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O'Connor C, McCarthy S, Kiely L, McAuliffe MAP, Bennett M. Novel multispectral imaging to predict disease progression in pediatric morphea. Pediatr Dermatol 2024; 41:229-233. [PMID: 38305508 DOI: 10.1111/pde.15485] [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: 07/19/2023] [Accepted: 11/07/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Morphea, or localized scleroderma, is an inflammatory, fibrosing skin disorder that can be progressive and debilitating. Infrared thermography frequently has false positive results. The aim of this study was to assess the ability of multispectral imaging to predict disease progression in children with morphea. METHODS Children with morphea were recruited between 2016 and 2022. Multispectral images of affected and matched contralateral unaffected sites were obtained using the Antera™ 3D camera. Clinical assessment was performed using the Localized Scleroderma Assessment Tool (LoSCAT). Children were followed up every 3 months for imaging and clinical review. The main outcome measurement was correlation of hemoglobin gradient between affected and matched contralateral unaffected tissue and progression. RESULTS Of 17 children, the average age was 12 years (range 6-18 years); most were female (76.5%) and white (94.1%). Nearly two-thirds (64.7%) had linear morphea, 35.2% had plaque morphea; 58.8% had been treated with systemic agents. The average LoSCAT score was 20.6 (range 5-73). The average hemoglobin gradient between affected and matched contralateral unaffected skin was four times higher in those who had progression (average differential 0.3, range 0.1-0.4) compared to those who did not (average differential 0.08, range 0.02-0.15). Using a cut off of a 0.18 hemoglobin gradient between affected and unaffected skin, the sensitivity of multispectral imaging for detecting progression in pediatric morphea is 90% with specificity of 100%. CONCLUSIONS Multispectral imaging is a novel assessment tool with promising accuracy in predicting progression as an adjunct to clinical assessment in pediatric morphea. Further research should examine its performance against thermography.
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Affiliation(s)
- Cathal O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Siobhan McCarthy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Lisa Kiely
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | | | - Mary Bennett
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
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Gilhooley E, Kiely L, Gallagher C, O'Connor C, McAuliffe M, Bourke J. Piloting Photographic Photonic Patch Testing: Pioneering Equitable Diagnosis of Contact Dermatitis. Dermatitis 2023; 34:568. [PMID: 36735582 DOI: 10.1089/derm.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | - Lisa Kiely
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Catriona Gallagher
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Cathal O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
- INFANT Research Centre, University College Cork, Ireland
| | - Michael McAuliffe
- Centre for Advanced Photonics and Process Analysis, Munster Technological University, Cork, Ireland
| | - John Bourke
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
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3
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Kiely L, O'Connor C, Murphy M. Dupilumab therapy following JAK inhibitor withdrawal in moderate-severe atopic dermatitis. Dermatol Ther 2022; 35:e15750. [PMID: 35906850 PMCID: PMC9787163 DOI: 10.1111/dth.15750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Lisa Kiely
- Department of DermatologySouth Infirmary Victoria University HospitalCorkIreland
| | - Cathal O'Connor
- Department of DermatologySouth Infirmary Victoria University HospitalCorkIreland,Department of MedicineUniversity CollegeCorkIreland
| | - Michelle Murphy
- Department of DermatologySouth Infirmary Victoria University HospitalCorkIreland,Department of MedicineUniversity CollegeCorkIreland
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4
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Finnegan P, Kiely L, Gallagher C, Mhaolcatha SN, Feeley L, Fitzgibbon J, White J, Bourke J, Murphy LA. Radiation-induced morphea of the breast-A case series. Skin Health Dis 2022; 3:e148. [PMID: 36751336 PMCID: PMC9892419 DOI: 10.1002/ski2.148] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/06/2022]
Abstract
Radiation-induced morphea (RIM) is a rare but recognized late complication of radiotherapy. It was first described in 1905, not long after the initial discovery of X-rays by Roentgen. Characterized by the deposition of excess collagen in the dermis, it results in thickening of the skin. Its frequency is approximately 2 in 1000. We present a series of three cases involving patients receiving radiotherapy treatment for breast cancer, each of which subsequently developed RIM. Because of its rarity, RIM is often misdiagnosed as infection or metastatic disease. This can lead to delayed diagnosis and treatment, leading to poorer outcomes such as chronic pain issues. Early dermatological involvement and tissue sampling to examine histopathological features can avoid this, leading to better care and improved results. A variety of treatment options are available, ranging from topical to systemic, with early induction more likely to result in a positive response.
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Affiliation(s)
- Paula Finnegan
- Department of DermatologyUniversity Hospital LimerickDooradoyleLimerickIreland
| | - Lisa Kiely
- Department of DermatologySouth Infirmary VictoriaUniversity HospitalCorkIreland
| | - Catriona Gallagher
- Department of DermatologySouth Infirmary VictoriaUniversity HospitalCorkIreland
| | | | - Linda Feeley
- Department of HistopathologyCork University HospitalWilton, CorkIreland
| | - Jim Fitzgibbon
- Department of HistopathologyCork University HospitalWilton, CorkIreland
| | - Jessica White
- Department of HistopathologyCork University HospitalWilton, CorkIreland
| | - John Bourke
- Department of DermatologySouth Infirmary VictoriaUniversity HospitalCorkIreland
| | - Lesley Ann Murphy
- Department of DermatologySouth Infirmary VictoriaUniversity HospitalCorkIreland
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5
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Kiely L, Ni Mhaolcatha S, Fitzgibbon J, Murphy L, O’Connor C. Porokeratotic adnexal ostial nevus: A paradigm of cutaneous mosaicism. Clin Case Rep 2022; 10:e05728. [PMID: 35432995 PMCID: PMC9005689 DOI: 10.1002/ccr3.5728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/20/2022] Open
Abstract
Porokeratotic adnexal ostial nevus (PAON) is a term encompassing porokeratotic eccrine ostial and dermal duct naevus (PEODDN) and porokeratotic eccrine and hair follicle naevus (PEHFN). We present the case of a 7‐year‐old girl who presented with hyperkeratotic verrucous papules in a blaschkolinear distribution on the sole of her left foot.
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Affiliation(s)
- Lisa Kiely
- Department of Dermatology South Infirmary Victoria University Hospital Cork Ireland
| | | | - Jim Fitzgibbon
- Department of Pathology Cork University Hospital Cork Ireland
| | - Lesley‐Ann Murphy
- Department of Dermatology South Infirmary Victoria University Hospital Cork Ireland
| | - Cathal O’Connor
- Department of Dermatology South Infirmary Victoria University Hospital Cork Ireland
- Department of Paediatrics and Child Health University College Cork Cork Ireland
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6
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O'Connor C, Kiely L, Heffron C, Ryan J, Bennett M. PAPA-like syndrome with heterozygous mutation in the MEFV gene. Clin Exp Dermatol 2021; 47:642-645. [PMID: 34882829 DOI: 10.1111/ced.15027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
A patient presented with a history of recurrent pyoderma gangrenosum, arthritis and extensive acne, prompting a genetic workup for PAPA syndrome. An MEFV mutation was identified and a change in therapeutic strategy from anakinra to colchicine was successful.
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Affiliation(s)
- C O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - L Kiely
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - C Heffron
- Pathology, Cork University Hospital, Cork, Ireland
| | - J Ryan
- Rheumatology, Cork University Hospital, Cork, Ireland
| | - M Bennett
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
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7
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Kiely L, Spracklen DV, Arnold SR, Papargyropoulou E, Conibear L, Wiedinmyer C, Knote C, Adrianto HA. Assessing costs of Indonesian fires and the benefits of restoring peatland. Nat Commun 2021; 12:7044. [PMID: 34857766 PMCID: PMC8639972 DOI: 10.1038/s41467-021-27353-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
Deforestation and drainage has made Indonesian peatlands susceptible to burning. Large fires occur regularly, destroying agricultural crops and forest, emitting large amounts of CO2 and air pollutants, resulting in adverse health effects. In order to reduce fire, the Indonesian government has committed to restore 2.49 Mha of degraded peatland, with an estimated cost of US$3.2-7 billion. Here we combine fire emissions and land cover data to estimate the 2015 fires, the largest in recent years, resulted in economic losses totalling US$28 billion, whilst the six largest fire events between 2004 and 2015 caused a total of US$93.9 billion in economic losses. We estimate that if restoration had already been completed, the area burned in 2015 would have been reduced by 6%, reducing CO2 emissions by 18%, and PM2.5 emissions by 24%, preventing 12,000 premature mortalities. Peatland restoration could have resulted in economic savings of US$8.4 billion for 2004-2015, making it a cost-effective strategy for reducing the impacts of peatland fires to the environment, climate and human health.
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Affiliation(s)
- L. Kiely
- grid.9909.90000 0004 1936 8403School of Earth and Environment, University of Leeds, Leeds, UK ,grid.266097.c0000 0001 2222 1582Present Address: Department of Chemical and Environmental Engineering, University of California, Riverside, CA USA
| | - D. V. Spracklen
- grid.9909.90000 0004 1936 8403School of Earth and Environment, University of Leeds, Leeds, UK
| | - S. R. Arnold
- grid.9909.90000 0004 1936 8403School of Earth and Environment, University of Leeds, Leeds, UK
| | - E. Papargyropoulou
- grid.9909.90000 0004 1936 8403Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds, UK
| | - L. Conibear
- grid.9909.90000 0004 1936 8403School of Earth and Environment, University of Leeds, Leeds, UK
| | - C. Wiedinmyer
- grid.464551.70000 0004 0450 3000CIRES, University of Colorado, Boulder, CO USA
| | - C. Knote
- grid.5252.00000 0004 1936 973XLudwig-Maximilians University, Munich, Germany
| | - H. A. Adrianto
- grid.9909.90000 0004 1936 8403School of Earth and Environment, University of Leeds, Leeds, UK ,grid.440754.60000 0001 0698 0773IPB University, Bogor, Indonesia
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8
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Prior L, O'Dwyer R, Farooq AR, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Othman EC, Watson G, Kelly D, Gleeson J, Kiely L, Hassan A, Walsh EM, O'Reilly D, Jones A, Featherstone H, Lim M, Murray H, Hennessy BT, Smyth LM, Leonard G, Grogan L, Breathnach O, Calvert P, Horgan AM, Coate L, Jordan EJ, O'Mahony D, Gupta R, Keane MM, Westrup J, Duffy K, O'Connor M, Morris PG, Kennedy MJ, O'Reilly S, McCaffrey J, Kelly CM, Carney D, Gullo G, Crown J, Higgins MJ, Walsh PM, Walshe JM. Pregnancy-associated breast cancer: evaluating maternal and foetal outcomes. A national study. Breast Cancer Res Treat 2021; 189:269-283. [PMID: 34125341 DOI: 10.1007/s10549-021-06263-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/13/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during the gestational period (gp-PABC) or in the first postpartum year (pp-PABC). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments, and maternal and foetal outcomes. METHODS This was a national, multi-site, retrospective observational study, including PABC patients treated in 12 oncology institutions from August 2001 to January 2020. Data extracted included information on patient demographics, tumour biology, staging, treatments, and maternal/foetal outcomes. Survival data for an age-matched breast cancer population over a similar time period was obtained from the National Cancer Registry of Ireland (NCRI). Standard biostatistical methods were used for analyses. RESULTS We identified 155 patients-71 (46%) were gp-PABC and 84 (54%) were pp-PABC. The median age was 36 years. Forty-four patients (28%) presented with Stage III disease and 25 (16%) had metastatic disease at diagnosis. High rates of triple-negative (25%) and HER2+ (30%) breast cancer were observed. We observed an inferior 5-year overall survival (OS) rate in our PABC cohort compared to an age-matched breast cancer population in both Stage I-III (77.6% vs 90.9%) and Stage IV disease (18% vs 38.3%). There was a low rate (3%) of foetal complications. CONCLUSION PABC patients may have poorer survival outcomes. Further prospective data are needed to optimise management of these patients.
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Affiliation(s)
- Lisa Prior
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland.
| | - Richard O'Dwyer
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | | | - Megan Greally
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cian Ward
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Connor O'Leary
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Razia Aslam
- Department of Medical Oncology, St James' Hospital, Dublin, Ireland
| | - Waseem Darwish
- Department of Medical Oncology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Nada Ahmed
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Elly Che Othman
- Department of Medical Oncology, Beacon Hospital, Dublin, Ireland
| | - Geoffrey Watson
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Deirdre Kelly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Jack Gleeson
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Lisa Kiely
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Anees Hassan
- Department of Medical Oncology, Tallaght University Hospital, Dublin, Ireland
| | - Elaine M Walsh
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - David O'Reilly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alfred Jones
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hannah Featherstone
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Marvin Lim
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Hazel Murray
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Lillian M Smyth
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Gregory Leonard
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Paula Calvert
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Anne M Horgan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Linda Coate
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Emmet J Jordan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Deirdre O'Mahony
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Rajnish Gupta
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Maccon M Keane
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Jennifer Westrup
- Department of Medical Oncology, Beacon Hospital, Dublin, Ireland
| | - Karen Duffy
- Department of Medical Oncology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Miriam O'Connor
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - M John Kennedy
- Department of Medical Oncology, St James' Hospital, Dublin, Ireland
| | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - John McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Catherine M Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Desmond Carney
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Giuseppe Gullo
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Michaela J Higgins
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Janice M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
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Kiely L, Bowe S, O'Connor C, Bennett M, Bourke J, Murphy M. Novel agents for atopic dermatitis in patients over 50 years of age: A case series. Dermatol Ther 2021; 34:e14890. [PMID: 33595883 DOI: 10.1111/dth.14890] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/09/2020] [Accepted: 02/13/2021] [Indexed: 11/29/2022]
Abstract
Lan et al recently highlighted the under-representation of older adults in clinical trials of systemic therapies for atopic dermatitis (AD). Late-onset AD is increasingly recognized in older adults. Spontaneous remission is uncommon with this phenotype. Existing drug treatments such as corticosteroids, methotrexate, ciclosporin, and azathioprine are complicated by adverse effects including increased malignancy risk, immunosuppression in the context of immunosenescence, and drug interactions in the setting of polypharmacy. A case series is presented of seven patients over 50 years of age with AD who were prescribed dupilumab or tofacitinib or upadacitinib for at least 6 months. All patients were clear or almost clear (investigator global assessment score 0/1) after 1 month of therapy. No significant adverse events were seen. This case series provides preliminary evidence about the safety and efficacy of these novel drugs for AD in older adults. Further studies with higher numbers of participants are needed to obtain real-world evidence for these drugs in older adults, given the limited data in clinical trials.
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Affiliation(s)
- Lisa Kiely
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Stephanie Bowe
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Cathal O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Dermatology, University College Cork, Cork, Ireland
| | - Mary Bennett
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Dermatology, University College Cork, Cork, Ireland
| | - John Bourke
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Dermatology, University College Cork, Cork, Ireland
| | - Michelle Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Dermatology, University College Cork, Cork, Ireland
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O'Connor C, Kiely L, O'Riordan A, O'Connell G, Bennett M, O'Shea S, Murphy LA, Bourke J, Murphy M. A change of climate for climate change: the environmental benefit of specialty outreach clinics. BMJ 2020; 369:m1410. [PMID: 32291288 DOI: 10.1136/bmj.m1410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/03/2022]
Affiliation(s)
- Cathal O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork T12 X23H, Republic of Ireland
| | - Lisa Kiely
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork T12 X23H, Republic of Ireland
| | - Anthony O'Riordan
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork T12 X23H, Republic of Ireland
| | - Garrett O'Connell
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork T12 X23H, Republic of Ireland
| | - Mary Bennett
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork T12 X23H, Republic of Ireland
| | - Sally O'Shea
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork T12 X23H, Republic of Ireland
| | - Lesley Ann Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork T12 X23H, Republic of Ireland
| | - John Bourke
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork T12 X23H, Republic of Ireland
| | - Michelle Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork T12 X23H, Republic of Ireland
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Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Abstract P6-08-17: Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-08-17] [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
Pregnancy associated breast cancer (PABC) is defined as breast cancer (BC) diagnosed during the gestational period (GP) or in the first year postpartum (PP). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first combined prospective and retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments and maternal outcomes. We present the retrospective findings to date.
Methods
We performed a retrospective multicentre observational study of patients (pts) with PABC treated in the eight Irish cancer centres from August 2001 to March 2017. Data extracted included information on pt demographics, tumour biology, staging, treatment administered and maternal outcomes. Standard biostatistical methods were used for analysis.
Results
111 PABC patients were identified. Sixty pts (54%) were diagnosed during the GP and 51 (46%) within 1 year PP. Median age at diagnosis was 36 years (yrs). Table 1 illustrates baseline characteristics. Two thirds of pts were node positive and a similar proportion had grade 3 pathology. Seventy pts (63%) were estrogen receptor (ER) positive, 36 (32%) HER2 positive, 25 (22%) triple negative. Twenty-two pts (20%) were metastatic at presentation. Seven pts (6%) had a known BRCA 1/2 mutation. The median OS (overall survival) and DFS (disease free survival) for the entire cohort was 107.4 and 94.2 months respectively (resp). There was no survival difference between those diagnosed during the GP versus PP. 5 yr DFS and OS was 68.6% and 69.2% resp. This compares unfavourably to results reported by the National Cancer Registry of Ireland in a similar age-matched BC population between 2000-2012 where the 5 yr OS was 86.5%. Variables in our study associated with poorer outcomes included younger age, tumour size, node positivity and lack of estrogen expression.
Baseline characteristics PABC patients (n=11) %(n)Diagnosed in GP (n=60) %(n)Diagnosed 1yr PP (n=51) %(n)p valueDemographic Age at diagnosis3636(25-49)36(21-44)0.31Stage I-II54(60)55(33)53(27)0.85III23(26)23(14)23(12)1IV20(22)18(11)22(11)0.81Unknown3(3)3(2)2(1)1Pathology Grade 366(74)70(42)63(32)0.43Node positive66(73)68(41)63(32)0.55ER+/HER2-41(45)38(23)43(22)0.69ER+/HER2+23(25)28(17)16(8)0.17ER-/HER2+14(16)17(10)12(6)0.59Triple negative22(25)17(10)29(15)0.11Surgery Breast conservation23(26)25(15)21(11)0.82Mastectomy56(63)57(34)59(30)0.84Adjuavnt/Neoadjuvant treatment Chemotherapy73(81)77(46)69(35)0.39Anthracycline68(55)78(36)54(19)0.03Taxane89(72)93(43)83(29)0.16Anti HER2 agent21(23)18(11)24(12)0.63Endocrine therapy64(52)63(29)66(23)0.84Radiotherapy79(64)74(34)86(30)0.85Relapse in Stage I-III Local relapse15(13)12(6)18(7)0.55Distant relapse24(21)22(11)25(10)0.80
Conclusions
PABC patients may have a poorer outcome. Our study reported higher rates of triple negative and HER2 positive breast cancer which are associated with more aggressive biology. Prospective evaluation of clinicopathological features, pharmacokinetics of treatments selected and maternal and fetal outcomes is imperative in this distinct pt group.
Citation Format: Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-17.
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Affiliation(s)
- L Prior
- Cancer Trials Ireland, Dublin, Ireland
| | - M Teo
- Cancer Trials Ireland, Dublin, Ireland
| | - M Greally
- Cancer Trials Ireland, Dublin, Ireland
| | - C Ward
- Cancer Trials Ireland, Dublin, Ireland
| | - C O'Leary
- Cancer Trials Ireland, Dublin, Ireland
| | - R Aslam
- Cancer Trials Ireland, Dublin, Ireland
| | - W Darwish
- Cancer Trials Ireland, Dublin, Ireland
| | - N Ahmed
- Cancer Trials Ireland, Dublin, Ireland
| | - G Watson
- Cancer Trials Ireland, Dublin, Ireland
| | - D Kelly
- Cancer Trials Ireland, Dublin, Ireland
| | - L Kiely
- Cancer Trials Ireland, Dublin, Ireland
| | - A Hassan
- Cancer Trials Ireland, Dublin, Ireland
| | - J Gleeson
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M Lim
- Cancer Trials Ireland, Dublin, Ireland
| | - H Murray
- Cancer Trials Ireland, Dublin, Ireland
| | | | - J Westrup
- Cancer Trials Ireland, Dublin, Ireland
| | | | - G Leonard
- Cancer Trials Ireland, Dublin, Ireland
| | - L Grogan
- Cancer Trials Ireland, Dublin, Ireland
| | | | - A Horgan
- Cancer Trials Ireland, Dublin, Ireland
| | - L Coate
- Cancer Trials Ireland, Dublin, Ireland
| | | | - L Coate
- Cancer Trials Ireland, Dublin, Ireland
| | | | - R Gupta
- Cancer Trials Ireland, Dublin, Ireland
| | - M Keane
- Cancer Trials Ireland, Dublin, Ireland
| | - K Duffy
- Cancer Trials Ireland, Dublin, Ireland
| | | | - J Kennedy
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M Higgins
- Cancer Trials Ireland, Dublin, Ireland
| | - C Kelly
- Cancer Trials Ireland, Dublin, Ireland
| | - D Carney
- Cancer Trials Ireland, Dublin, Ireland
| | - G Gullo
- Cancer Trials Ireland, Dublin, Ireland
| | - J Crown
- Cancer Trials Ireland, Dublin, Ireland
| | - J Walshe
- Cancer Trials Ireland, Dublin, Ireland
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12
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Christie CD, Garrison KM, Kiely L, Gupta RK, Heubi J, Marchant CD. A trial of acellular pertussis vaccine in hospital workers during the Cincinnati pertussis epidemic of 1993. Clin Infect Dis 2001; 33:997-1003. [PMID: 11528571 DOI: 10.1086/322618] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2000] [Revised: 03/26/2001] [Indexed: 11/03/2022] Open
Abstract
The safety and immunogenicity of acellular pertussis (AP) vaccine in outbreak control was determined in a randomized, double-blind, controlled trial. Participants received AP vaccine (n=102), which contained 25 microg of pertussis toxoid (PT) and 3 microg of filamentous hemagglutinin (FHA), or licensed meningococcal vaccine (MN; n=97). Local reactions (pain or tenderness, redness, swelling, and induration) and systemic reactions (fever, sleepiness or lethargy, and irritability) were similar among AP and MN vaccinees. One month after AP vaccination, the geometric mean level of IgG anti-PT was 33.1 microg/mL, with 2-fold increases in 85% of patients and 4-fold increases in 73% of patients; for IgG anti-FHA, the respective values were 34.7 microg/mL, 92%, and 63%. After 6 months of follow-up, no serological evidence of pertussis was seen among symptomatic or asymptomatic subjects. However, recent evidence of Bordetella pertussis infection before immunization was shown. Thus, AP vaccine was safe and immunogenic in adults.
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Affiliation(s)
- C D Christie
- Divisions of Infectious Diseases and Epidemiology, Children's Hospital Medical Center, Cincinnati, OH, USA.
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