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Abstract
BACKGROUND Osteoarticular infections are uncommon and required a multimodal approach for diagnosis. Imaging forms an important component of this multimodal approach. OBJECTIVES In this narrative review, we describe the different imaging modalities, features of osteoarticular infections present on these imaging approaches and recommendations for which imaging modality should be considered in different types of osteoarticular infections. SOURCES This narrative review was based on literature review from PubMed and was limited to bacterial infections in adult patients. CONTENT Imaging modalities include modalities that provide information on the anatomy or radionuclide imaging that provides information about the metabolic activity of the area of interest. Anatomical imaging includes plain radiographs (X-ray), computed tomography, and magnetic resonance imaging. Radionuclide approaches include three-phase bone scintigraphy, gallium scans, white blood cell scintigraphy, and 18F-fluorodeoxy-glucose positron emission tomography. The optimal radiological modality for diagnosis is influenced by multiple factors, including infection location, presence of metalware, timing of infection from any preceding surgery or fracture, antibiotic use, and patient comorbidities. Local availability of scanning modality, tracer supply, technical expertise, and patient access also influences choice. IMPLICATIONS A collaborative approach with imaging, pathology and clinical input in a multidisciplinary setting is paramount for the diagnosis of osteoarticular infections. Increasing research and improvements in technology will further improve the utility and accuracy of imaging approaches for imaging in osteoarticular infections.
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Affiliation(s)
- Trisha N Peel
- Department of Infectious Diseases, Monash University and Alfred Health, Melbourne, VIC, Australia.
| | - Martin Cherk
- Department of Nuclear Medicine & PET, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Kenneth Yap
- Department of Nuclear Medicine & PET, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
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2
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Groot Bruinderink ML, Boyd A, Coyer L, Boers S, Blitz L, Brand JM, Götz HM, Stip M, Woudstra J, Yap K, Vermey K, Matser A, Feddes AR, Jongen VW, Prins M, Hoornenborg E, van Harreveld F, Schim van der Loeff MF, Davidovich U. Online-Mediated HIV Pre-exposure Prophylaxis Care and Reduced Monitoring Frequency for Men Who Have Sex With Men: Protocol for a Randomized Controlled Noninferiority Trial (EZI-PrEP Study). JMIR Res Protoc 2023; 12:e51023. [PMID: 37938875 PMCID: PMC10666015 DOI: 10.2196/51023] [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: 07/20/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Daily and event-driven HIV pre-exposure prophylaxis (PrEP) with oral tenofovir-emtricitabine is highly effective to prevent HIV in men who have sex with men (MSM). PrEP care generally consists of in-clinic monitoring every 3 months that includes PrEP dispensing, counseling, and screening for HIV and sexually transmitted infections (STIs). However, the optimal frequency for monitoring remains undetermined. Attending a clinic every 3 months for monitoring may be a barrier for PrEP. Online-mediated PrEP care and reduced frequency of monitoring may lower this barrier. OBJECTIVE The primary objective of this study is to establish the noninferiority of online PrEP care (vs in-clinic care) and monitoring every 6 months (vs every 3 months). The secondary objectives are to (1) examine differences between PrEP care modalities regarding incidences of STIs, HIV infection, and hepatitis C virus infection; retention in PrEP care; intracellular tenofovir-diphosphate concentration; and satisfaction, usability, and acceptability of PrEP care modalities; and (2) evaluate associations of these study outcomes with sociodemographic, behavioral, and psychological characteristics. METHODS This study is a 2×2 factorial, 4-arm, open-label, multi-center, randomized, controlled, noninferiority trial. The 4 arms are (1) in-clinic monitoring every 3 months, (2) in-clinic monitoring every 6 months, (3) online monitoring every 3 months, and (4) online monitoring every 6 months. The primary outcome is a condomless anal sex act with a casual partner not covered or insufficiently covered by PrEP (ie, "unprotected act") as a proxy for HIV infection risk. Eligible individuals are MSM, and transgender and gender diverse people aged ≥18 years who are eligible for PrEP care at 1 of 4 participating sexual health centers in the Netherlands. The required sample size is 442 participants, and the planned observation time is 24 months. All study participants will receive access to a smartphone app, which contains a diary. Participants are requested to complete the diary on a daily basis during the first 18 months of participation. Participants will complete questionnaires at baseline and 6, 12, 18, and 24 months. Dried blood spots will be collected at 6 and 12 months for assessment of intracellular tenofovir-diphosphate concentration. Incidence rates of unprotected acts will be compared between the online and in-clinic arms, and between the 6-month and 3-month arms. Noninferiority will be concluded if the upper limit of the 2-sided 97.5% CI of the incidence rate ratio is <1.8. RESULTS The results of the main analysis are expected in 2024. CONCLUSIONS This trial will demonstrate whether online PrEP care and monitoring every 6 months is noninferior to standard PrEP care in terms of PrEP adherence. If noninferiority is established, these modalities may lower barriers for initiating and continuing PrEP use and potentially reduce the systemic burden for PrEP providers. TRIAL REGISTRATION ClinicalTrials.gov NCT05093036; https://tinyurl.com/28b8ndvj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51023.
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Affiliation(s)
- Marije L Groot Bruinderink
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- HIV Monitoring Foundation, Amsterdan, Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Sophie Boers
- Department of Sexual Health, Public Health Service of Gelderland-Zuid, Nijmegen, Netherlands
| | - Laura Blitz
- Department of Sexual Health, Public Health Service of Haaglanden, The Hague, Netherlands
| | - Jean-Marie Brand
- Department of Sexual Health, Public Health Service of Haaglanden, The Hague, Netherlands
| | - Hannelore M Götz
- Department of Infectious Diseases, Public Health Service of Rotterdam-Rijnmond, Rotterdam, Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Martijn Stip
- Department of Infectious Diseases, Public Health Service of Rotterdam-Rijnmond, Rotterdam, Netherlands
| | - Joey Woudstra
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Kenneth Yap
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | | | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection & Immunity, Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Allard R Feddes
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Vita W Jongen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- HIV Monitoring Foundation, Amsterdan, Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection & Immunity, Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection & Immunity, Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Frenk van Harreveld
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection & Immunity, Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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Yan MK, Adler NR, Wolfe R, Pan Y, Chamberlain A, Kelly J, Yap K, Voskoboynik M, Haydon A, Shackleton M, Mar VJ. The role of surveillance imaging for resected high‐risk melanoma. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13913] [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] [Received: 04/27/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Mabel K. Yan
- Victorian Melanoma Service Alfred Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Nikki R. Adler
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Yan Pan
- Victorian Melanoma Service Alfred Health Melbourne Australia
- Central Clinical School Monash University Melbourne Australia
| | - Alexander Chamberlain
- Victorian Melanoma Service Alfred Health Melbourne Australia
- Central Clinical School Monash University Melbourne Australia
| | - John Kelly
- Victorian Melanoma Service Alfred Health Melbourne Australia
| | - Kenneth Yap
- Central Clinical School Monash University Melbourne Australia
- Department of Nuclear Medicine and PET Alfred Health Melbourne Australia
| | - Mark Voskoboynik
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Andrew Haydon
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Mark Shackleton
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Victoria J. Mar
- Victorian Melanoma Service Alfred Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
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Koole JC, de la Court F, Welkers MR, Yap K, Stalenhoef JE, Jurriaans S, de Vries HJ, Op de Coul EL, Prins M, Hoornenborg E. HIV-1-infection in a man who has sex with men despite self-reported excellent adherence to pre-exposure prophylaxis, the Netherlands, August 2021: be alert to emtricitabine/tenofovir-resistant strain transmission. Euro Surveill 2022; 27. [PMID: 35393931 PMCID: PMC8991733 DOI: 10.2807/1560-7917.es.2022.27.14.2200275] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In August 2021, a man who has sex with men was diagnosed with HIV-1 infection despite using event-driven pre-exposure prophylaxis for over 2 years with self-reported excellent adherence. Sequencing identified resistance-associated mutations (RAM) M184V and K65R, conferring resistance to emtricitabine and tenofovir, and RAM V108I and E138A. Background RAM prevalence was two of 164 (1.2%) new HIV diagnoses in Amsterdam (2017–19). We reiterate the need for frequent HIV testing among PrEP users and additional testing in case of symptoms.
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Affiliation(s)
- Jeffrey Cd Koole
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Feline de la Court
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Matthijs Ra Welkers
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.,Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kenneth Yap
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | | | - Suzanne Jurriaans
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam, the Netherlands
| | - Henry Jc de Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.,Department of Dermatology, Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC, University of Amsterdam, location Academic Medical Centre, Amsterdam, the Netherlands
| | - Eline Lm Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
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5
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Yan MK, Adler NR, Pan Y, Chamberlain A, Kelly J, Yap K, Voskoboynik M, Haydon A, Shackleton M, Mar VJ. Yield of baseline imaging for distant metastases in high-risk primary melanoma. J Surg Oncol 2022; 125:1312-1317. [PMID: 35262187 DOI: 10.1002/jso.26846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The yield of baseline imaging in patients presenting with higher risk primary tumours, at least American Joint Committee on Cancer 8th edition stage IIC or III melanoma, is unclear. METHODS This retrospective study included patients referred to the Victorian Melanoma Service from January 2017 to April 2020, diagnosed with at least stage IIC or stage III melanoma. Patients with a T4b tumour and no sentinel lymph node biopsy were included as 'T4bNX'. RESULTS One hundred and sixty-four patients (median age 65 years) with baseline imaging (T4bNX: 19, IIC: 30, IIIA: 21, IIIB: 43, IIIC: 50, IIID: 1) were included. The majority were male (73%), and those with T4bNX melanoma tended to be older (median age 79 years). Distant metastases were detected in 21% (4/19) of T4bNX, 3% (1/30) of stage IIC, 0% (0/21) of stage IIIA, and 6% (6/94) of stages IIIB-D melanoma patients. All stage III patients with distant metastases had palpable lymphadenopathy a presentation. Two patients had brain metastases, both of whom had T4bNX melanoma and synchronous extra-cranial metastases. CONCLUSIONS Compared to stage IIC, baseline imaging detects higher rates of extra-cranial distant disease in stages IIIB-D and T4bNX melanoma. Intracranial imaging has greater yield in patients with distant extra-cranial disease.
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Affiliation(s)
- Mabel K Yan
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nikki R Adler
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yan Pan
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Alexander Chamberlain
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John Kelly
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Kenneth Yap
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Nuclear Medicine and PET, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Voskoboynik
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Shackleton
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Victoria J Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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de Gee F, Manuels C, Boerwinkel EK, Yap K, Muntinga ME. 'They say "I did it", but they don't say "I got an STI from it"': Exploring the experiences of youth with a migration background with sexual health in Amsterdam, the Netherlands. Glob Public Health 2021; 17:2095-2110. [PMID: 34432598 DOI: 10.1080/17441692.2021.1970207] [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: 10/20/2022]
Abstract
Youth with a migration background are underserved by sexual healthcare. Insight in their experiences is essential to develop tailored services and counter disparities. We explored how youth with a migration background access sexual health information, experience public sexual healthcare, and navigate sexual health in their particular sociocultural contexts. We carried out nine semi-structured interviews and one group interview with twelve young people (18-24) with a migration background in Amsterdam, the Netherlands. Respondents were heterosexually oriented and of various sociocultural backgrounds. Data were analysed using thematic content analysis. Three themes emerged: 'Access to sexual health information', 'Access to primary sexual health care', and 'Strategies for sexual self-care'. Youth sought out information online or from peers, however, conversations mostly focussed on pleasure while risk was often not discussed. Youth valued anonymity when accessing sexual healthcare, and used several strategies, such as staying silent or adhering to values such as 'self-respect', to navigate sexual health within their everyday gendered environments. While these strategies manifested as sources of empowerment, they also resulted in potential vulnerabilities. To counter sexual health disparities among youth with a migration background, public sexual health services should provide culturally safe care and foster participatory collaborations with local stakeholders.
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Affiliation(s)
- Floor de Gee
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
| | - Carien Manuels
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
| | | | - Kenneth Yap
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
| | - Maaike E Muntinga
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
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Johari Y, Wickremasinghe A, Kiswandono P, Yue H, Ooi G, Laurie C, Hebbard G, Beech P, Yap K, Brown W, Burton P. Mechanisms of Esophageal and Gastric Transit Following Sleeve Gastrectomy. Obes Surg 2020; 31:725-737. [PMID: 32964369 DOI: 10.1007/s11695-020-04988-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/05/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Sleeve gastrectomy (SG) patients have substantially altered anatomy. The mechanism of rapid gastric emptying and the role of esophageal contractile function in esophago-gastric transit has not been defined. We aimed to determine the mechanisms of esophago-gastric transit and role of esophageal function following sleeve gastrectomy. METHODS Prospective study of twenty-six asymptomatic participants post SG underwent nuclear scintigraphy and high-resolution manometry. Fourteen had semi-solid stress barium to model the emptying process. Concurrent video fluoroscopy and manometry were performed on 7 participants. RESULTS Demographic data are as follows: age 45.3 ± 15.0 years, 73.1% female, excess weight loss 62.2 ± 28.1% at 8 months. Scintigraphy showed rapid gastric emptying (24.4 ± 11.4 vs. 75.80 ± 45.19 min in control, p < 0.001) with 35.24 ± 17.12% of bolus transited into small bowel on initial frame. Triggered deglutitive reflux was common (54.4% vs. 18.2%, p = 0.017). Stress barium delineated separate vertical and antral gastric compartments with cyclical emptying of 8 stages, including reflux-induced repeated esophageal peristalsis. During manometry, ramping effects were noted, with sequential swallows producing sustained isobaric pressurizations in proximal stomach (33.6 ± 29.5 mmHg). Video fluoroscopy showed individual esophageal peristalsis generating pressurizations at 5.0 ± 1.4 cm below lower esophageal sphincter (LES), at amplitude of 31.6 ± 13.1 mmHg, associated with intragastric transit. Pressurizations were sustained for 17.3 ± 8.2 s, similar to the prolonged LES contraction (18.5 ± 9.0 s, p = 0.355). CONCLUSIONS Repeated esophageal peristaltic contractions induced isobaric pressurization of proximal stomach, thus providing the drive to pressurize and empty the vertical compartment of the gastric sleeve. Transit following SG appeared to be esophageal-mediated and followed a distinct cycle with strong associations with reflux.
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Affiliation(s)
- Yazmin Johari
- Department of Surgery, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia. .,Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
| | - Anagi Wickremasinghe
- Department of Surgery, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Pradipta Kiswandono
- Department of Surgery, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Helen Yue
- Department of Nuclear Medicine, The Alfred Hospital, Melbourne, Australia
| | - Geraldine Ooi
- Department of Surgery, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Cheryl Laurie
- Department of Surgery, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Geoffrey Hebbard
- Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Paul Beech
- Department of Nuclear Medicine, The Alfred Hospital, Melbourne, Australia
| | - Kenneth Yap
- Department of Nuclear Medicine, The Alfred Hospital, Melbourne, Australia
| | - Wendy Brown
- Department of Surgery, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Paul Burton
- Department of Surgery, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
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Ferguson MT, Mallia A, Yap K, Wright S, Hicks RJ, Hofman MS. 'Hot spot' cardiac ischemia imaging with fluorodeoxyglucose positron emission tomography. J Nucl Cardiol 2016; 23:1514-1517. [PMID: 26754464 DOI: 10.1007/s12350-015-0390-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/15/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Marissa T Ferguson
- Department of Anaesthesia, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Andrew Mallia
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, Melbourne, VIC, 8006, Australia
| | - Kenneth Yap
- Department of Nuclear Medicine, Alfred Hospital, Melbourne, Australia
| | - Samuel Wright
- Department of Cardiology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rodney J Hicks
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, Melbourne, VIC, 8006, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Michael S Hofman
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, Melbourne, VIC, 8006, Australia.
- Department of Medicine, University of Melbourne, Parkville, Australia.
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Booij KAC, de Reuver PR, Yap K, van Dieren S, van Delden OM, Rauws EA, Gouma DJ. Morbidity and mortality after minor bile duct injury following laparoscopic cholecystectomy. Endoscopy 2015; 47:40-6. [PMID: 25532112 DOI: 10.1055/s-0034-1390908] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND STUDY AIMS Cystic duct and Luschka duct leakage after laparoscopic cholecystectomy are often classified as minor injuries because the outcome of endoscopic stenting and percutaneous drainage is generally reported to be good. However, the potential associated early mortality and risk factors for mortality are scarcely reported. The aim of this study was to describe the outcome, mortality, and risk factors for poor survival of patients with type A bile duct injury (BDI) referred to a tertiary center. PATIENTS AND METHODS Between January 1990 and January 2012, 800 patients were referred for BDI treatment and included in a prospective database. RESULTS Type A BDI, according to the Amsterdam and Strasberg classifications, was diagnosed in 216 patients. Treatment after referral was mainly endoscopic (n = 192 [88.9 %]) and radiologic (n = 14 [6.5 %]). Complications related to endoscopic retrograde cholangiopancreatography (ERCP) occurred in 14 patients (6.5 %). Other complications were sepsis (n = 34 [15.7 %]), cardiopulmonary (n = 22 [10.2 %]), and abscess formation (n = 15 [6.9 %]). BDI-related mortality was 4.2 % (9/216). Multivariate analysis showed age (hazard ratio [HR] = 1.04, 95 % confidence interval [CI] 1.00 - 1.07) and American Society of Anesthesiologists class 3 or 4 (HR = 5.64, 95 %CI 2.31 - 13.77) to be independent factors significantly associated with mortality. CONCLUSIONS Type A "minor" BDI after laparoscopic cholecystectomy is associated with considerable short-term mortality related to the patient's condition at referral. Older patients and patients with ASA 3 or 4 have a significantly higher risk of mortality.
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Affiliation(s)
- Klaske A C Booij
- Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Philip R de Reuver
- Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Kenneth Yap
- Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Susan van Dieren
- Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Erik A Rauws
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Dirk J Gouma
- Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Yap K, Campbell P, Cherk M, McGrath C, Kalff V. Effect of prone versus supine positioning on left ventricular ejection fraction (LVEF) and heart rate using ECG gated Tl-201 myocardial perfusion scans and gated cardiac blood pool scans. J Med Imaging Radiat Oncol 2012; 56:525-31. [DOI: 10.1111/j.1754-9485.2012.02438.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 04/01/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Kenneth Yap
- Department of Nuclear Medicine; The Alfred Hospital; Melbourne; Victoria; Australia
| | - Patrina Campbell
- Department of Nuclear Medicine; The Alfred Hospital; Melbourne; Victoria; Australia
| | - Martin Cherk
- Department of Nuclear Medicine; The Alfred Hospital; Melbourne; Victoria; Australia
| | - Catherine McGrath
- Department of Nuclear Medicine; The Alfred Hospital; Melbourne; Victoria; Australia
| | - Victor Kalff
- Department of Nuclear Medicine; The Alfred Hospital; Melbourne; Victoria; Australia
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Bhattacharjee S, Yap K, Longano A, Powell A. Is fluorine 18 fluorodeoxyglucose positron emission tomography scanning a suitable diagnostic test for histologically active large-vessel vasculitis? J Clin Rheumatol 2010; 17:31-4. [PMID: 21169851 DOI: 10.1097/rhu.0b013e3182050d07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent publications have highlighted the use of fluorine 18 fluorodeoxyglucose (F-FDG) positron emission tomography (PET) as a moderately sensitive, noninvasive diagnostic test for medium- and large-vessel vasculitis. We report the atypical case of a patient with biopsy-proven granulomatous vasculitis of the aorta in addition to a non-small cell lung cancer, whose whole-body F-FDG PET/computed tomography scan demonstrated metabolic activity within the lung malignancy but was metabolically inactive in the aorta. We submit that F-FDG PET may not be an accurate diagnostic test for histologically active large-vessel vasculitis and should be used with caution.
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Affiliation(s)
- Shomoresh Bhattacharjee
- Rheumatology Unit, Department of Nuclear Medicine, Alfred Hospital, Commercial Road, Melbourne, Australia.
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Leung K, Yap K, Dashti N, Bottomley PJ. Serological and Ecological Characteristics of a Nodule-Dominant Serotype from an Indigenous Soil Population of Rhizobium leguminosarum bv. trifolii. Appl Environ Microbiol 2010; 60:408-15. [PMID: 16349170 PMCID: PMC201328 DOI: 10.1128/aem.60.2.408-415.1994] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although at least 13 antigenically distinct serotypes of Rhizobium leguminosarum bv. trifolii exist in an Abiqua silty clay loam soil, one serotype, AS6, occupies >/=50% of the root nodules formed on field-grown subclover and between 33 and 78% of the nodules formed on five annual clover species grown in the same soil under laboratory conditions. The dominance of subclover nodules by serotype AS6 was reproducible over a 4-year sampling period and throughout the entire 200- by 100-m pasture examined. Serotype AS6 was composed of three antigenically distinct subtypes (AS6-a, AS6-b, and AS6-c). Each subtype contributed about one-third of the AS6 isolates recovered from nodules of field-grown subclover plants and maintained similar population densities in nonrhizosphere and rhizosphere soil. Rhizobia with the AS6 antigenic signature accounted for from 20 to 100% of the soil populations of R. leguminosarum in arable and pasture soils under legumes throughout the state of Oregon. Over a 12-month period, the population densities of the serotype AS6 complex and three minor nodule-occupying serotypes (AG4, AP17, and AS21) were measured in the rhizospheres of field-grown subclover and orchard grass and in nonrhizosphere Abiqua soil. Regardless of season or serotype, the orchard grass rhizosphere effect was minimal, with the ratio between rhizosphere and nonrhizosphere serotype population densities ranging between 2.5 (midsummer) and 10.5 (spring). In contrast, the magnitude of the subclover rhizosphere effect varied seasonally and among serotypes. Between October and December the ratios for all serotypes were similar (12.5 to 25.5). However, in the spring (April and May), the magnitude of the rhizosphere effect varied among the indigenous serotypes (ratios, 10.5 to 442) and for minor nodule-occupying serotypes AS21 (ratio, 442) and AP17 (ratio, 47) was as great as, or even greater than, the magnitude of the rhizosphere effect observed with the AS6 complex (ratio, 65.5).
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Affiliation(s)
- K Leung
- Department of Microbiology, Oregon State University, Corvallis, Oregon 97331-3804
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Whelan J, van Binnendijk R, Greenland K, Fanoy E, Khargi M, Yap K, Boot H, Veltman N, Swaan C, van der Bij A, de Melker H, Hahné S. Ongoing mumps outbreak in a student population with high vaccination coverage, Netherlands, 2010. ACTA ACUST UNITED AC 2010; 15. [PMID: 20460086 DOI: 10.2807/ese.15.17.19554-en] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since December 2009, mumps incidence has increased in the Netherlands. As of 20 April 2010, 172 cases have been notified on the basis of laboratory confirmation or linkage to a laboratory-confirmed case. Of these, 112 were students, the majority of whom had been vaccinated (81%). Although outbreaks in vaccinated populations have been described before, risk factors for exposure and susceptibility, and dose-dependent vaccine effectiveness in a student population of this nature are relatively unknown.
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Affiliation(s)
- J Whelan
- Centre for Infectious Disease Control, Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and Environment, RIVM), Bilthoven, the Netherlands.
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Hartman M, Hartman M, Lim G, Czene K, Bhalla V, Chow K, Yap K, Chia K, Chia K, Verkooijen H, Verkooijen H, Verkooijen H. Childbirth Following Breast Cancer: An Evaluation of the 'Healthy Mothers' Excess Mortality Risk. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3173] [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: The favorable outcome of mothers giving birth after breast cancer compared to those who do not, has been attributed to a healthy mother effect. Mainly former breast cancer patients with excellent health status and outlook proceed to having children after their disease. This study evaluates the excess mortality risk among these 'healthy mothers' and factors modifying this risk.Methods: By linking the Singapore Birth Registry (319'437 individuals) and Swedish Multi-Generation Cohort (11 million women) with the respective national cancer registries we identified all 509 women who gave birth >12 months after a breast cancer diagnosis. We calculated excess absolute mortality risks and Standardized Mortality Ratios (SMRs). We used Poisson regression analysis to calculate relative risks of death by country, period of follow up and interval between cancer diagnosis and subsequent birth.Results: The overall 15-year cumulative mortality was 18.2% (95% CI: 13.3 – 20.7%) which is substantially higher than that of the background population (SMR 13.3, 95%CI: 10.4-16.9). Excess mortality risks remained constant over follow up time and were comparable between Sweden and Singapore. Mortality risks decreased significantly with increasing interval between diagnosis and subsequent birth.Conclusion: Despite being 'healthy mothers', women who give birth after a diagnosis of breast cancer have a substantially higher risk of death than the background population. This information may be useful in a woman's decision whether to have a(another) child after breast cancer.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3173.
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Affiliation(s)
- M. Hartman
- 2National University of Singapore, Singapore
| | | | - G. Lim
- 2National University of Singapore, Singapore
| | | | | | - K. Chow
- 5Health Promotion Board, Singapore
| | - K. Yap
- 1National University of Singapore, Singapore
| | - K. Chia
- 1National University of Singapore, Singapore
| | - K. Chia
- 2National University of Singapore, Singapore
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Angeles D, Refai F, Siddique M, Yap K, Ho P, Fook-Chong S, Zhao Y, Tan EK. P3.090 Heterozygous mutations in PINK1 kinase domain exert a gene dosage effect. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70654-6] [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: 10/20/2022]
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Abstract
BACKGROUND Preliminary work has shown that diffusion tensor MRI (DTI) may contribute to the diagnosis of Parkinson's disease (PD). OBJECTIVES We conducted a large, prospective, case control study to determine: (1) if fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values on DTI in the basal ganglia and substantia nigra are different between patients with PD and healthy controls; and (2) the predictive value of these parameters and their clinical utility. METHODS DTI imaging was carried out in patients with PD and controls. FA and ADC values were obtained from various brain structures on the DTI scan using the diffusion tensor taskcard. The structures studied were: caudate, putamen, globus pallidus, thalamus and substantia nigra. RESULTS 151 subjects (73 PD patients, 41 men, 32 women; mean age 63.6 years) and 78 age and sex matched control subjects were studied. The FA value of the substantia nigra in patients with PD was lower compared with controls (0.403 vs 0.415; p = 0.001). However, no significant differences were demonstrated for FA or ADC values of other structures. Multiple regression analysis revealed that the clinical severity of PD correlated inversely with the FA value in the substantia nigra in patients with PD (regression coefficient -0.019). No single FA value had both a high positive and negative predictive power for PD. CONCLUSIONS We demonstrated in a large, prospective, case control study that the FA value in the substantia nigra on DTI was lower in PD compared with healthy controls, and correlated inversely with the clinical severity of PD. Further longitudinal studies would be helpful to assess the clinical utility of serial FA measurements of the substantia nigra in objective quantification of disease progression and monitoring of the therapeutic response.
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Affiliation(s)
- L-L Chan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Republic of Singapore
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Raj SM, Yap K, Haq JA, Singh S, Hamid A. Further evidence for an exceptionally low prevalence of Helicobacter pylori infection among peptic ulcer patients in north-eastern peninsular Malaysia. Trans R Soc Trop Med Hyg 2001; 95:24-7. [PMID: 11280057 DOI: 10.1016/s0035-9203(01)90319-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The Helicobacter pylori infection rate was determined in 124 consecutive patients with duodenal ulcers (DU), gastric ulcers (GU), duodenal erosions or gastric erosions diagnosed by endoscopy at a single institution in north-eastern peninsular Malaysia in 1996-97. Biopsies of the gastric antrum and body were subjected to the urease test, Gram staining of impression smears, culture and histopathological examination. Serology was undertaken on all patients using a locally validated commercial kit. Infection was defined as a positive result in at least one test. The infection rates were 20% (10/50), 21.2% (7/33), 16.7% (1/6) and 17.1% (6/35) in DU, GU, duodenal erosion and gastric erosion patients, respectively. The infection rate among Malays [7.0%, (6/86)] was lower than in non-Malays [47.4% (18/38)] (P < 0.001). There was a higher infection rate among males, who constituted 62.1% (77/124) of the sample. Seventy-eight patients (62.9%) were receiving non-steroidal anti-inflammatory drugs (NSAIDs) and 33 patients (26.6%) were neither receiving NSAIDs nor were infected with H. pylori. The H. pylori infection rate among peptic ulcer patients in this predominantly Malay rural population appears to be the lowest reported in the world thus far. Empirical H. pylori eradication therapy in peptic ulcer patients is clearly not indicated in this community. The possible reasons for the low prevalence of H. pylori infection are discussed.
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Affiliation(s)
- S M Raj
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan 16150, Malaysia.
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McCready DR, Chapman JA, Hanna WM, Kahn HJ, Yap K, Fish EB, Lickley HL. Factors associated with local breast cancer recurrence after lumpectomy alone: postmenopausal patients. Ann Surg Oncol 2000; 7:562-7. [PMID: 11005553 DOI: 10.1007/bf02725334] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We have been following a cohort of patients who underwent a lumpectomy without receiving adjuvant radiotherapy or adjuvant systemic therapy. We now report the experience of a postmenopausal subgroup. METHODS The postmenopausal subgroup included 244 patients accrued between 1977 and 1986 and followed up. The end point was ipsilateral local breast cancer recurrence. The factors studied were the patient's age in years; tumor size (in mm); nodal status (N-, Nx, N+); estrogen and progesterone receptor status (< 10, - 10 fmol/mg protein); presence or absence of lymphovascular/perineural invasion; presence or absence, and type, of DCIS (none, non-comedo, comedo); percentage of DCIS; histological grade (1,2,3); and nuclear grade (1,2,3). Univariate analyses consisted of Kaplan-Meier plots and the Wilcoxon (Peto-Prentice) test statistic; the multivariate analyses were step-wise Cox and log-normal regressions. RESULTS The median follow-up of those patients still alive was 9.1 years, and the overall relapse rate was 24% (59/244). The univariate results indicated that the characteristics of smaller tumor size, negative nodes, positive ER status, and no lymphovascular or perineural invasion were associated with significantly (P <.05) lower relapse. From the multivariate analyses, the factors lymphovascular or perineural invasion, age, and amount of DCIS were all significantly associated with local relapse with both Cox and log-normal regressions. Additionally, there was weak evidence of an association between ER (P = .08 in the Cox regression and in the log-normal) and nodal status (P = .09 in the log-normal regression) with local relapse. We also are able to define a low-risk subgroup (N-, age -65, no comedo, ER positive, no emboli) with a crude 10-year local recurrence rate of 9%. CONCLUSION With longer follow-up, and for postmenopausal patients, there continues to be support for the theory that local relapse is affected by the factors lymphovascular or perineural invasion, age, amount of DCIS, ER, and nodal status. A low risk subgroup has been identified.
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Affiliation(s)
- D R McCready
- Department of Surgical Oncology, University Health Network, Princess Margaret Hospital, University of Toronto, Ontario, Canada
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Awang A, Yap K. Group A rotavirus infection in animals from an animal house and in wild-caught monkeys. J Diarrhoeal Dis Res 1990; 8:82-6. [PMID: 2122998] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Randomly selected samples from different animal colonies from two laboratory animal houses and from the wild-caught monkeys were tested for the presence of anti-rotavirus antibodies to estimate the rates of infection with group A rotavirus. Antibodies to the common group A rotaviral antigen were detected by a competitive enzyme-linked immunosorbent assay (ELISA) using reagents of WHO ELISA rotavirus detection kit. The results of the study showed that white mice, albino rats, and guinea pigs from long-established breeding colonies and resident house rats and house shrews from the animal house had no serological evidence of rotaviral infection. In contrast, one mousedeer from a colony of 19 animals and most of the rabbits from two separate breeding colonies at the same animal house were serologically positive for the infection. Also a significant number of the same species of monkey kept in captivity were found to acquire the infection. Leaf monkeys had no serological evidence of rotaviral infection. The infection rate in wild cynomolgus monkeys did not seem to be influenced by the different ecological environments of their respective habitats. The rate of infection in adults and juveniles was similar.
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Affiliation(s)
- A Awang
- Department of Microbiology, Faculty of Medicine, Universiti Kebangsaan Malaysia
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