037 (23·3%) died. Most commonly observed comorbidities among individuals with available data were hypertension in 61 098 (37·4%) of 163 350, diabetes in 43 885 (27·4%) of 159 932, and HIV in 13 793 (9·1%) of 151 779. Tuberculosis was reported in 5282 (3·6%) of 146 381 individuals. Increasing age was the strongest predictor of COVID-19 in-hospital mortality. Other factors associated were HIV infection (adjusted odds ratio 1·34, 95% CI 1·27–1·43), past tuberculosis (1·26, 1·15–1·38), current tuberculosis (1·42, 1·22–1·64), and both past and current tuberculosis (1·48, 1·32–1·67) compared with never tuberculosis, as well as other described risk factors for COVID-19, such as male sex; non-White race; underlying hypertension, diabetes, chronic cardiac disease, chronic renal disease, and malignancy in the past 5 years; and treatment in the public health sector. After adjusting for other factors, people with HIV not on antiretroviral therapy (ART; adjusted odds ratio 1·45, 95% CI 1·22–1·72) were more likely to die in hospital than were people with HIV on ART. Among people with HIV, the prevalence of other comorbidities was 29·2% compared with 30·8% among HIV-uninfected individuals. Increasing number of comorbidities was associated with increased COVID-19 in-hospital mortality risk in both people with HIV and HIV-uninfected individuals. Interpretation Individuals identified as being at high risk of COVID-19 in-hospital mortality (older individuals and those with chronic comorbidities and people with HIV, particularly those not on ART) would benefit from COVID-19 prevention programmes such as vaccine prioritisation as well as early referral and treatment. Funding South African National Government.
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Affiliation(s)
- Waasila Jassat
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; MassGenics, Duluth, GA, USA
| | | | - Susan Goldstein
- South Africa Medical Research Council Centre for Health Economics and Decision Science-PRICELESS SA, University of the Witwatersrand, Johannesburg, South Africa
| | - Tendesayi Kufa
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Pelagia Murangandi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Dana Savulescu
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Jamy-Lee Bam
- Western Cape Department of Health, Cape Town, South Africa
| | | | - Hans W Prozesky
- Tygerberg Hospital and Division of Infectious Disease, University of Stellenbosch, Cape Town, South Africa
| | - Jonathan Naude
- Mitchells Plain District Hospital, Cape Town, South Africa
| | | | | | - Hlengani T Mathema
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Jarrod Zamparini
- Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - John Black
- Livingstone Hospital, Walter Sisulu University, Nelson Mandela Bay, South Africa
| | - Ruchika Mehta
- Klerksdorp-Tshepong Hospital, University of Witwatersrand, Klerksdorp, South Africa
| | - Arifa Parker
- Tygerberg Hospital and Division of Infectious Disease, University of Stellenbosch, Cape Town, South Africa
| | | | | | | | - Riaan Strydom
- Northern Cape Department of Health, Kimberley, South Africa
| | | | | | - Nirvasha Moodley
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | | | - Paul Rheeder
- School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jacqueline Venturas
- Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nombulelo Magula
- Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lucille Blumberg
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
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Davis AG, Wasserman S, Maxebengula M, Stek C, Bremer M, Daroowala R, Aziz S, Goliath R, Stegmann S, Koekemoer S, Jackson A, Lai Sai L, Kadernani Y, Sihoyiya T, Liang CJ, Dodd L, Denti P, Crede T, Naude J, Szymanski P, Vallie Y, Banderker I, Moosa S, Raubenheimer P, Lai RPJ, Joska J, Nightingale S, Dreyer A, Wahl G, Offiah C, Vorster I, Candy S, Robertson F, Meintjes E, Maartens G, Black J, Meintjes G, Wilkinson RJ. Study protocol for a phase 2A trial of the safety and tolerability of increased dose rifampicin and adjunctive linezolid, with or without aspirin, for HIV-associated tuberculous meningitis [LASER-TBM]. Wellcome Open Res 2021; 6:136. [PMID: 34286103 PMCID: PMC8283551 DOI: 10.12688/wellcomeopenres.16783.1] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Tuberculous meningitis (TBM) is the most lethal form of tuberculosis with a mortality of ~50% in those co-infected with HIV-1. Current antibiotic regimens are based on those known to be effective in pulmonary TB and do not account for the differing ability of the drugs to penetrate the central nervous system (CNS). The host immune response drives pathology in TBM, yet effective host-directed therapies are scarce. There is sufficient data to suggest that higher doses of rifampicin (RIF), additional linezolid (LZD) and adjunctive aspirin (ASA) will be beneficial in TBM yet rigorous investigation of the safety of these interventions in the context of HIV associated TBM is required. We hypothesise that increased dose RIF, LZD and ASA used in combination and in addition to standard of care for the first 56 days of treatment with be safe and tolerated in HIV-1 infected people with TBM. Methods: In an open-label randomised parallel study, up to 100 participants will receive either; i) standard of care (n=40, control arm), ii) standard of care plus increased dose RIF (35mg/kg) and LZD (1200mg OD for 28 days, 600mg OD for 28 days) (n=30, experimental arm 1), or iii) as per experimental arm 1 plus additional ASA 1000mg OD (n=30, experimental arm 2). After 56 days participants will continue standard treatment as per national guidelines. The primary endpoint is death and the occurrence of solicited treatment-related adverse events at 56 days. In a planned pharmacokinetic (PK) sub-study we aim to assess PK/pharmacodynamic (PD) of oral vs IV rifampicin, describe LZD and RIF PK and cerebrospinal fluid concentrations, explore PK/PD relationships, and investigate drug-drug interactions between LZD and RIF. Safety and pharmacokinetic data from this study will inform a planned phase III study of intensified therapy in TBM. Clinicaltrials.gov registration: NCT03927313 (25/04/2019)
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Affiliation(s)
- Angharad G Davis
- The Francis Crick Institute, Midland Rd, London, NW1 1AT, UK.,Faculty of Life Sciences, University College London, London, WC1E 6BT, UK.,Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Mpumi Maxebengula
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Cari Stek
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
| | - Marise Bremer
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Remy Daroowala
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
| | - Saalikha Aziz
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Stephani Stegmann
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Sonya Koekemoer
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Amanda Jackson
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Louise Lai Sai
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Yakub Kadernani
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Thandi Sihoyiya
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - C Jason Liang
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Maryland, USA
| | - Lori Dodd
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Maryland, USA
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Thomas Crede
- Mitchells Plain Hospital, 8 A Z Berman Drive, Lentegeur, Cape Town, 7785, South Africa
| | - Jonathan Naude
- Mitchells Plain Hospital, 8 A Z Berman Drive, Lentegeur, Cape Town, 7785, South Africa
| | - Patryk Szymanski
- Mitchells Plain Hospital, 8 A Z Berman Drive, Lentegeur, Cape Town, 7785, South Africa
| | - Yakoob Vallie
- New Somerset Hospital, Portswood Rd, Green Point, Cape Town, 8051, South Africa
| | - Ismail Banderker
- New Somerset Hospital, Portswood Rd, Green Point, Cape Town, 8051, South Africa
| | - Shiraz Moosa
- New Somerset Hospital, Portswood Rd, Green Point, Cape Town, 8051, South Africa
| | - Peter Raubenheimer
- Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Rachel P J Lai
- The Francis Crick Institute, Midland Rd, London, NW1 1AT, UK.,Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
| | - John Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Observatory, 7925, South Africa
| | - Sam Nightingale
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Observatory, 7925, South Africa
| | - Anna Dreyer
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Observatory, 7925, South Africa
| | - Gerda Wahl
- Department of Medicine, Water Sisulu University, Mthatha, 5117, South Africa
| | - Curtis Offiah
- Department of Neuroradiology, Imaging Department, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - Isak Vorster
- Division of Diagnostic Radiology, University of Cape Town, Groote Schuur Hospital, Observatory, 7925, South Africa
| | - Sally Candy
- Division of Diagnostic Radiology, University of Cape Town, Groote Schuur Hospital, Observatory, 7925, South Africa
| | - Frances Robertson
- MRC/UCT Medical Imaging Research Unit Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, 7925, South Africa
| | - Ernesta Meintjes
- MRC/UCT Medical Imaging Research Unit Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, 7925, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - John Black
- Department of Medicine, Water Sisulu University, Mthatha, 5117, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Robert J Wilkinson
- The Francis Crick Institute, Midland Rd, London, NW1 1AT, UK.,Faculty of Life Sciences, University College London, London, WC1E 6BT, UK.,Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,Department of Medicine, University of Cape Town, Observatory, 7925, South Africa.,Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
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Trail I, Black J. Professor John Knowles Stanley. J Hand Surg Eur Vol 2021; 46:562-563. [PMID: 33784839 DOI: 10.1177/17531934211004373] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ian Trail
- Wigan & Leigh NHS Foundation Trust, Wrightington Hospital, Wigan, UK
| | - John Black
- Wigan & Leigh NHS Foundation Trust, Wrightington Hospital, Wigan, UK
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Hill J, Dickson-Hall L, Grant AD, Grundy C, Black J, Kielmann K, Mlisana K, Mitrani L, Loveday M, Moshabela M, Le Roux S, Jassat W, Nicol M, Cox H. Drug-resistant tuberculosis patient care journeys in South Africa: a pilot study using routine laboratory data. Int J Tuberc Lung Dis 2021; 24:83-91. [PMID: 32005310 DOI: 10.5588/ijtld.19.0100] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Thirteen districts in Eastern Cape (EC), KwaZulu-Natal (KZN) and Western Cape (WC) Provinces, South Africa.OBJECTIVE: To pilot a methodology for describing and visualising healthcare journeys among drug-resistant tuberculosis (DR-TB) patients using routine laboratory records.DESIGN: Laboratory records were obtained for 195 patients with laboratory-detected rifampicin-resistant TB (RR-TB) during July-September 2016. Health facility visits identified from these data were plotted to visualise patient healthcare journeys. Data were verified by facility visits.RESULTS: In the 9 months after the index RR-TB sample was collected, patients visited a mean of 2.3 health facilities (95% CI 2.1-2.6), with 9% visiting ≥4 facilities. The median distance travelled by patients from rural areas (116 km, interquartile range [IQR] 50-290) was greater than for urban patients (51 km, IQR 9-140). A median of 21% of patient's time was spent under the care of primary healthcare facilities: this was respectively 6%, 37% and 39% in KZN, EC and WC. Journey patterns were generally similar within districts. Some reflected a semi-centralised model of care where patients were referred to regional hospitals; other journeys showed greater involvement of primary care.CONCLUSION: Routine laboratory data can be used to explore DR-TB patient healthcare journeys and show how the use of healthcare services for DR-TB varies in different settings.
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Affiliation(s)
- J Hill
- TB Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - L Dickson-Hall
- Division of Medical Microbiology, University of Cape Town, Cape Town
| | - A D Grant
- TB Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, UK, Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal and School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - C Grundy
- Department of Infectious Disease Epidemiology, LSHTM, London, UK
| | - J Black
- Livingstone Hospital, Eastern Cape Department of Health, Port Elizabeth, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - K Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - K Mlisana
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban
| | - L Mitrani
- Division of Medical Microbiology, University of Cape Town, Cape Town
| | - M Loveday
- Health Systems Research Unit, South African Medical Research Council, Cape Town, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban
| | - M Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban
| | - S Le Roux
- Division of Medical Microbiology, University of Cape Town, Cape Town
| | - W Jassat
- School of Public Health, University of the Western Cape, Cape Town
| | - M Nicol
- Division of Medical Microbiology, University of Cape Town, Cape Town, National Health Laboratory Service, Johannesburg, Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Diseases in Africa, University of Cape Town, Cape Town, South Africa
| | - H Cox
- Division of Medical Microbiology, University of Cape Town, Cape Town, Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Diseases in Africa, University of Cape Town, Cape Town, South Africa
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Kielmann K, Dickson-Hall L, Jassat W, Le Roux S, Moshabela M, Cox H, Grant AD, Loveday M, Hill J, Nicol MP, Mlisana K, Black J. 'We had to manage what we had on hand, in whatever way we could': adaptive responses in policy for decentralized drug-resistant tuberculosis care in South Africa. Health Policy Plan 2021; 36:249-259. [PMID: 33582787 PMCID: PMC8059133 DOI: 10.1093/heapol/czaa147] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 11/16/2022] Open
Abstract
In 2011, the South African National TB Programme launched a policy of decentralized management of drug-resistant tuberculosis (DR-TB) in order to expand the capacity of facilities to treat patients with DR-TB, minimize delays to access care and improve patient outcomes. This policy directive was implemented to varying degrees within a rapidly evolving diagnostic and treatment landscape for DR-TB, placing new demands on already-stressed health systems. The variable readiness of district-level systems to implement the policy prompted questions not only about differences in health systems resources but also front-line actors' capacity to implement change in resource-constrained facilities. Using a grounded theory approach, we analysed data from in-depth interviews and small group discussions conducted between 2016 and 2018 with managers (n = 9), co-ordinators (n = 15), doctors (n = 7) and nurses (n = 18) providing DR-TB care. Data were collected over two phases in district-level decentralized sites of three South African provinces. While health systems readiness assessments conventionally map the availability of 'hardware', i.e. resources and skills to deliver an intervention, a notable absence of systems 'hardware' meant that systems 'software', i.e. health care workers (HCWs) agency, behaviours and interactions provided the basis of locally relevant strategies for decentralized DR-TB care. 'Software readiness' was manifest in four areas of DR-TB care: re-organization of service delivery, redressal of resource shortages, creation of treatment adherence support systems and extension of care parameters for vulnerable patients. These strategies demonstrate adaptive capacity and everyday resilience among HCW to withstand the demands of policy change and innovation in stressed systems. Our work suggests that a useful extension of health systems 'readiness' assessments would include definition and evaluation of HCW 'software' and adaptive capacities in the face of systems hardware gaps.
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Affiliation(s)
- Karina Kielmann
- Institute of Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Lindy Dickson-Hall
- Division of Medical Microbiology, Faculty of Medicine, University of Cape Town, South Africa
| | | | - Sacha Le Roux
- Division of Medical Microbiology, Faculty of Medicine, University of Cape Town, South Africa
| | - Mosa Moshabela
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Helen Cox
- Institute for Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Alison D Grant
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
- London School of Hygiene & Tropical Medicine, TB Centre, UK
- School of Public Health, University of the Witwatersrand, South Africa
| | - Marian Loveday
- Health Systems Research Unit, South African Medical Research Council
| | - Jeremy Hill
- Division of Medical Microbiology, Faculty of Medicine, University of Cape Town, South Africa
- London School of Hygiene & Tropical Medicine, TB Centre, UK
| | - Mark P Nicol
- Division of Medical Microbiology, Faculty of Medicine, University of Cape Town, South Africa
- Infection and Immunity, School of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Koleka Mlisana
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - John Black
- Department of Infectious Diseases, Livingstone Hospital, Lindsay Rd, Industrial, Port Elizabeth, 6020, South Africa
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30
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Annear D, Gaida R, Myburg K, Black J, Truter I, Bamford C, Govender S. Spectrum of Bacterial Colonization in Patients Hospitalized for Treatment of Multidrug-Resistant Tuberculosis. Microb Drug Resist 2020; 27:691-697. [PMID: 33074767 DOI: 10.1089/mdr.2020.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study investigated the bacterial colonization in patients admitted for treatment of drug-resistant tuberculosis in a specialized TB hospital. Identification and antimicrobial susceptibility testing of bacterial isolates (n = 62) from nasal, groin, and rectal swabs [patient cohort (n = 37)] were determined by the VITEK-MS system. Resistance gene analysis was by PCR and DNA sequencing. Molecular typing of Klebsiella pneumoniae isolates was by Multilocus Sequencing Typing (MLST). Patients (n = 13/37; 35%) were colonized by multidrug-resistant (MDR) bacteria (ESBL and MRSA) on admission. Of the 24 patients who were not colonized by MDR bacteria on admission, 46% (17/37) became colonized by MDR bacteria within 1 month of admission, mostly with ESBL-producing Enterobacteriales and resistance to aminoglycosides and fluoroquinolones. ESBL Escherichia coli (41/62; 66%) and K. pneumoniae (14/62; 23%) predominated. Genes encoding for ESBLs (blaCTX-M-14, blaCTX-M-15, blaSHV-28, blaOXA-1, and blaOXY-2) and plasmid-mediated quinolone resistant genes (qnrB1, qnrB4, and qnrB10) were detected. MLST revealed genetic diversity among the K. pneumoniae isolates from hospitalized patients. This study provides insight into bacterial pathogen colonization in hospitalized TB patients with the first occurrence of the qnrB4 and qnrB10 genes and co-expression of genes: qnrB4+aac(6')-lb-cr, qnrB10+aac(6')-lb-cr, qnrB4+qnrS1, and qnrB10+qnrS1 in fluoroquinolone-resistant E. coli isolates within South Africa. However, the source and colonization routes of these isolates could not be determined.
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Affiliation(s)
- Dale Annear
- Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, South Africa
| | - Razia Gaida
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa
| | - Kierra Myburg
- Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, South Africa
| | - John Black
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa.,Department of Medicine, Livingstone Hospital, Eastern Cape Department of Health, Port Elizabeth, South Africa
| | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa
| | - Colleen Bamford
- National Health Laboratory Service, Groote Schuur Hospital Microbiology Laboratory, Cape Town, South Africa.,Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Sharlene Govender
- Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, South Africa
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31
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Ryan S, Hahn E, Rao A, Mwinnyaa G, Black J, Maharaj R, Mvandaba N, Nyanisa Y, Quinn TC, Hansoti B. The impact of HIV knowledge and attitudes on HIV testing acceptance among patients in an emergency department in the Eastern Cape, South Africa. BMC Public Health 2020; 20:1066. [PMID: 32631297 PMCID: PMC7339484 DOI: 10.1186/s12889-020-09170-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transmission of HIV in South Africa continues to be high due to a large proportion of individuals living with undiagnosed HIV. Uptake of HIV testing is influenced by a multitude of factors including the patient's knowledge and beliefs about HIV. METHODS This study sought to quantify the impact of knowledge and attitudes on HIV testing acceptance in an emergency department by co-administering a validated HIV knowledge and attitudes survey to patients who were subsequently offered HIV testing. RESULTS During the study period 223 patients were interviewed and offered HIV testing. Individuals reporting more negative overall attitudes (p = 0.006), higher levels of stigma to HIV testing (p < 0.001), and individuals who believed their test was confidential (p < 0.001) were more likely to accept an HIV test. CONCLUSIONS Interventions focused on improving patient perceptions around testing confidentiality will likely have the greatest impact on testing acceptance in the emergency department.
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Affiliation(s)
- Sofia Ryan
- The Johns Hopkins University, Baltimore, MD, USA.
| | - Elizabeth Hahn
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aditi Rao
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - George Mwinnyaa
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
| | - John Black
- Department of Infectious Disease, Livingstone Hospital, Port Elizabeth, South Africa.,Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Roshen Maharaj
- Department of Emergency Medicine, Livingstone Hospital, Port Elizabeth, South Africa
| | - Nomzamo Mvandaba
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Yandisa Nyanisa
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Thomas C Quinn
- The Johns Hopkins University, Baltimore, MD, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
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Francis N, Penna M, Carter F, Mortensen NJ, Hompes R, Bandyopadhyay D, Black J, Campbell K, Chadwick M, Chase K, Chitsabesen P, Coleman M, Dalton S, Doeve J, Hendrickse C, Katory M, Knol J, Lee L, McArthur D, Miles T, Miskovic D, Ng P, Nicol D, Samad A, Talwar A, Kochupapy RT, Theobald I, Wegstapel H, West N, Wood S, Wynn G, Ziyaie D. Development and early outcomes of the national training initiative for transanal total mesorectal excision in the UK. Colorectal Dis 2020; 22:756-767. [PMID: 32065425 DOI: 10.1111/codi.15022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/01/2019] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
AIM Transanal total mesorectal excision (TaTME) has attracted substantial interest amongst colorectal surgeons but its technical challenges may underlie the early reports of visceral injuries and oncological concerns. The aim of this study was to report on the feasibility, development and the outcome of the national pilot training initiative for TaTME-UK. METHODS TaTME-UK was successfully launched in September 2017 in partnership with the healthcare industry and endorsed by the Association of Coloproctology of Great Britain and Ireland. This multi-modal training curriculum consisted of three phases: (i) set-up; (ii) selection of pilot sites; and (iii) formal proctorship programme. Bespoke Global Assessment Scoring (GAS) forms were designed and completed by both trainees and mentors. Data were collected on patient demographics, tumour characteristics and perioperative clinical and histological outcomes. RESULTS Twenty-four proctored cases were performed by 10 colorectal surgeons from five selected pilot sites. Median operative time was 331 ± 90 (195-610) min which was reduced to 283 ± 62 (195-340) min in the final case. Independent performance (GAS score of 5) was achieved for most operative steps by case 5. There was one conversion (4.2%), but no visceral injuries. Pathological data confirmed no bowel perforation and intact quality of the mesorectal TME specimens with clear distal margin in all cases and circumferential margins in 23/24 cases (96%). CONCLUSION This exploratory study demonstrates acceptable early outcomes in a small cohort suggesting that a competency-based multi-modal training programme for TaTME can be feasible and safe to implement at a national level.
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Affiliation(s)
- N Francis
- Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Faculty of Science, University of Bath, Bath, UK
| | - M Penna
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - F Carter
- South West Surgical Training Network c.i.c., Yeovil, UK
| | - N J Mortensen
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - R Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng 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Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Ohayon MM, Krystal AD, Black J, Shapiro CM, Sullivan S, Swick TJ, Wells CC. 0774 Factors Associated With The Continuous Use Of Psychotropic Treatments For Narcolepsy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Narcolepsy is a debilitating disorder characterized by excessive sleepiness and cataplexy episodes. There is no cure for this disease. Current treatments focus on controlling the symptoms with CNS stimulants for sleepiness and antidepressants and/or CNS depressants for cataplexy. This study examines the factors that can contribute to the cessation of narcolepsy treatment.
Methods
The study includes 291 narcoleptic individuals who were interviewed twice, approximately five to seven years apart, in Wave 1 (W1) and Wave 2 (W2). Telephone interviews were conducted with the help of the Sleep-EVAL system; narcolepsy individuals were initially evaluated and diagnosed by a Sleep Specialist.
Results
At W1, 49.2% of narcoleptic individuals were taking a CNS stimulant; at W2, 37% of narcoleptic individuals were taking a CNS stimulant. The use was chronic (i.e., present at W2 and W1) for 52.7% of the W2 subjects. CNS depressants were used by 19.1% at W1 and 17% at W2. Of the W1 subjects, 67.6% still reported using CNS depressants at W2. In terms of antidepressants, 38.6% and 29.6% of subjects reported using these medications at W1 and W2 respectively. Of those taking antidepressants at W2, 58.9% reported chronic use (ie, were also on antidepressants at W1). At least one of the aforementioned medication classes was used by 72% of participants at W1 and 56.1% at W2. Chronicity of nocturnal awakenings (RR: 2.7), the frequency of cataplexy episodes (RR: 2.3) and the chronicity of hypnopompic hallucinations (RR: 2.8) were associated with long-term use of narcolepsy treatment.
Conclusion
Narcolepsy treatments are mostly taken to long term. Some narcoleptics individuals were able to reduce or stop treatment either because the intensity of symptoms decreased or because they developed coping mechanisms to deal with the symptoms.
Support
NIH (R01NS044199), the Arrillaga Foundation and Jazz Pharmaceuticals Inc.
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Affiliation(s)
| | - A D Krystal
- Department of Psychiatry, UCSF School of Medicine, San Francisco, CA
| | - J Black
- Jazz Pharmaceuticals Inc, Jazz Pharmaceuticals inc, CA
| | - C M Shapiro
- Department of Psychiatry, University of Toronto, Toronto, ON, CANADA
| | | | - T J Swick
- Neurology and Sleep Medicine Consultants, Houston, TX
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Rosenberg R, Babson K, Menno D, Morris S, Baladi M, Hyman D, Black J. 0751 Epworth Sleepiness Scale Test-Retest Reliability Analysis In Solriamfetol Studies. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The Epworth Sleepiness Scale (ESS) measures excessive daytime sleepiness. This analysis examined test-retest reliability of ESS scores in participants with narcolepsy or obstructive sleep apnea (OSA) in solriamfetol studies.
Methods
Intraclass correlation coefficient (ICC) estimates and 95% confidence intervals (CIs) for ESS scores from two 12-week, placebo-controlled trials (1 narcolepsy; 1 OSA), and one long-term open-label extension (OLE) trial (narcolepsy or OSA) were calculated separately for each trial, based on assessments (at time-point pairs) when scores were expected to be stable (at weeks 4 and 8, 8 and 12, and 4 and 12 in the 12-week trials, and weeks 14 and 26/27, 26/27 and 39/40, and 14 and 39/40 in the OLE). ICCs were analyzed for the overall population in each trial and by treatment and adherence to primary OSA therapy. An ICC >0.7 has been recommended as a quality criterion for acceptable test-retest reliability.
Results
In the 12-week narcolepsy trial, ICCs (95% CI) were 0.83 (0.79, 0.87) for weeks 4 and 8 (n=199), 0.87 (0.83, 0.90) for weeks 8 and 12 (n=196), and 0.81 (0.76, 0.85) for weeks 4 and 12 (n=196). In the 12-week OSA trial, ICCs (95% CI) were 0.74 (0.69, 0.78) for weeks 4 and 8 (n=416), 0.80 (0.76, 0.83) for weeks 8 and 12 (n=405), and 0.74 (0.69, 0.78) for weeks 4 and 12 (n=405). In the OLE trial, ICCs (95% CI) were 0.82 (0.79, 0.85) for weeks 14 and 27/26 (n=495), 0.85 (0.82, 0.87) for weeks 27/26 and 40/39 (n=463), and 0.78 (0.74, 0.81) for weeks 14 and 40/39 (n=463). Treatment (solriamfetol combined/placebo) or adherence to primary OSA therapy did not impact reliability.
Conclusion
In 3 large clinical trials of participants with narcolepsy or OSA, the ESS demonstrated an acceptable level of test-retest reliability.
Support
Jazz Pharmaceuticals
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Affiliation(s)
| | - K Babson
- Jazz Pharmaceuticals, Palo Alto, CA
| | - D Menno
- Jazz Pharmaceuticals, Palo Alto, CA
| | - S Morris
- Jazz Pharmaceuticals, Palo Alto, CA
| | - M Baladi
- Jazz Pharmaceuticals, Palo Alto, CA
| | - D Hyman
- Jazz Pharmaceuticals, Palo Alto, CA
| | - J Black
- Stanford Center for Sleep Sciences and Medicine, Palo Alto, CA
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Shroufi A, Govender NP, Meintjes G, Black J, Nel J, Moosa MYS, Menezes C, Dawood H, Wilson D, Duran LT, Ajose O, Murphy RA, Harrison T, Loyse A, Ruffell C, Van Cutsem G. Time to embrace access programmes for medicines: lessons from the South African flucytosine access programme. Int J Infect Dis 2020; 95:459-461. [PMID: 32126322 DOI: 10.1016/j.ijid.2020.02.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Cryptococcal meningitis (CM) is estimated to cause 181 000 deaths annually, with the majority occurring in Sub-Saharan Africa. Flucytosine is recommended by the World Health Organization as part of the treatment for CM. Widespread use of flucytosine could reduce mortality in hospital by as much as 40% compared to the standard of care, yet due to market failure, quality-assured flucytosine remains unregistered and largely inaccessible throughout Africa. METHODS The recently established South African flucytosine clinical access programme is an attempt to address the market failure that led to a lack of public sector access to flucytosine for CM, by making the medicine freely available to tertiary hospitals in South Africa. RESULTS Between November 2018 and September 2019, 327 CM patients received flucytosine through this programme, with efforts to support sustainable national scale-up presently ongoing. We describe why this programme was needed, its catalytic potential, what is still required to ensure widespread access to flucytosine, and observations from this experience that may have wider relevance. CONCLUSIONS The South African flucytosine access programme illustrates how access programmes may be one part of the solution to addressing the vicious cycle of perceived low demand, limiting manufacturer interest in specific product markets.
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Affiliation(s)
- Amir Shroufi
- Doctors Without Borders South Africa, Johannesburg, South Africa
| | - Nelesh P Govender
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | | | - John Black
- Livingstone Hospital, Eastern Cape, South Africa
| | - Jeremy Nel
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Colin Menezes
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Halima Dawood
- University of Kwa Zulu Natal, Kwa Zulu Natal, South Africa
| | | | | | - Olawale Ajose
- Drugs for Neglected Diseases Initiative, Los Angeles, USA
| | - Richard A Murphy
- David Geffen School of Medicine at UCLA, Los Angeles, USA; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, USA
| | - Thomas Harrison
- Centre for Global Health, Institute of Infection and Immunity, St George's University of London, London, UK; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Angela Loyse
- Department of Infection and Immunity, St George's University of London, London, UK
| | - Carol Ruffell
- Drugs for Neglected Diseases Initiative, Los Angeles, USA; Global Antibiotic Research and Development Partnership (GARDP), Cape Town, South Africa
| | - Gilles Van Cutsem
- Doctors Without Borders South Africa, Johannesburg, South Africa; Centre for Infectious Disease and Research, University of Cape Town, Cape Town, South Africa
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Goetz MP, Suman VJ, Reid JM, Kuffel M, Buhrow SA, McGovern RM, Black J, Dockter T, Symmans WF, Liu MC, Hawse JR, Doroshow J, Storniolo AM, Collins JM, Streicher H, Ames MM, Ingle JN, Partridge A, Carey L. Abstract PD7-06: A randomized phase II trial of tamoxifen versus Z-endoxifen HCL in postmenopausal women with metastatic estrogen receptor positive, HER2 negative breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd7-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Endx is a Tam metabolite with promising antitumor activity in Tam and aromatase inhibitor (AI) resistant estrogen receptor (ER) positive (+) metastatic breast cancer (MBC). Methods: This randomized phase II study compared progression-free survival (PFS) and toxicity of Endx 80 mg/day to Tam 20 mg/day in patients (pts) with ER+ MBC. Eligibility included postmenopausal women, ECOG PS 0-2, prior progression on AI but not Tam (unlimited endocrine therapy [ET] lines allowed), and a preregistration biopsy confirming ER+ (>10% nuclear staining) and HER2-negative MBC. Stratified randomization was used balancing prior CDK 4/6 inhibitor (CDK 4/6i) use and/or everolimus (yes/no), measurable disease (yes/no) and endocrine resistance (primary/secondary) between arms. Pts randomized to Tam were allowed to cross over to Endx at progression. Due to short expected median PFS, differences in PFS were assessed using approaches for interval-censored data (ICD). 40 eligible pts were to be randomized to each arm so a one-sided alpha=0.10 generalized log-rank test (GLRT) would have a 90% chance of detecting a 50% decrease in hazard of disease progression with Endx (median: 6 months) relative to Tam (median: 3 months). Secondary endpoints include clinical benefit rate (stable or partial response > 6 cycles) (CBR) for measurable and non-measurable disease. Pharmacokinetic (PK) data were obtained Day (d) 1 (4 hour), end of cycle 2, and at time of progression.
Results: From March 2015 to March 2017, 108 women with endocrine refractory recurrent or MBC were preregistered. 27 pts did not register due to: biopsy demonstrating ER-/HER2- (3 pts), ER+/HER2+ (5 pts), cancer other than breast (3 pts), no cancer in specimen (6 pts), brain metastases (2 pts), acute infection (1 pt), progression on or recent use of Tam (2 pts), or pt refusal (5 pts). 4/81 pts who registered were excluded due to ineligibility (3 pts) or refusal to start protocol treatment (1 pt). The study cohort consisted of 40 pts randomized to Endx and 37 pts to Tam. The median (m) number of ETs in the metastatic setting was 2 (range 1-4) for each arm including prior CDK 4/6i (Endx: 42.5%, Tam: 29.7%) and everolimus (Endx: 35.0%, Tam: 40.5%). The m cycle number was 6 for Endx (range: 1-35) and 3 for Tam (range: 1-42). PFS for Endx was not significantly different compared to Tam (HR= 0.77; 95% CI: 0.49-1.22, GLRT p=0.309; mPFS: Endx 130 days [95% CI: 76-138 days] and Tam 42 days [95%CI: 24-129 days]). However, PFS was significantly longer in pts with no prior CDK 4/6i in the Endx arm (GLRT p=0.002; HR(no/yes)=0.31; 95%CI: 0.15-0.65) but not in the Tam arm (GLRT p=0.708) (unplanned analysis). Severe (grade (G) 3+) toxicities included: Endx G3 hypertriglyceridemia (3 pts); Tam: G3 hypertension with G2 stroke (1 pt), G3 thromboembolic event (1 pt), and G3 abdominal, bone and liver pain (1 pt). In Endx arm, d1 m Endx plasma concentration (conc) was 216 ng/ml (n=17; range: 144-400). For Tam arm, d1 m Tam conc was 17 ng/ml (n=17; range:11-23) (Endx not detectable). For the 25 pts that crossed over to Endx, CBR was 28.0% (90% CI: 14.0-46.2%) and 14 pts had pk data at progression. A lower median Endx conc (6 ng/ml range: 3.3-16.3) was observed in Tam patients at progression who then had Endx clinical benefit compared to Tam pts without clinical benefit after Endx crossover (median Endx 12 ng/ml; range 4.4-36.6).Conclusions: In endocrine-resistant breast cancer, Z-Endx was not significantly superior to Tam, but clinical benefit was observed in 28% that crossed over to Endx after Tam progression. In pts with no prior CDK 4/6i, the observation of significantly longer PFS in the Endx arm is hypothesis generating. Support: U10CA180821, U10CA180882, U24CA196171, U10CA180820 (ECOG-ACRIN), https://acknowledgments.alliancefound.org; Clinical Trials.gov Identifier:NCT02311933
Citation Format: Matthew P. Goetz, Vera J Suman, Joel M Reid, Mary Kuffel, Sarah A Buhrow, Renee M McGovern, John Black, Travis Dockter, William F Symmans, Minetta C Liu, John R Hawse, James Doroshow, Anna M Storniolo, Jerry M Collins, Howard Streicher, Matthew M Ames, James N Ingle, Ann Partridge, Lisa Carey. A randomized phase II trial of tamoxifen versus Z-endoxifen HCL in postmenopausal women with metastatic estrogen receptor positive, HER2 negative breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD7-06.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - James Doroshow
- 3Division of Cancer Treatment and Diagnosis and Center for Cancer Research, NCI, Bethesda, MD
| | | | - Jerry M Collins
- 3Division of Cancer Treatment and Diagnosis and Center for Cancer Research, NCI, Bethesda, MD
| | - Howard Streicher
- 3Division of Cancer Treatment and Diagnosis and Center for Cancer Research, NCI, Bethesda, MD
| | | | | | | | - Lisa Carey
- 6UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Harris L, Humber J, Agin J, Black J, Boling R, Calicchia M, Cooper C, Dickinson S, Heisick J, Kelly M, Knight M, LaClair D, Marshall C, Newman S, Presla L, Romine A, Schulke M, Scott J, Scott T, Sivey C, Tardio J, Twohy C, Vorhies I, Wagner T, Wazenski T. AutoMicrobic System for Biochemical Identification of Listeria Species Isolated From Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/76.4.822] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A collaborative study was conducted to evaluate the performance of the AutoMicrobic System Gram- Positive Identification (GPI) and Gram-Negative Identification (GNI) test kits to biochemically characterize Listeria spp. Thirteen laboratories each tested 97 food and environmental isolates, representing the 7 species of Listeria, as well as 11 additional genera of Gram-positive rods. Each collaborator inoculated both a GPI and a GNI card with a pure culture of each organism. The AutoMicrobic System identified the isolates and printed out the biochemical results. The GPI card is used to obtain a species identification and a mannitol reaction result, and the GNI card is used to obtain rhamnose and xylose reaction results. Organisms are classified into species groups and can be further distinguished on the basis of hemolysis or nitrate reduction tests. The AutoMicrobic System method correctly classified 90.8% of the Listeria spp. isolates and 100% of the non-Listeria isolates. The AutoMicrobic System method was adopted first action by AOAC International for the biochemical characterization of Listeria spp. isolated from food and environmental sources.
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Affiliation(s)
- Loralyn Harris
- Kraft General Foods, Technology Center, 801 Waukegan Rd, Glen view, IL 60025
| | - John Humber
- Kraft General Foods, Technology Center, 801 Waukegan Rd, Glen view, IL 60025
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Jiguet F, Burgess M, Thorup K, Conway G, Arroyo Matos JL, Barber L, Black J, Burton N, Castelló J, Clewley G, Copete JL, Czajkowski MA, Dale S, Davis T, Dombrovski V, Drew M, Elts J, Gilson V, Grzegorczyk E, Henderson I, Holdsworth M, Husbands R, Lorrilliere R, Marja R, Minkevicius S, Moussy C, Olsson P, Onrubia A, Pérez M, Piacentini J, Piha M, Pons JM, Procházka P, Raković M, Robins H, Seimola T, Selstam G, Skierczyński M, Sondell J, Thibault JC, Tøttrup AP, Walker J, Hewson C. Desert crossing strategies of migrant songbirds vary between and within species. Sci Rep 2019; 9:20248. [PMID: 31882957 PMCID: PMC6934701 DOI: 10.1038/s41598-019-56677-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 01/10/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022] Open
Abstract
Each year, billions of songbirds cross large ecological barriers during their migration. Understanding how they perform this incredible task is crucial to predict how global change may threaten the safety of such journeys. Earlier studies based on radar suggested that most songbirds cross deserts in intermittent flights at high altitude, stopping in the desert during the day, while recent tracking with light loggers suggested diurnal prolongation of nocturnal flights and common non-stop flights for some species. We analyzed light intensity and temperature data obtained from geolocation loggers deployed on 130 individuals of ten migratory songbird species, and show that a large variety of strategies for crossing deserts exists between, but also sometimes within species. Diurnal stopover in the desert is a common strategy in autumn, while most species prolonged some nocturnal flights into the day. Non-stop flights over the desert occurred more frequently in spring than in autumn, and more frequently in foliage gleaners. Temperature recordings suggest that songbirds crossed deserts with flight bouts performed at various altitudes according to species and season, along a gradient ranging from low above ground in autumn to probably >2000 m above ground level, and possibly at higher altitude in spring. High-altitude flights are therefore not the general rule for crossing deserts in migrant songbirds. We conclude that a diversity of migration strategies exists for desert crossing among songbirds, with variations between but also within species.
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Affiliation(s)
- Frédéric Jiguet
- CESCO, UMR7204 MNHN-CNRS-Sorbonne Université, CP135, 43 Rue Buffon, 75005, Paris, France.
| | - Malcolm Burgess
- RSPB Centre for Conservation Science, The Lodge, Sandy, SG19 2DL, United Kingdom
| | - Kasper Thorup
- Center for Macroecology, Evolution and Climate, Natural History Museum of Denmark, University of Copenhagen, Universitetsparken 15, 2100, Copenhagen, Denmark
| | - Greg Conway
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | | | - Lee Barber
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | - John Black
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | - Niall Burton
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | - Joan Castelló
- RSPB Centre for Conservation Science, The Lodge, Sandy, SG19 2DL, United Kingdom
| | - Gary Clewley
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | - José Luis Copete
- Handbook of the Birds of the World Alive, Lynx Edicions, Montseny 8, 08193, Bellaterra, Spain
| | | | - Svein Dale
- Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, P.O. Box 5003, NO-1432, Ås, Norway
| | - Tony Davis
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | - Valery Dombrovski
- Institute of Zoology, National Academy of Sciences, Academichnaya 27, 220072, Minsk, Belarus
| | - Mike Drew
- Biodiversity & Catchment, Anglian Water Services Limited, Lancaster House, Lancaster Way, Ermine Business Park, Huntingdon, Cambridgeshire, PE29 6XU, United Kingdom
| | - Jaanus Elts
- Estonian Ornithological Society, Veski 4, 51005 Tartu, Estonia & Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu, 46 Vanemuise St., 51014, Tartu, Estonia
| | - Vicky Gilson
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | - Emilienne Grzegorczyk
- CESCO, UMR7204 MNHN-CNRS-Sorbonne Université, CP135, 43 Rue Buffon, 75005, Paris, France
| | - Ian Henderson
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | - Michael Holdsworth
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | - Rob Husbands
- 3 Oakhill Road, Mitcheldean, Gloucestershire, GL17 0BN, United Kingdom
| | - Romain Lorrilliere
- CESCO, UMR7204 MNHN-CNRS-Sorbonne Université, CP135, 43 Rue Buffon, 75005, Paris, France
| | - Riho Marja
- MTA Centre for Ecological Research, Institute of ecology and Botany, "Lendület" Landscape and Conservation Ecology, Alkotmány u. 2-4, 2163, Vácrátót, Hungary
| | | | - Caroline Moussy
- CESCO, UMR7204 MNHN-CNRS-Sorbonne Université, CP135, 43 Rue Buffon, 75005, Paris, France
| | - Peter Olsson
- Centre for Environmental and Climate Research (CEC), Ekologihuset, Sölvegatan 37, Lund, Sweden
| | - Alejandro Onrubia
- Migres Foundation, International Bird Migration Center (CIMA), N-340, Km 85, P.O. Box 152, 11380, Tarifa, Cádiz, Spain
| | - Marc Pérez
- Nostra Senyora de Montserrat 19, 08756, La Palma de Cervelló, Spain
| | | | - Markus Piha
- Finnish Museum of Natural History LUOMUS, P.O. Box 17 (Pohjoinen Rautatiekatu 13), FI-00014 University of Helsinki, Helsinki, Finland
| | - Jean-Marc Pons
- Institut Systématique, Evolution, Biodiversité (ISYEB, UMR7205), MNHN-CNRS-SU-EPHE, 57 Rue Cuvier, CP50, 75005, Paris, France
| | - Petr Procházka
- The Czech Academy of Sciences, Institute of Vertebrate Biology, Květná 8, CZ-603 65, Brno, Czech Republic
| | - Marko Raković
- Natural History Museum of Belgrade, Njegoševa, 51, Serbia
| | - Harriet Robins
- New buildings, Howle Hill, Ross on Wye, Herefordshire, HR9 5RD, United Kingdom
| | - Tuomas Seimola
- Natural Resources Institute Finland (Luke), Natural Resources, Latokartanonkaari 9, 00790, Helsinki, Finland
| | - Gunnar Selstam
- Department of Agricultural Research in Northern Sweden, Swedish University of Agricultural Sciences and Department of Molecular Biology, University of Umeå, 901 85, Umeå, Sweden
| | - Michał Skierczyński
- Department of Behavioural Ecology, Adam Mickiewicz University, Poznan, Poland, Dziczenie.pl, Gruszki, Poland
| | - Jan Sondell
- Kvismare Bird Observatory, Rulleuddsvägen 10, S-178 51, Ekerö, Sweden
| | - Jean-Claude Thibault
- Institut Systématique, Evolution, Biodiversité (ISYEB, UMR7205), MNHN-CNRS-SU-EPHE, 57 Rue Cuvier, CP50, 75005, Paris, France
| | - Anders P Tøttrup
- Natural History Museum of Denmark, University of Copenhagen, Universitetsparken 15, 2100, Copenhagen, Denmark
| | - Justin Walker
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
| | - Chris Hewson
- British Trust for Ornithology, The Nunnery, Thetford, Norfolk, IP24 2PU, United Kingdom
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Mignot E, Bogan R, Black J, Parvataneni R, Menno D, Wang G, Dauvilliers Y. Effects of sodium oxybate treatment on sleep architecture in paediatric patients with narcolepsy. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.715] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Strunc M, Mignot E, Wang Y, Black J, Chakravarthy D, Parvataneni R, Plazzi G. Long-term safety of Sodium Oxybate in paediatric narcolepsy with cataplexy: open-label continuation after 1 year of treatment. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1146] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Govender NP, Meintjes G, Mangena P, Nel J, Potgieter S, Reddy D, Rabie H, Wilson D, Black J, Boulware D, Boyles T, Chiller T, Dawood H, Dlamini S, Harrison TS, Ive P, Jarvis J, Karstaedt A, Madua MC, Menezes C, Moosa MYS, Motlekar Z, Shroufi A, Stacey SL, Tsitsi M, van Cutsem G, Variava E, Venter M, Wake R. Southern African HIV Clinicians Society guideline for the prevention, diagnosis and management of cryptococcal disease among HIV-infected persons: 2019 update. South Afr J HIV Med 2019; 20:1030. [PMID: 32201629 PMCID: PMC7081625 DOI: 10.4102/sajhivmed.v20i1.1030] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Nelesh P Govender
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Graeme Meintjes
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Phetho Mangena
- Department of Medicine, Polokwane Hospital, Polokwane, South Africa
| | - Jeremy Nel
- Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Samantha Potgieter
- Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - Denasha Reddy
- Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Helena Rabie
- Department of Paediatrics, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Douglas Wilson
- Department of Internal Medicine, Edendale Hospital, Pietermaritzburg, South Africa
- School of Clinical Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - John Black
- Department of Infectious Diseases, Livingstone Hospital, Port Elizabeth, South Africa
| | - David Boulware
- Department of Medicine, Centre for Infectious Diseases and Microbiology Translational Research, University of Minnesota, Minneapolis, United States
| | - Tom Boyles
- Anova Health Institute, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tom Chiller
- Mycotic Diseases Branch, US Centres for Disease Control and Prevention, Atlanta, United States
| | - Halima Dawood
- Department of Medicine, Grey's Hospital, Pietermaritzburg, South Africa
- Caprisa, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Sipho Dlamini
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Thomas S Harrison
- Centre for Global Health, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
| | - Prudence Ive
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Infectious Diseases, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, Helen Joseph Hospital, Johannesburg, South Africa
| | - Joseph Jarvis
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alan Karstaedt
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Infectious Diseases, Department of Internal Medicine, Charlotte Maxeke Johannesburg Hospital, Johannesburg, South Africa
| | - Matamela C Madua
- Department of Medicine, Rob Ferreira Hospital, Mbombela, South Africa
| | - Colin Menezes
- Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Zaaheera Motlekar
- Department of Medicine, Kimberley Provincial Hospital, Kimberley, South Africa
| | - Amir Shroufi
- Mycotic Diseases Branch, US Centres for Disease Control and Prevention, Atlanta, United States
| | - Sarah Lynn Stacey
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Merika Tsitsi
- Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gilles van Cutsem
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Ebrahim Variava
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medicine, Tshepong Hospital, Klerksdorp, South Africa
| | - Michelle Venter
- Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Wake
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Centre for Global Health, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
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Hansoti B, Mwinnyaa G, Hahn E, Rao A, Black J, Chen V, Clark K, Clarke W, Eisenberg AL, Fernandez R, Iruedo J, Laeyendecker O, Maharaj R, Mda P, Miller J, Mvandaba N, Nyanisa Y, Reynolds SJ, Redd AD, Ryan S, Stead DF, Wallis LA, Quinn TC. Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments. EClinicalMedicine 2019; 15:14-22. [PMID: 31709410 PMCID: PMC6833451 DOI: 10.1016/j.eclinm.2019.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 05/13/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Eastern Cape province of South Africa has one of the highest burdens of HIV in the world. Emergency Departments (EDs) can serve as optimal clinical sites for the identification of new HIV infections and entry into care. We sought to determine the current burden of HIV disease among ED patients in the Eastern Cape. METHODS We conducted a prospective cross-sectional observational study in the EDs of three Hospitals in the Eastern Cape province of South Africa from June 2017 to July 2018. All adult, non-critical patients presenting to the ED were systematically approached and offered a Point-Of-Care (POC) HIV test in accordance with South African guidelines. All HIV-positive individuals had their blood tested for the presence of antiretroviral therapy (ART) and the presence of viral suppression (≤ 1000 copies/ml). HIV incidence was estimated using a multi-assay algorithm, validated for a subtype C epidemic. FINDINGS Of the 2901 patients for whom HIV status was determined (either known HIV-positive or underwent POC HIV testing), 811 (28.0%) were HIV positive, of which 234 (28.9%) were newly diagnosed. HIV prevalence was higher in Mthatha [34% (388/1134) at Mthatha Regional Hospital and 28% (142/512) at Nelson Mandela Academic Hospital], compared to Port Elizabeth [22% (281/1255) at Livingstone Hospital]. HIV incidence was estimated at 4.5/100 person-years (95% CI: 2.4, 6.50) for women and 1.5 (CI 0.5, 2.5) for men. Of all HIV positive individuals tested for ART (585), 54% (316/585) tested positive for the presence of ARTs, and for all HIV positive participants with viral load data (609), 49% (299/609) were found to be virally suppressed. INTERPRETATION Our study not only observed a high prevalence and incidence of HIV among ED patients but also highlights significant attrition along the HIV care cascade for HIV positive individuals. Furthermore, despite developing an optimal testing environment, we were only able to enrol a small sub-set of the ED population. Given the high HIV prevalence and high attrition in the ED population, HIV services in the ED should also develop strategies that can accommodate large testing volumes and ART initiation.
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Affiliation(s)
- Bhakti Hansoti
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - George Mwinnyaa
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | - Elizabeth Hahn
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Aditi Rao
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - John Black
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Medicine, Livingstone Hospital, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
| | - Victoria Chen
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Kathryn Clark
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - William Clarke
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Anna L. Eisenberg
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | | | - Joshua Iruedo
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Oliver Laeyendecker
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | - Roshen Maharaj
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Emergency Medicine, Livingstone Hospital, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
| | - Pamela Mda
- Nelson Mandela Hospital Clinical Research Unit, Sisson St, Fort Gale, Mthatha 5100, South Africa
| | - Jernelle Miller
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Nomzamo Mvandaba
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Yandisa Nyanisa
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Steven J. Reynolds
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | - Andrew D. Redd
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | - Sofia Ryan
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - David F. Stead
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Medicine, Frere Hospital, Amalinda Main Rd, Braelyn, East London 5201, South Africa
| | - Lee A. Wallis
- Division of Emergency Medicine, University of Cape Town, Main Rd, Observatory, Cape Town 7925, South Africa
| | - Thomas C. Quinn
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
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Affiliation(s)
- Jeremy Hill
- Guide Dog Association of New South Wales and ACT, 4/1 Duke Street, Coffs Harbour, NSW 2450, Australia
| | - John Black
- Guide Dog Association of New South Wales and ACT, 5 North-cliff Street, Milsons Point, NSW 2061, Australia
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45
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Black J, Joyce R, Morgan C. The Use of Escalators by Dog Guide Owners. Journal of Visual Impairment & Blindness 2019. [DOI: 10.1177/0145482x9809200909] [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: 11/16/2022]
Affiliation(s)
- John Black
- Guide Dog Association of New South Wales and ACT, P.O. Box 107, Milsons Point NSW 2061, Australia
| | - Ray Joyce
- Guide Dog Association of New South Wales and ACT, P.O. Box 107, Milsons Point NSW 2061, Australia
| | - Carta Morgan
- Guide Dog Association of New South Wales and ACT, P.O. Box 107, Milsons Point NSW 2061, Australia
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Lam A, Black J, Parnell B, West CT. Appendicitis due to incarceration within a laparoscopic umbilical port-site hernia secondary to a degree of intestinal malrotation. Ann R Coll Surg Engl 2019; 101:e119-e121. [PMID: 30854864 DOI: 10.1308/rcsann.2019.0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/22/2022] Open
Abstract
A 37-year-old woman presented with an incarcerated hernia at a previous umbilical laparoscopic port site. This was found to contain an ischaemic appendix, which was managed successfully with open appendicectomy and a mesh repair. Previous imaging from a year prior to these events demonstrated a degree of intestinal malrotation with the caecal pole lying just under the umbilicus. Finding the appendix within an incisional port site is very rare, for this to occur at the umbilicus is unique.
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Affiliation(s)
- Aky Lam
- Epsom and St Helier University Hospitals NHS Trust
| | - J Black
- Brighton and Sussex University Hospitals NHS Trust
| | - B Parnell
- Brighton and Sussex University Hospitals NHS Trust
| | - C T West
- Dorset County Hospital NHS Foundation Trust
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Cheng K, Black J, Negishi K, Plottier G, Marwick T. Chest Pain Risk Scores Correlates with Initiation of Medical Therapy or Revascularisation Following Rapid Access Chest Pain Clinic Review. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lawless G, Kydd C, Black J, Maude E, Glynn D. The relationship between spinal rotation and lung function in patients with scoliosis. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Evans J, Sita-Lumsden A, Black J, Mackay K, Bendle M, Hatcher O, Power D, Newsom-Davis T. Missing the boat: real world analysis of second line osimertanib use across North West London. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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