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Li Y, Baumert BO, Costello E, Chen JC, Rock S, Stratakis N, Goodrich JA, Zhao Y, Eckel SP, Walker DI, Valvi D, La Merrill MA, McConnell R, Cortessis VK, Aung M, Wu H, Baccarelli A, Conti D, Chatzi L. Per- and polyfluoroalkyl substances, polychlorinated biphenyls, organochlorine pesticides, and polybrominated diphenyl ethers and dysregulation of MicroRNA expression in humans and animals-A systematic review. Environ Res 2024; 244:117832. [PMID: 38056610 DOI: 10.1016/j.envres.2023.117832] [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] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/08/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Persistent organic pollutants (POPs) are chemicals characterized by their environmental persistence. Evidence suggests that exposure to POPs, which is ubiquitous, is associated with microRNA (miRNA) dysregulation. miRNA are key regulators in many physiological processes. It is thus of public health concern to understand the relationships between POPs and miRNA as related to health outcomes. OBJECTIVES This systematic review evaluated the relationship between widely recognized, intentionally manufactured, POPs, including per- and polyfluoroalkyl substances (PFAS), polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and organochlorine pesticides (dichlorodiphenyltrichloroethane [DDT], dichlorodiphenyldichloroethylene [DDE], hexachlorobenzene [HCB]), with miRNA expression in both human and animal studies. METHODS We used PubMed and Embase to systematically search the literature up to September 29th, 2023. Search results for human and animal studies were included if they incorporated at least one POP of interest in relation to at least one miRNA. Data were synthesized to determine the direction and significance of associations between POPs and miRNA. We utilized ingenuity pathway analysis to review disease pathways for miRNA that were associated with POPs. RESULTS Our search identified 38 eligible studies: 9 in humans and 29 in model organisms. PFAS were associated with decreased expression of miR-19, miR-193b, and miR-92b, as well as increased expression of miR-128, miR-199a-3p, and miR-26b across species. PCBs were associated with increased expression of miR-15a, miR-1537, miR-21, miR-22-3p, miR-223, miR-30b, and miR-34a, as well as decreased expression of miR-130a and let-7b in both humans and animals. Pathway analysis for POP-associated miRNA identified pathways related to carcinogenesis. DISCUSSION This is the first systematic review of the association of POPs with miRNA in humans and model organisms. Large-scale prospective human studies are warranted to examine the role of miRNA as mediators between POPs and health outcomes.
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Affiliation(s)
- Yijie Li
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Brittney O Baumert
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Costello
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jiawen Carmen Chen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sarah Rock
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Jesse A Goodrich
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yinqi Zhao
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Douglas I Walker
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michele A La Merrill
- Department of Environmental Toxicology, University of California, Davis, CA, USA
| | - Rob McConnell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Victoria K Cortessis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Max Aung
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Haotian Wu
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Andrea Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - David Conti
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lida Chatzi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Eick SM, Geiger SD, Alshawabkeh A, Aung M, Barrett ES, Bush N, Carroll KN, Cordero JF, Goin DE, Ferguson KK, Kahn LG, Liang D, Meeker JD, Milne GL, Nguyen RHN, Padula AM, Sathyanarayana S, Taibl KR, Schantz SL, Woodruff TJ, Morello-Frosch R. Urinary oxidative stress biomarkers are associated with preterm birth: an Environmental Influences on Child Health Outcomes program study. Am J Obstet Gynecol 2023; 228:576.e1-576.e22. [PMID: 36400174 PMCID: PMC10149536 DOI: 10.1016/j.ajog.2022.11.1282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/05/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preterm birth is the leading cause of infant morbidity and mortality worldwide. Elevated levels of oxidative stress have been associated with an increased risk of delivering before term. However, most studies testing this hypothesis have been conducted in racially and demographically homogenous study populations, which do not reflect the diversity within the United States. OBJECTIVE We leveraged 4 cohorts participating in the Environmental Influences on Child Health Outcomes Program to conduct the largest study to date examining biomarkers of oxidative stress and preterm birth (N=1916). Furthermore, we hypothesized that elevated oxidative stress would be associated with higher odds of preterm birth, particularly preterm birth of spontaneous origin. STUDY DESIGN This study was a pooled analysis and meta-analysis of 4 birth cohorts spanning multiple geographic regions in the mainland United States and Puerto Rico (208 preterm births and 1708 full-term births). Of note, 8-iso-prostaglandin-F2α, 2,3-dinor-5,6-dihydro-8-iso-prostaglandin-F2α (F2-IsoP-M; the major 8-iso-prostaglandin-F2α metabolite), and prostaglandin-F2α were measured in urine samples obtained during the second and third trimesters of pregnancy. Logistic regression was used to calculate adjusted odds ratios and 95% confidence intervals for the associations between averaged biomarker concentrations for each participant and all preterm births, spontaneous preterm births, nonspontaneous preterm births (births of medically indicated or unknown origin), and categories of preterm birth (early, moderate, and late). Individual oxidative stress biomarkers were examined in separate models. RESULTS Approximately 11% of our analytical sample was born before term. Relative to full-term births, an interquartile range increase in averaged concentrations of F2-IsoP-M was associated with higher odds of all preterm births (odds ratio, 1.29; 95% confidence interval, 1.11-1.51), with a stronger association observed for spontaneous preterm birth (odds ratio, 1.47; 95% confidence interval, 1.16-1.90). An interquartile range increase in averaged concentrations of 8-iso-prostaglandin-F2α was similarly associated with higher odds of all preterm births (odds ratio, 1.19; 95% confidence interval, 0.94-1.50). The results from our meta-analysis were similar to those from the pooled combined cohort analysis. CONCLUSION Here, oxidative stress, as measured by 8-iso-prostaglandin-F2α, F2-IsoP-M, and prostaglandin-F2α in urine, was associated with increased odds of preterm birth, particularly preterm birth of spontaneous origin and delivery before 34 completed weeks of gestation.
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Affiliation(s)
- Stephanie M Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Sarah D Geiger
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL; Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
| | | | - Max Aung
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Emily S Barrett
- Environmental and Occupational Health Sciences Institute, Rutgers School of Public Health, Rutgers University, Piscataway, NJ
| | - Nicole Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Kecia N Carroll
- Departments of Pediatrics and Environmental Medicine and Public Health, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA
| | - Dana E Goin
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA
| | - Kelly K Ferguson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC
| | - Linda G Kahn
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Donghai Liang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Ginger L Milne
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ruby H N Nguyen
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Amy M Padula
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA; Seattle Children's Research Institute, Seattle, WA
| | - Kaitlin R Taibl
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Susan L Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL; Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA
| | - Rachel Morello-Frosch
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA; Department of Environmental Science, Policy, and Management, School of Public Health, University of California, Berkeley, Berkeley, CA
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Eick SM, Geiger SD, Alshawabkeh A, Aung M, Barrett E, Bush NR, Cordero JF, Ferguson KK, Meeker JD, Milne GL, Nguyen RHN, Padula AM, Sathyanarayana S, Welch BM, Schantz SL, Woodruff TJ, Morello-Frosch R. Associations between social, biologic, and behavioral factors and biomarkers of oxidative stress during pregnancy: Findings from four ECHO cohorts. Sci Total Environ 2022; 835:155596. [PMID: 35490822 PMCID: PMC9177811 DOI: 10.1016/j.scitotenv.2022.155596] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Lower socioeconomic status (SES) and elevated psychosocial stress are known contributors to adverse pregnancy outcomes; however, biological mechanisms linking these factors to adverse pregnancy outcomes are not well-characterized. Oxidative stress may be an important, yet understudied mechanistic pathway. We used a pooled study design to examine biological, behavioral, and social factors as predictors of prenatal oxidative stress biomarkers. METHODS Leveraging four pregnancy cohorts from the Environmental influences on Child Health Outcomes (ECHO) Program spanning multiple geographic regions across the United States (U.S.) (N = 2082), we measured biomarkers of oxidative stress in urine samples at up to three time points during pregnancy, including 8-isoprostane-prostaglandin F2α (8-isoPGF2α), its major metabolite, 2,3-dinor-5,6-dihydro-15-F2t-isoprostane, and prostaglandin F2α (PGF2α). Maternal age, pre-pregnancy body mass index, marital/partnered status, parity, and smoking status were included as biological and behavioral factors while race/ethnicity, maternal education, and stressful life events were considered social factors. We examined associations between each individual biological, behavioral, and social factor with oxidative stress biomarkers using multivariable-adjusted linear mixed models. RESULTS Numerous biological, behavioral, and social factors were associated with elevated levels of 8-isoPGF2α, its major metabolite, and PGF2α. Pregnant people who were current smokers relative to non-smokers or had less than a high school education relative to a college degree had 11.04% (95% confidence interval [CI] = -1.97%, 25.77%) and 9.13% (95% CI = -1.02%, 20.32%) higher levels of 8-isoPGF2α, respectively. CONCLUSIONS Oxidative stress biomarkers are elevated among pregnant people with higher socioeconomic disadvantage and may represent one pathway linking biological, behavioral, and social factors to adverse pregnancy and child health outcomes, which should be explored in future work.
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Affiliation(s)
- Stephanie M Eick
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA.
| | - Sarah Dee Geiger
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA 02115, USA
| | - Max Aung
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Emily Barrett
- Environmental and Occupational Health Sciences Institute, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, USA; Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA 30606, USA
| | - Kelly K Ferguson
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Durham, NC 27709, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Ginger L Milne
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Ruby H N Nguyen
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA
| | - Amy M Padula
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sheela Sathyanarayana
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
| | - Barrett M Welch
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Durham, NC 27709, USA
| | - Susan L Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL 61802, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Rachel Morello-Frosch
- Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, CA 94143, USA; Department of Environmental Science, Policy and Management and School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA
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4
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Eick SM, Enright EA, Padula AM, Aung M, Geiger SD, Cushing L, Trowbridge J, Keil AP, Gee Baek H, Smith S, Park JS, DeMicco E, Schantz SL, Woodruff TJ, Morello-Frosch R. Prenatal PFAS and psychosocial stress exposures in relation to fetal growth in two pregnancy cohorts: Applying environmental mixture methods to chemical and non-chemical stressors. Environ Int 2022; 163:107238. [PMID: 35436721 PMCID: PMC9202828 DOI: 10.1016/j.envint.2022.107238] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Prenatal exposure to individual per‑ and poly‑fluoroalkyl substances (PFAS) and psychosocial stressors have been associated with reductions in fetal growth. Studies suggest cumulative or joint effects of chemical and non-chemical stressors on fetal growth. However, few studies have examined PFAS and non-chemical stressors together as a mixture, which better reflects real life exposure patterns. We examined joint associations between PFAS, perceived stress, and depression, and fetal growth using two approaches developed for exposure mixtures. METHODS Pregnant participants were enrolled in the Chemicals in Our Bodies cohort and Illinois Kids Development Study, which together make up the ECHO.CA.IL cohort. Seven PFAS were previously measured in 2nd trimester maternal serum samples and were natural log transformed for analyses. Perceived stress and depression were assessed using self-reported validated questionnaires, which were converted to t-scores using validated methods. Quantile g-computation and Bayesian kernel machine regression (BKMR) were used to assess joint associations between PFAS, perceived stress and depression t-scores and birthweight z-scores (N = 876). RESULTS Individual PFAS, depression and perceived stress t-scores were negatively correlated with birthweight z-scores. Using quantile g-computation, a simultaneous one quartile increase in all PFAS, perceived stress and depression t-scores was associated with a slight reduction in birthweight z-scores (mean change per quartile increase = -0.09, 95% confidence interval = -0.21,0.03). BKMR similarly indicated that cumulative PFAS and stress t-scores were modestly associated with lower birthweight z-scores. Across both methods, the joint association appeared to be distributed across multiple exposures rather than due to a single exposure. CONCLUSIONS Our study is one of the first to examine the joint effects of chemical and non-chemical stressors on fetal growth using mixture methods. We found that PFAS, perceived stress, and depression in combination were modestly associated were lower birthweight z-scores, which supports prior studies indicating that chemical and non-chemical stressors are jointly associated with adverse health outcomes.
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Affiliation(s)
- Stephanie M Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Elizabeth A Enright
- Department of Psychology, St. Mary's College of Maryland, St. Mary's City, MD, USA
| | - Amy M Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Max Aung
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Sarah D Geiger
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Lara Cushing
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Jessica Trowbridge
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Alexander P Keil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hyoung Gee Baek
- Environmental Chemistry Laboratory, Department of Toxic Substances Control, California Environmental Protection Agency, Berkeley, CA, USA
| | - Sabrina Smith
- Environmental Chemistry Laboratory, Department of Toxic Substances Control, California Environmental Protection Agency, Berkeley, CA, USA
| | - June-Soo Park
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA; Environmental Chemistry Laboratory, Department of Toxic Substances Control, California Environmental Protection Agency, Berkeley, CA, USA
| | - Erin DeMicco
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Susan L Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL USA; Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Rachel Morello-Frosch
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA; Department of Environmental Science, Policy and Management and School of Public Health, University of California, Berkeley, CA, USA.
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Aung M, Khalil A, Abdelaal M. 104 The Assessment of the Clinical Frailty Scale in Emergency Department (Quality Improvement Project). Br J Surg 2022. [DOI: 10.1093/bjs/znac039.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To enforce clinicians to use clinical frailty scale (CFS) in the elderly population which can guide the management pathway i.e., suitable for ITU admission or surgical intervention
Method
As part of the QIP, an audit was carried out which looked at two criteria:
The above criteria are based on NICE guidelines NG191 and the specialized Clinical Frailty Network website.
The inclusion criteria are patients older than 80 years of age. The first cycle looks at 50 randomized patients presented to A&E in July 2021, followed by the implementation of change. The target for all criteria is 75%. The second cycle looks at 50 randomized patients presented to A&E in August 2021.
Results
Initial audit data suggests the following:
Crit 1: 40%
Crit 2: 2%
This suggests we are performing less than the national standard. Therefore, an implementation that involves a change in a software system, poster and teaching session was done. This approach improves our performance immensely.
Crit 1: 100% (now mandatory due to software system i.e., sustainable change)
Crit 2: 40%
The third cycle was currently underway with a plan to undertake CFS awareness month.
Conclusions
This QIP helps not only the emergency team but also admission teams particularly ITU and surgical speciality to reach the management decision for the elderly population.
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Affiliation(s)
- M. Aung
- Poole Hospital, Poole, United Kingdom
| | - A. Khalil
- Poole Hospital, Poole, United Kingdom
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6
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Oo MK, Tun TN, Aung M. 794 Diagnostic Pitfall in Atypical Presentation of Malignant Gastric Ulcer Perforation. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.321] [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]
Abstract
Abstract
Background
Peptic ulcer perforation is one of the most common surgical problems in daily practice. Although it can be easily diagnosed clinically, the clinical presentation can be less obvious in some cases leading to diagnostic pitfalls and mortality. This case report aims to highlight an atypical presentation of malignant gastric ulcer perforation in a patient with chronic abdominal pain.
Case presentation
A 78-year-old lady presented with chronic abdominal pain for 3 months. Investigations and imaging revealed T2N1M0 malignant gastric ulcer which was confirmed by endoscopy. Due to her low body mass index and underlying comorbidities, she was admitted for pre-operative optimization. However, she was a good 78 with the clinical frailty scale 4 and the National Early Warning Score 0 throughout the stay. On the night before the operation, she suddenly developed delirium. Further history revealed marked oliguria for 12 hours. There was mild abdominal distension without peritonism. She was catheterized and treated with fluids and antibiotics. X-ray suggested massive pneumoperitonium. Subsequently, she developed full-blown septic shock with rapid clinical deterioration within 3 hours. With the estimated Boey scoring of 3 and rapid clinical deterioration, the symptom control approach was decided. A palliative bedside ascitic tap was performed to relieve the discomfort. Four hours after the onset, unfortunately, the patient passed away.
Conclusions
Although gastric ulcer perforation usually presents with obvious symptoms, extra precaution should be exercised in elderly patients with chronic abdominal pain and comorbidities. We could learn that routine monitoring of urine output might aid in the early diagnosis of sepsis.
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Affiliation(s)
- M K Oo
- United Lincolnshire Hospitals Trust, Boston, United Kingdom
| | - T N Tun
- East Yangon General Hospital, Yangon, Myanmar
| | - M Aung
- University Hospital Dorset NHS Foundation Trust, Poole, United Kingdom
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Bhatti K, Yousef H, Aung M. 1321 Repeat Colonoscopy: Incidence, Etiology, And Suggestions for Improvement. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.427] [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: 11/12/2022]
Abstract
Abstract
Aim
Colonoscopy is an invasive procedure. Repeating such a procedure has many implications in terms of risks, costs, increased workload and strains on hospital resources. The current study reports the incidence and aetiology of repeat colonoscopies and provides recommendations for improvement.
Method
The current study was conducted at North Cumbria Integrated Care (NCIC) hospitals over a period of 1 year (January 1st to December 31st, 2019). All patients with a label of “Repeat” by JAG software system, were included in the primary analysis. Patients with colonoscopy after 52 weeks of the index procedure, were excluded. Two authors manually assessed the validity of the data and determined “True repeat rate” and aetiology.
Results
During the study period, 4717 colonoscopies were performed, where 187 were recorded as a repeat. Manual validation showed that true repeat cases were 355/4717 (7.52%). Moreover, 5% of the system labelled cases where not true repeats rather were escalated from sigmoidoscopy to colonoscopy. Analysis of the first 1000 colonoscopies detected 72 cases. Male to female ratio was 47:25 with a mean age of 66.26 ± 11.75(SD). The causes included further management of polyps (n = 30); poor bowel preparation(n = 22); inability to proceed (n = 9); anticoagulation (n = 8) and others (n = 3). Subgroup analyses of the polyp group showed that the reasons for repeating colonoscopy in such cases were appropriate.
Conclusions
An operational definition of the ‘Repeat coloscopy’ should be clearly established. Although most of the repeat colonoscopies for “further management of polyps” are appropriate, repeat due to poor bowel preparation and anticoagulation are clearly preventable.
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Affiliation(s)
- K Bhatti
- North Cumbira Integrated Care, Carlisle, United Kingdom
- Sunderland Royal Hospital, Sunderland, United Kingdom
| | - H Yousef
- North Cumbira Integrated Care, Carlisle, United Kingdom
| | - M Aung
- North Cumbira Integrated Care, Carlisle, United Kingdom
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Lai MY, Rafieqin N, Lee PYL, Amir Rawa MS, Dzul S, Yahaya N, Abdullah FH, Othman N, Jelip J, Ooi CH, Ibrahim J, Aung M, Abdullah AH, Laili Z, Lau YL. High incidence of Plasmodium knowlesi malaria compared to other human malaria species in several hospitals in Malaysia. Trop Biomed 2021; 38:248-253. [PMID: 34362867 DOI: 10.47665/tb.38.3.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Through the regional control programme, Malaysia has been successfully reducing the incidence of Plasmodium falciparum and Plasmodium vivax infections. However, the incidence of zoonotic malaria Plasmodium knowlesi infection is increasing and now has been the major cause of malaria in Malaysia especially Malaysian Borneo. The emergence of knowlesi infection has threatened the malaria elimination programme which the government aims to reduce the overall malaria infections by 2020. Unlike other benign human Plasmodium spp., P. knowlesi can cause fatal infections. The aim of this study was to determine the incidence and distribution of five human malaria parasites including P. knowlesi in Peninsular Malaysia and Malaysian Borneo. A total of 112 blood samples were collected from seven states and district hospitals in Peninsular Malaysia and Malaysian Borneo from year 2015 to 2016. The samples were examined by microscopy and further confirmed by nested PCR assay targeting 18S rRNA gene of Plasmodium spp. Following the nested PCR assays, a total of 54 (48.2%) samples were positive for P. knowlesi infections, 12 (10.7%) cases were positive for P. vivax infections, followed by 7 (6.3%) cases of P. falciparum and 4 (3.5%) cases of P. malariae. There were 3 cases (2.7%) of mixed infections (P. knowlesi/P. vivax). However, no cases were identified as P. ovale. A total of 32 (28.6%) cases were found as negative infections. LoopMediated Isothermal Amplification Assay (LAMP) was performed to confirm inconclusive results produced by microscopy and nested PCR. P. knowlesi showed the highest prevalence in Sarawak (n= 30), Sabah (n=13), Pulau Pinang (n=5) and Pahang (n=6). PCR and LAMP was not able to detect a large number of microscopy positive samples due to DNA degradation during storage and shipping. Among all the states involved in this study, the highest prevalence of P. knowlesi infection was found in Sabah and Sarawak.
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Affiliation(s)
- M Y Lai
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - N Rafieqin
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - P Y Lee Lee
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - M S Amir Rawa
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - S Dzul
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - N Yahaya
- Jabatan Kesihatan Negeri Pulau Pinang, 10590 Pulau Pinang, Malaysia
| | - F H Abdullah
- Pusat Penyelidikan Klinikal, Hospital Sultanah Nur Zahirah, 20400 Kuala Terengganu, Malaysia
| | - N Othman
- Microbiology Unit, Department of Pathology, Hospital Sultanah Nur Zahirah, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Malaysia
| | - J Jelip
- Ministry of Health Malaysia, 62590 Putrajaya, Malaysia
| | - C H Ooi
- Sarawak State Health Department, 03050 Kuching, Sarawak
| | - J Ibrahim
- Sarawak State Health Department, 03050 Kuching, Sarawak
| | - M Aung
- Hospital Kuala Lipis, 27200 Kuala Lipis, Pahang
| | | | - Z Laili
- Hospital Raja Permaisuri Bainun, 30450 Ipoh, Perak
| | - Y L Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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9
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Aung M, Obakponovwe O, Raymond A, Apostolidis K, Bahadori S, Wainwright T, Middleton R. 242 Maintaining Surgical Training During the Covid-19 Pandemic; A Novel Use of Surgical Simulators. Br J Surg 2021. [PMCID: PMC8135789 DOI: 10.1093/bjs/znab134.127] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction During Covid-19 pandemic, operation theatres limit the number of staff during each session, which causes a decrease in training opportunity. To counteract this lapse, the Orthopaedic Research Institute (ORI) designs an innovative training session. During the nationwide lockdown, the closure of the Institute allowed for the transfer of the VirtaMed ArthrosTM (VA), to our NHS facility. VA is a surgical simulator which enables the participant to practise knee arthroscopy. Method Participants with little arthroscopic experience were included in the study. Three fellowship-trained surgeons conducted daily teaching sessions. Participants were taught necessary arthroscopic skills before undertaking training modules on diagnostic arthroscopy. 90% of the participants attended the session at least three times. At the end of every module, VA generates a score based on parameters which include procedure duration, visualisation of key structures and iatrogenic chondral damage. Structure questionnaires were also used to analyse feedback. Results The overall confidence and module scores progress with each subsequent session. A keystone of success is the location and ease of access to the simulator. Conclusions Surgical simulators are a useful tool for surgical education and training. We should encourage their use in the future, especially in the UK surgical training programme.
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Affiliation(s)
- M Aung
- Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - O Obakponovwe
- Royal Bournemouth and Christchurch NHS Foundation Trust, Bournemouth, United Kingdom
| | - A Raymond
- Royal Bournemouth and Christchurch NHS Foundation Trust, Bournemouth, United Kingdom
| | - K Apostolidis
- Royal Bournemouth and Christchurch NHS Foundation Trust, Bournemouth, United Kingdom
| | - S Bahadori
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
| | - T Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
| | - R Middleton
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
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10
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Aung M. 714 Venous Thromboembolism Risk Re-Assessment Within 24 and 72 Hours After Admission (Closed-Loop Audit). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.476] [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: 11/12/2022]
Abstract
Abstract
Introduction
NICE and Poole Hospital guideline state venous thromboprophylaxis (VTE) risk assessment must be done on admission and at consultant review (within 24hr and 72hr after admission)
Changing from paper to electronic patient records(EPR) system omits some mandatory protocols.
Although VTE risk assessment on admission remains mandatory on EPR, records of re-assessment within 24 and 72hr becomes optional.
Method
100 random patients admitted to the orthopaedic department, before and after implementation of change.
Results
The initial data indicates 0% of recording for re-assessment after admission.
This action led to incorrect dosage and duration of chemical VTE prophylaxis in 20% of the patients.
After presenting the data to stakeholders, an instruction of entering VTE re-assessment on EPR was done by a teaching session and by putting up posters.
A discussion with the IT department resulted in setting up a dropdown-box for VTE re-assessment on EPR.
Re-audit shows a slight improvement in the recording from 0% to 3% for within 24hr and 22% for within 72hr.
Feedbacks indicates an insufficient time, a lack of senior staff member involvement and established workplace culture.
Conclusions
Despite some improvement, more junior and senior staff engagement, including cultural changes, are needed to achieve the national standard.
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Affiliation(s)
- M Aung
- Poole Hospital NHS Foundation Trust, Poole, United Kingdom
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11
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Aung M, Konoshita T, Moodley J, Naicker T, Connolly C, Khaliq OP, Gathiram P. Aminopeptidase A (ENPEP) gene polymorphisms and preeclampsia: Descriptive analysis. Eur J Obstet Gynecol Reprod Biol 2020; 258:70-74. [PMID: 33421813 DOI: 10.1016/j.ejogrb.2020.12.051] [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: 11/12/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The etiology of preeclampsia (PE) remains elusive. Recent genome-wide association studies have identified a number of genetic variants associated with blood pressure variations in east Asians. One of the genetic variants is the aminopeptidase A (ENPEP) gene, which converts angiotensin II to angiotensin III. The C allele of rs6825911 is a risk for hypertension. The current study investigated whether genetic variants of ENPEP play a role in the pathogenesis of preeclampsia. STUDY DESIGN The study was a descriptive analysis of gene polymorphisms of ENPEP; 602 pregnant women of African ancestry [normotensive (n = 245) and PE (n = 357)] were recruited. The two groups were divided according to their HIV status. The PE group consisted of early- and late-onset sub-categories. A single nucleotide polymorphism of rs6825911 was analyzed using the TaqMan® Probe mix and by means of real time polymerase chain reaction. RESULTS The risk of C allele for PE was 1.07 (95 % CI 0.83-1.38, P = 0.589) for allele comparison and the risk for preeclampsia CC to CT/TT was 1.33 (95 % CI 0.96-1.85, P = 0.086). The sub analysis for the PE group without HIV infection the risk of C allele was 1.25 (95 % CI 0.838-1.78, P = 0.199) and the risk of PE of CC to CT/TT was 1.51 (95 %CI: 0.96-2.35, P = 0.071). CONCLUSION This is the first study in a homogenous South African population of African ancestry to show that the variant of ENPEP gene does not play a role in pathogenesis of preeclampsia.
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Affiliation(s)
- M Aung
- Department of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - T Konoshita
- The Third Department of Internal Medicine, University of Fukui Faculty of Medicine Sciences, Fukui, Japan
| | - J Moodley
- Department of Women's Health and HIV Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - T Naicker
- Department of Optics & Imaging, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - C Connolly
- Department of Public Health Medicine & Biostatistics, College of Health Science, University of KwaZulu-Natal, Durban. South Africa
| | - O P Khaliq
- Department of Women's Health and HIV Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - P Gathiram
- Department of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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12
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Aung M, Ohtsuka H, Izumi K. Short communication: Effect of yeast cell wall supplementation on peripheral leukocyte populations and mRNA expression of cytokines in lactating dairy cows. J Dairy Sci 2020; 103:5634-5640. [PMID: 32307166 DOI: 10.3168/jds.2019-17660] [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: 09/26/2019] [Accepted: 01/28/2020] [Indexed: 11/19/2022]
Abstract
This study was designed to examine the effect of yeast cell wall (YCW) supplementation on peripheral leukocyte populations and mRNA expression of cytokines in lactating dairy cows. Fourteen Holstein lactating cows were assigned to 1 of 2 treatments; the control group (n = 7) were fed a total mixed ration without supplementation and cows in the YCW group (n = 7) were fed a total mixed ration supplemented with YCW (SafMannan; Phileo, Lesaffre Animal Care, Lille, France; 10 g/cow per day). Blood samples were collected 3 times during the experimental period [wk 0 (before any treatment), wk 4, and wk 8]. Peripheral leukocyte populations and cytokine mRNA expression of peripheral blood monocular cells were measured using flow cytometry and real-time PCR, respectively. Among the peripheral leukocyte populations, TcR1-N12 + and CD14+ T cells increased at wk 4, and CD4+ T cells and CD8+ T cells increased at wk 4 and wk 8 with YCW supplementation. The mRNA level of IL8 tended to be increased in the YCW group at wk 4. Expression of IL12A was lower in the YCW group than in the control group before the experiment (wk 0) but no differences were observed at later time points (wk 4 and wk 8). Expression of IL12A decreased in the control group and increased in the YCW group. Expression of CCR2 increased at wk 4, and CCL2 and CCL3 were increased at wk 8 in the YCW group. Thus, YCW supplementation increased the mRNA expression of cytokines in peripheral blood mononuclear cells of lactating dairy cows.
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Affiliation(s)
- M Aung
- Department of Animal Nutrition, University of Veterinary Science, Nay Pyi Taw, 15013, Myanmar
| | - H Ohtsuka
- Large Animal Internal Medicine, Rakuno Gakuen University, Ebetsu, 069-8501, Japan
| | - K Izumi
- College of Agriculture, Food and Environment Sciences, Rakuno Gakuen University, Ebetsu, 069-8501, Japan.
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13
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Chaudhury P, Aung M, Savage HO, Barbagallo R, Southgate C, Pickford L, Hardie A, Hearn L, Meredith A, Adams D, Hindmarsh V, Barden E, Gedela S, Dungu J. P594Real-world clinical CMR: 1-year diagnosis and survival data from a busy tertiary centre serving the Essex region in the UK. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez116.001] [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: 11/12/2022] Open
Affiliation(s)
- P Chaudhury
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - M Aung
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - H O Savage
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - R Barbagallo
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - C Southgate
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - L Pickford
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - A Hardie
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - L Hearn
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - A Meredith
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - D Adams
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - V Hindmarsh
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - E Barden
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - S Gedela
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - J Dungu
- Essex Cardiothoracic Centre, Cardiology, Basildon, United Kingdom of Great Britain & Northern Ireland
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14
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Renaud JM, Wiles M, Aung M, Gardner K, Guo A, Garrard L, Beanlands R, Dekemp R. 243Quality assurance metrics for routine clinical PET rubidium-82 myocardial blood flow quantification. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez145.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/14/2022] Open
Affiliation(s)
- J M Renaud
- University of Ottawa Heart Institute, National Cardiac PET Centre, Ottawa, Canada
| | - M Wiles
- University of Ottawa Heart Institute, National Cardiac PET Centre, Ottawa, Canada
| | - M Aung
- University of Ottawa Heart Institute, National Cardiac PET Centre, Ottawa, Canada
| | - K Gardner
- University of Ottawa Heart Institute, National Cardiac PET Centre, Ottawa, Canada
| | - A Guo
- University of Ottawa Heart Institute, National Cardiac PET Centre, Ottawa, Canada
| | - L Garrard
- University of Ottawa Heart Institute, National Cardiac PET Centre, Ottawa, Canada
| | - R Beanlands
- University of Ottawa Heart Institute, National Cardiac PET Centre, Ottawa, Canada
| | - R Dekemp
- University of Ottawa Heart Institute, National Cardiac PET Centre, Ottawa, Canada
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15
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Willis R, Heslop O, Bodonaik N, Thame M, Kumar U, Aung M, Kellier A, Drysdale S, Leon V, Smikle M. Pneumococcal disease burden, clinical presentations and vaccine coverage in the Jamaican population. Hum Antibodies 2018; 26:193-199. [PMID: 29843230 DOI: 10.3233/hab-180338] [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: 11/15/2022]
Abstract
BACKGROUND Pneumococcal serotypes circulating in any population vary over time and between countries and impacts the effectiveness of pneumococcal vaccination. OBJECTIVE This study investigated the epidemiology of pneumococcal disease in Jamaica. METHODS Streptococcus pneumoniae isolates (n= 349) along with demographic and clinical information were collected from patients presenting at the 4 major hospitals in Jamaica over a 2-year period. Serotyping was done using latex agglutination tests and the Quellung reaction assay. RESULTS Invasive pneumococcal disease (IPD) incidence was 45.4/100,000 in children under 5 yrs and 16.3/100,000 in adults over 65 yrs. Thirteen serogroups were identified among the 120 isolates subjected to grouping; the most common being serogroups: 19 (22/120,18.3%), 6 (20/120,16.7%), 14 (20/120,16.7%), 23 (18/120,15.0%), 3 (11/120,9.2%) and nontypeable (8/120,2.3%). The estimated vaccine coverage rates for the PCV7 and PCV13 vaccines in children less than 5 yrs were 82.5% and 88.7% respectively. The 23-valent PPV23 provided 100% coverage rate in adults over 65 yrs and 82.9% coverage rate for the entire population. CONCLUSIONS Pneumococcal vaccine coverage rates in Jamaica are comparable to those reported in certain developed countries and higher than in other developing countries. The high incidence of IPD in the paediatric population indicates that routine vaccination would be beneficial.
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Affiliation(s)
- R Willis
- University Hospital of the West Indies, Kingston, Jamaica.,University of Texas Medical Branch, Galveston, TX, USA
| | - O Heslop
- University Hospital of the West Indies, Kingston, Jamaica
| | - N Bodonaik
- University Hospital of the West Indies, Kingston, Jamaica
| | - M Thame
- University Hospital of the West Indies, Kingston, Jamaica
| | - U Kumar
- National Public Health Laboratory, Kingston, Jamaica
| | - M Aung
- Cornwall Regional Hospital, St. James, Jamaica
| | - A Kellier
- Cornwall Regional Hospital, St. James, Jamaica
| | - S Drysdale
- Jamaica Bustamante Hospital for Children, Kingston, Jamaica
| | - V Leon
- Jamaica Bustamante Hospital for Children, Kingston, Jamaica
| | - M Smikle
- University Hospital of the West Indies, Kingston, Jamaica
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16
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Kim SS, Meeker JD, Carroll R, Zhao S, Mourgas MJ, Richards MJ, Aung M, Cantonwine DE, McElrath TF, Ferguson KK. Urinary trace metals individually and in mixtures in association with preterm birth. Environ Int 2018; 121:582-590. [PMID: 30300816 PMCID: PMC6233299 DOI: 10.1016/j.envint.2018.09.052] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/17/2018] [Accepted: 09/29/2018] [Indexed: 05/20/2023]
Abstract
One in ten infants born in the United States is born preterm, or prior to 37 weeks gestation. Exposure to elevated levels of metals, such as lead and arsenic, has been linked to higher risk of preterm birth (PTB), but consequences of lower levels of exposure and less studied metals are unclear. We examined the associations between 17 urinary trace metals individually and in mixtures in relation to PTB. The LIFECODES birth cohort enrolled pregnant women at <15 weeks gestation at Brigham and Women's Hospital in Boston. We selected cases of PTB (n = 99) and unmatched controls (n = 291) and analyzed urine samples for a panel of trace metals (median: 26 weeks gestation). We used logistic regression models to calculate the odds ratio (OR) for PTB and subtypes of PTB based on presentation at delivery. Subtypes included spontaneous and placental PTB. We used elastic net (ENET) regularization to identify individual metals or pairwise interactions that had the strongest associations with PTB, and principal components analysis (PCA) to identify classes of exposures associated with the outcome. We observed increased odds of PTB (OR: 1.41, 95% Confidence Interval [CI]: 1.12, 1.78) in association with an interquartile range difference in urinary copper (Cu). We also observed an increased OR for selenium (OR: 1.33, 95% CI: 0.98, 1.81). ENET selected Cu as the most important trace metal associated with PTB. PCA identified 3 principal components (PCs) that roughly reflected exposure to toxic metals, essential metals, and metals with seafood as a common source of exposure. PCs reflecting essential metals were associated with increased odds of overall and spontaneous PTB. Maternal urinary copper in the third trimester was associated with increased risk of PTB, and statistical analyses for mixtures indicated that after accounting for correlation this metal was the most important statistical predictor of the outcome.
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Affiliation(s)
- Stephani S Kim
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW, Alexander Dr., Research Triangle Park, NC 27709, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Rachel Carroll
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr., Research Triangle Park, NC 27709, USA
| | - Shanshan Zhao
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr., Research Triangle Park, NC 27709, USA
| | - Michael J Mourgas
- NSF International, PO Box 130140, 789 N. Dixboro Rd., Ann Arbor, MI 48105, USA
| | - Michael J Richards
- NSF International, PO Box 130140, 789 N. Dixboro Rd., Ann Arbor, MI 48105, USA
| | - Max Aung
- Department of Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - David E Cantonwine
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Thomas F McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Kelly K Ferguson
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW, Alexander Dr., Research Triangle Park, NC 27709, USA.
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17
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Aung M, Konoshita T, Moodley J, Gathiram P. Association of gene polymorphisms of four components of renin-angiotensin-aldosterone system and preeclampsia in South African black women. Eur J Obstet Gynecol Reprod Biol 2017. [DOI: 10.1016/j.ejogrb.2017.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Mc Ardle B, Shukla T, Nichol G, deKemp RA, Bernick J, Guo A, Lim SP, Davies RA, Haddad H, Duchesne L, Hendry P, Masters R, Ross H, Freeman M, Gulenchyn K, Racine N, Humen D, Benard F, Ruddy TD, Chow BJ, Mielniczuk L, DaSilva JN, Garrard L, Wells GA, Beanlands RS, Higginson L, Mesana T, Ukkonen H, Yoshinaga K, Renaud J, Klein R, Aung M, Kostuk W, Wisenberg G, White M, Iwanochko R, Mickleborough L, Abramson B, Latter D, Lamy A, Fallen E, Coates G. Long-Term Follow-Up of Outcomes With F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging–Assisted Management of Patients With Severe Left Ventricular Dysfunction Secondary to Coronary Disease. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.004331. [DOI: 10.1161/circimaging.115.004331] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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] [Received: 06/15/2015] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
Background—
Whether viability imaging can impact long-term patient outcomes is uncertain. The PARR-2 study (Positron Emission Tomography and Recovery Following Revascularization) showed a nonsignificant trend toward improved outcomes at 1 year using an F-18-fluorodeoxyglucose positron emission tomography (PET)–assisted strategy in patients with suspected ischemic cardiomyopathy. When patients adhered to F-18-fluorodeoxyglucose PET recommendations, outcome benefit was observed. Long-term outcomes of viability imaging–assisted management have not previously been evaluated in a randomized controlled trial.
Methods and Results—
PARR-2 randomized patients with severe left ventricular dysfunction and suspected CAD being considered for revascularization or transplantation to standard care (n= 195) versus PET-assisted management (n=197) at sites participating in long-term follow-up. The predefined primary outcome was time to composite event (cardiac death, myocardial infarction, or cardiac hospitalization). After 5 years, 105 (53%) patients in the PET arm and 111 (57%) in the standard care arm experienced the composite event (hazard ratio for time to composite event =0.82 [95% confidence interval 0.62–1.07];
P
=0.15). When only patients who adhered to PET recommendations were included, the hazard ratio for the time to primary outcome was 0.73 (95% confidence interval 0.54–0.99;
P
=0.042).
Conclusions—
After a 5-year follow-up in patients with left ventricular dysfunction and suspected CAD, overall, PET-assisted management did not significantly reduce cardiac events compared with standard care. However, significant benefits were observed when there was adherence to PET recommendations. PET viability imaging may be best applied when there is likely to be adherence to imaging-based recommendations.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00385242.
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Affiliation(s)
- Brian Mc Ardle
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Tushar Shukla
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Graham Nichol
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Robert A. deKemp
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Jordan Bernick
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Ann Guo
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Siok Ping Lim
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Ross A. Davies
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Haissam Haddad
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Lloyd Duchesne
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Paul Hendry
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Roy Masters
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Heather Ross
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Michael Freeman
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Karen Gulenchyn
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Normand Racine
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Dennis Humen
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Francois Benard
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Terrence D. Ruddy
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Benjamin J. Chow
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Lisa Mielniczuk
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Jean N. DaSilva
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Linda Garrard
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - George A. Wells
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Rob S.B. Beanlands
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | | | - T. Mesana
- University of Ottawa Heart Institute
| | | | | | - J. Renaud
- University of Ottawa Heart Institute
| | - R. Klein
- University of Ottawa Heart Institute
| | - M. Aung
- University of Ottawa Heart Institute
| | | | | | | | | | | | | | | | - A. Lamy
- Hamilton Health Sciences Centre
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Vaughan-Shaw PG, Aung M, Knight H, Williams T, Borley NR, Wheeler JMD. Systematic analysis of missed colorectal cancer cases and common pitfalls in diagnosis. Frontline Gastroenterol 2015; 6:232-240. [PMID: 28839816 PMCID: PMC5369597 DOI: 10.1136/flgastro-2014-100513] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/05/2014] [Accepted: 12/16/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Missed colorectal cancer on endoscopic or radiological investigations may delay diagnosis and impact outcome. This study audits incidence of previous investigations in patients with colorectal cancer, considers outcome in 'missed' cancer cases and examines the diagnostic pathway in the derived case series to identify common pitfalls in diagnosis. METHODS Patients diagnosed with colorectal cancer in 2011 at a single National Health Service (NHS) Trust were reviewed. Incidence of endoscopic and radiological investigations in the 3 years preceding diagnosis and outcome data were collected. Cases of prior investigation not leading to diagnosis were considered 'missed' cancers and survival compared with 'detected' cases. The diagnostic pathway in each 'missed' case was reviewed. RESULTS 395 colorectal cancer cases were studied. Eighteen (4.6%) patients underwent previous investigation including colonoscopy (n=4), flexible sigmoidoscopy (n=5), barium enema (n=5) and diagnostic abdominal CT scan (n=12), median 708 days prior to diagnosis. Previous investigation predicted reduced overall and disease-free survival (HR 2.07, p=0.04 and HR 2.66, p<0.0001), after age and gender adjustment. Ten different categories termed 'pitfalls' were derived from analysis of the diagnostic pathway. These included CT scanning for abdominal pain without further investigation (n=7), rectosigmoid cancer following a previous diagnosis of diverticular disease (n=4) and incomplete diagnostic investigations without adequate follow-up (n=3). CONCLUSIONS A proportion of patients diagnosed with colorectal cancer have previously been investigated for gastrointestinal symptoms and survival appears reduced in these patients. Regular audit and analysis of previous investigations can identify common pitfalls in diagnosis, which should be used to inform training and improve practice.
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Affiliation(s)
- P G Vaughan-Shaw
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK
| | - M Aung
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK
| | - H Knight
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK
| | - T Williams
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK
| | - N R Borley
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK
| | - J M D Wheeler
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK
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Vaughan-Shaw PG, Aung M, Sahnan K, Rai P, Goodman A. Findings on interval colonoscopies: an auditable performance indicator for colonoscopy quality? Frontline Gastroenterol 2014; 5:249-253. [PMID: 28839781 PMCID: PMC5369743 DOI: 10.1136/flgastro-2014-100439] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/27/2014] [Accepted: 04/02/2014] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE An important marker of colonoscopy quality is detection of pathology and incidence of missed pathology. Back-to-back colonoscopies cannot ethically be performed for quality assurance alone yet may be required for clinical reasons. This study aims to investigate the incidence of new findings in colonoscopies repeated within a 12 month period and considers the role of such an analysis in the assessment of colonoscopy quality. DESIGN All colonoscopies performed over a 3-year period at an endoscopy training unit were studied. Colonoscopies repeated within a 12-month period were analysed. RESULTS 5747 colonoscopies were performed over the study period. 137 repeat colonoscopies were included with median interval from initial colonoscopy of 174 days. 19 (14%) repeat colonoscopies yielded new findings including one cancer, 234 days following a normal colonoscopy. Additional polyps were identified in 13 colonoscopies indicating a missed polyp rate of 9%. In these, a median number of two polyps per colonoscopy with median size 5.5 mm were found. There was no morbidity associated with repeat colonoscopy in this series. New findings on repeat colonoscopy appeared more likely following initial colonoscopy by non-consultant non-training grade endoscopists (23% vs 11%, p=0.09) yet small numbers involved preclude meaningful comparison. CONCLUSIONS Analysis of clinically indicated repeat colonoscopies and rate of detection of new pathology may offer utility in colonoscopy quality assurance and would offer a direct assessment of the most important aspect of colonoscopy quality.
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Affiliation(s)
- P G Vaughan-Shaw
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
| | - M Aung
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
| | - K Sahnan
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
| | - P Rai
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
| | - A Goodman
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
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McCree-Hale R, Hale TM, Rutley KR, Aung M, Jolly PE. Evaluating a theory-based health education intervention to improve awareness of prostate cancer among men in Western Jamaica. W INDIAN MED J 2012; 61:580-586. [PMID: 23441351] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the impact of a theory-based health education intervention on awareness of prostate cancer and intention to screen among men in Western Jamaica. METHODS One hundred and eighty-eight men attending outpatient clinics in a hospital in Western Jamaica completed an interviewer-administered pretest survey. Following the pretest, participants received a health education intervention related to prostate cancer and an immediate post-test survey RESULTS There were statistically significant increases in the percentage of correct responses between the pretest and post-test (p < 0.05). The greatest improvement was among items measuring knowledge of prostate cancer screening tests. Participants moved across the Stages of Change theoretical constructs indicating intention to screen. CONCLUSION The sample was receptive to information about prostate cancer and the use of a theory-based educational intervention positively influenced knowledge of prostate cancer risk factors, symptoms, and types of screenings. PRACTICE IMPLICATIONS This theory-based patient education programme can be replicated to promote awareness of prostate cancer and informed screening methods including potential risk associated with screening behaviours.
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Affiliation(s)
- R McCree-Hale
- University of Alabama at Birmingham, Department of Health Behaviour, RPHB, 227, 1530 3rd Ave S, Birmingham, AL 35294-0022, USA.
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Rajda E, Cocker M, deKemp R, Chow B, Ruddy T, Davies R, Hessian R, Garrard L, Brennan J, Aung M, Guo A, DaSilva J, Beanlands R. 710 Reduced Left Atrial Metabolic Activity in Patients With Atrial Fibrillation is Associated With Worse LV Function. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.643] [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] Open
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Taktak A, Antolini L, Aung M, Boracchi P, Campbell I, Damato B, Ifeachor E, Lama N, Lisboa P, Setzkorn C, Stalbovskaya V, Biganzoli E. Double-blind evaluation and benchmarking of survival models in a multi-centre study. Comput Biol Med 2006; 37:1108-20. [PMID: 17184760 DOI: 10.1016/j.compbiomed.2006.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 10/10/2006] [Indexed: 10/23/2022]
Abstract
Accurate modelling of time-to-event data is of particular importance for both exploratory and predictive analysis in cancer, and can have a direct impact on clinical care. This study presents a detailed double-blind evaluation of the accuracy in out-of-sample prediction of mortality from two generic non-linear models, using artificial neural networks benchmarked against a partial logistic spline, log-normal and COX regression models. A data set containing 2880 samples was shared over the Internet using a purpose-built secure environment called GEOCONDA (www.geoconda.com). The evaluation was carried out in three parts. The first was a comparison between the predicted survival estimates for each of the four survival groups defined by the TNM staging system, against the empirical estimates derived by the Kaplan-Meier method. The second approach focused on the accurate prediction of survival over time, quantified with the time dependent C index (C(td)). Finally, calibration plots were obtained over the range of follow-up and tested using a generalization of the Hosmer-Lemeshow test. All models showed satisfactory performance, with values of C(td) of about 0.7. None of the models showed a systematic tendency towards over/under estimation of the observed survival at tau=3 and 5 years. At tau=10 years, all models underestimated the observed survival, except for COX regression which returned an overestimate. The study presents a robust and unbiased benchmarking methodology using a bespoke web facility. It was concluded that powerful, recent flexible modelling algorithms show a comparative predictive performance to that of more established methods from the medical and biological literature, for the reference data set.
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Affiliation(s)
- A Taktak
- Department of Clinical Engineering, Royal Liverpool University Hospital, Liverpool, UK.
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Otsubo H, Ochi A, Elliott I, Chuang SH, Rutka JT, Jay V, Aung M, Sobel DF, Snead OC. MEG predicts epileptic zone in lesional extrahippocampal epilepsy: 12 pediatric surgery cases. Epilepsia 2001; 42:1523-30. [PMID: 11879362 DOI: 10.1046/j.1528-1157.2001.16701.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To discover whether the spatial distribution of spike sources determined by magnetoencephalography (MEG) provides reliable information for planning surgery and predicting outcomes in pediatric patients with lesional extrahippocampal epilepsy. METHODS We retrospectively studied 12 children with extrahippocampal epilepsy secondary to cortical dysplasia (CD), tumor, or porencephalic cyst. We compared interictal MEG spike source locations and somatosensory evoked fields derived from equivalent-current dipole modeling with intraoperative or extraoperative electrocorticography (ECoG). RESULTS MEG spike sources were found in proximity to the lesion in all patients and extended from lesions in five patients with CD. Marginal spike sources were noted in three patients with tumors, one patient with a cyst, and one with CD, and extramarginal sources in three patients with tumors. Three patients with tumors underwent lesionectomy only; two had further cortical excisions. One patient with CD underwent lesionectomy only, three had lesionectomy and cortical excisions, and two had lesionectomy and multiple subpial transection. Asymmetric MEG spike sources correlated with ECoG findings in all patients. Residual epileptiform discharges on postexcisional ECoG corresponded to spike sources in three patients with tumors and one patient with a cyst. Eleven patients have been seizure free for 1-6 years (mean, 4 years). One patient had residual seizures after incomplete excision of right temporal CD. CONCLUSIONS MEG delineated asymmetric epileptogenicity surrounding lesions and the eloquent cortex. Complete tumor resection produced favorable outcomes despite residual postexcisional ECoG spikes and extramarginal MEG spike sources. CD characterized by clusters of MEG spike sources within and extending from lesions seen on magnetic resonance imaging (MRI) should be removed to prevent seizures.
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Affiliation(s)
- H Otsubo
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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McShea WJ, Aung M, Poszig D, Wemmer C, Monfort S. Forage, Habitat use, and Sexual Segregation by a Tropical Deer (Cervus Eldi Thamin) in a Dipterocarp Forest. J Mammal 2001. [DOI: 10.1093/jmammal/82.3.848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aung M, McShea WJ, Htung S, Than A, Soe TM, Monfort S, Wemmer C. Ecology and Social Organization of a Tropical Deer (Cervus Eldi Thamin). J Mammal 2001. [DOI: 10.1093/jmammal/82.3.836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sobel DF, Aung M, Otsubo H, Smith MC. Magnetoencephalography in children with Landau-Kleffner syndrome and acquired epileptic aphasia. AJNR Am J Neuroradiol 2000; 21:301-7. [PMID: 10696012 PMCID: PMC7975336] [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] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND PURPOSE Landau-Kleffner syndrome (LKS) is epileptiform aphasia acquired during childhood and occurring in children with previously normal language development. The epileptiform activity in these children is thought to result in a functional ablation of eloquent speech areas. The purpose of this study was to investigate the usefulness of magnetoencephalography (MEG) for localizing the source of epileptiform activity in these patients. METHODS Nineteen patients with acquired aphasia and a suspected diagnosis of LKS were referred for MEG evaluation. Patients ranged in age from 4 to 14 years. Fourteen MEG studies were performed on a 74-channel system, four on a 148-channel whole-head system, and one on a 37-channel system. RESULTS Thirteen of the 19 patients had perisylvian MEG spikes. In 10 of the patients, the spikes were bilateral, and in three they were unilateral. Four other patients had non-sylvian spikes, and two patients had no spikes recorded. The results of MR imaging were normal or noncontributory for all 19 patients. CONCLUSIONS MEG can play a useful role in evaluating children with LKS and acquired epileptiform aphasia, both in diagnosis and in aiding presurgical localization of epileptiform activity when surgery is being considered.
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Affiliation(s)
- D F Sobel
- Division of Neuroradiology, Scripps Clinic, La Jolla, CA 92037, USA
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Beanlands RS, Labinaz M, Ruddy TD, Marquis JF, Williams W, LeMay M, Laramee LA, O'Brien E, Kearns SA, Aung M, Johansen H, Higginson LA. Establishing an approach for patients with recent coronary occlusion: identification of viable myocardium. J Nucl Cardiol 1999; 6:298-305. [PMID: 10385185 DOI: 10.1016/s1071-3581(99)90042-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 12/26/2022]
Abstract
BACKGROUND Revascularization of occluded coronary arteries after myocardial infarction (MI) may restore flow to viable myocardium and improve ventricular function. The aim of this pilot study was to determine the potential utility of thallium-201 viability imaging for the prediction of recovery of regional ventricular function in patients undergoing revascularization of total or subtotal occlusion of infarct-related arteries (TIMI 0-2 flow) during the convalescent period after MI. METHODS Twenty-three patients were identified < 6 weeks after MI and underwent Tl-201 viability imaging (rest imaging, n = 16; stress/reinjection imaging, n = 7) and radionuclide angiography. Patients were revascularized with percutaneous transluminal coronary artery in 10, stent in 10, and bypass in 3. Follow-up radionuclide angiography at 3 months was used to assess recovery of regional wall motion. RESULTS Among 41 abnormal wall motion segments in the infarct territories, the sensitivity, specificity, and accuracy for Tl-201 imaging in the prediction of recovery of regional function were 89% (25/28), 54% (7/13), and 78% (32/41), respectively. When 8 segments supplied by vessels with restenosis to >70% were excluded, specificity improved to 70%. Wall motion scores improved in those with adequate revascularization (1.6+/-1.4 vs 2.7+/-1.6; P < .001) but not in those with restenosis or occlusion (1.8+/-1.0 vs 2.0+/-1.6; P = NS). CONCLUSIONS In patients with an occluded artery after MI, Tl-201 viability imaging can detect recoverable myocardium with reasonable accuracy and may help select which patients will most benefit from revascularization.
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Affiliation(s)
- R S Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada.
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Abstract
The kidney is a likely source for some urinary epinephrine (E) since adrenalectomized animals and humans continue to excrete urinary E and the human kidney contains E synthesizing enzymes. We studied subjects during an intravenous infusion of 3H-E to determine the fraction of urinary E derived from the kidney. Eight normal subjects (CON) and 5 older, heavier hypertensives (OHH) ate a light breakfast along with ascorbic acid supplementation and had intravenous and arterial lines placed. They received an infusion of 3H-E and had an oral water load. During the final hour of 3H-E infusion, urine and arterial blood samples were collected for 3H-E and E levels. After the 3H-E infusion was abruptly discontinued, arterial blood samples were collected to measure 3H-E kinetics. The total body clearance of 3H-E was about 2,500 ml/min from plasma and clearance of 3H-E to urine was about 170 ml/min. CON had plasma E levels of 43 +/- 4 pg/ml. Their predicted rate of clearance of E from plasma to urine of 7,471 +/- 865 pg/min was less than (P = 0.018) the actual urinary E excretion of 15,037 +/- 2,625 pg/min. Thus, 43 +/- 9% of urinary E in CON was apparently derived from renal sources and not filtered from blood. Among OHH 85 +/- 4% of urinary E was derived from the kidney, significantly (P < 0.01) different from CON. The OHH also produced much more urinary E than predicted from plasma 3H-E clearance into urine (P = 0.03). A major fraction of urinary E is not filtered from the blood stream but is apparently derived from kidney. A small fraction of urinary E may be derived from E stored in nerve endings along with norepinephrine, but this probably represents less than 2% of urinary E. Renal cleavage of E sulfate into E may be another potential source of urinary E. Some, and perhaps most, urinary E not filtered from the bloodstream is derived from renal N-methylation of norepinephrine as the human kidney has two enzymes capable of converting norepinephrine to E. In conclusion, a major portion of urinary E is derived from the kidney and not filtered from the bloodstream. This is an important factor in the interpretation of urine E levels. Renal E could alter renal blood flow, electrolyte reabsorption, and renin release prior to excretion into urine.
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Affiliation(s)
- M G Ziegler
- Department of Medicine, University of California San Diego, USA.
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Nwe Oo K, Than A, Aung M, Saw T, Oo M. The use of calcium oxide in controlling house flies in Yangon, Myanmar. J Diarrhoeal Dis Res 1996; 14:117-8. [PMID: 8870407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Aung M, Sobel DF, Gallen CC, Hirschkoff EC. Potential contribution of bilateral magnetic source imaging to the evaluation of epilepsy surgery candidates. Neurosurgery 1995; 37:1113-20; discussion 1120-1. [PMID: 8584152 DOI: 10.1227/00006123-199512000-00011] [Citation(s) in RCA: 25] [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: 01/31/2023] Open
Abstract
The current procedures that are used to evaluate candidates for epilepsy surgery are time-consuming, costly, and often invasive. Magnetic source imaging (MSI), the combination of magnetoencephalography and anatomic imaging modalities, has shown promise as an efficient noninvasive means of localizing and characterizing seizure sources for possible resection. However, MSI has been limited by the inability to conduct simultaneous bilateral monitoring. In this study, a newly developed dual-magnetometer system was employed to record bilaterally the interictal activity in 30 candidates for epilepsy surgery. A standard monitoring protocol that included concurrent electroencephalographic recording and required a 2- to 3-hour examination period for each patient was developed. As a first step in a series of studies, the resultant MSI indications were compared with the information available from standard magnetic resonance imaging and concurrent electroencephalographic results. In 83% of the cases, this MSI protocol provided new information about the location of interictal epileptic activity that could be directive for subsequent patient care. Based on these results, it seems that MSI may become a cost-effective early step in epilepsy surgery evaluation. To continue the development on this basis, a study intended to validate the accuracy of MSI indicated by comparison with invasive electroencephalography has been initiated.
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Affiliation(s)
- M Aung
- Department of Neurology, Scripps Clinic and Research Foundation, La Jolla, California, USA
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Abstract
A mild electric shock applied to the lower lip was used to elicit reliable evoked potentials from the trigeminal nerve in 50 normal adults who ranged in age from 20 to 69 years. The waveforms were morphologically similar to those observed with invasive procedures. No substantial effects for subject age, side of stimulation, or recording electrode were obtained for any of the individual trigeminal evoked potential amplitudes or latencies. Female subjects tended to have somewhat larger amplitudes and shorter latencies than male subjects. The results suggest that non-invasive procedures produce reliable evoked potential measures of trigeminal nerve function for patients of all ages.
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Affiliation(s)
- J Polich
- Department of Neuropharmacology, Scripps Research Institute, La Jolla, CA, USA
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Gallen CC, Sobel DF, Schwartz B, Copeland B, Waltz T, Aung M. Magnetic source imaging. Present and future. Invest Radiol 1993; 28 Suppl 3:S153-7. [PMID: 8376043] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- C C Gallen
- Scripps Research Institute, La Jolla, California
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Gallen CC, Sobel DF, Waltz T, Aung M, Copeland B, Schwartz BJ, Hirschkoff EC, Bloom FE. Noninvasive presurgical neuromagnetic mapping of somatosensory cortex. Neurosurgery 1993; 33:260-8; discussion 268. [PMID: 8367048] [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] [Indexed: 01/30/2023] Open
Abstract
Rapid presurgical neuromagnetic localization of the somatosensory cortex was performed successfully on five patients with a large-array biomagnetometer by a protocol called magnetic source imaging (MSI). Determination of the location of the central sulcus is important in assessing operative risk and determining the optimal operative approach to structural lesions in the vicinity of the motor strip. The use of magnetic resonance imaging anatomical methods and intraoperative visual identification can be imprecise, whereas invasive localization prolongs operative time, adds cost, and entails added risk. Until the recent development of large-array biomagnetometer systems, neuromagnetic localization of the central sulcus had been demonstrated in research but was so time consuming and laborious as to preclude routine clinical use. In this study, the validity of MSI localizations was confirmed intraoperatively by direct cortical recording of somatosensory evoked potentials and/or direct motor stimulation. Complete agreement was found between MSI and intraoperative mapping in locating the central sulcus. Objective confirmations considered together with the speed and reliability of the procedure and with the presurgical availability of the results suggests the potential utility of MSI for routine surgical planning.
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Affiliation(s)
- C C Gallen
- Scripps Research Institute, La Jolla, CA
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Abstract
The P300 component of the event-related brain potential (ERP) elicited with auditory stimuli and pattern-shift visual evoked potentials (VEPs) was obtained from 16 patients with multiple sclerosis (MS) and 16 matched control subjects. P300 latency was significantly longer and component amplitude relatively depressed in the MS patients compared to control subjects. The P100 potential of the VEP also was delayed for both full-field and half-field stimulus conditions in the patients compared to control subjects. The findings suggest that the P300 ERP may reflect the cognitive decline associated with MS.
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Affiliation(s)
- J Polich
- Department of Neuropharmacology, Scripps Research Institute, La Jolla, CA 92037
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Abstract
A mild electric shock applied to the lower lip was used to elicit reliable evoked potentials from the trigeminal nerve in 20 normal young adults. The wave forms were morphologically similar to those observed with invasive procedures. No substantial differences for either the right or left side of stimulation, recording electrode, or subject sex were obtained for any of the individual potential amplitudes or latencies. The same procedures were applied to 10 patients who had been treated with retrogasserian glycerol injections for trigeminal neuralgia. Trigeminal evoked potentials were elicited in all patients, although the quality of the individual wave forms was more variable than that observed for the normal subjects. Comparison of the treated with the unaffected face side in the patients demonstrated significantly smaller N2-P2 amplitudes and longer N2 latencies for the affected face side. The results suggest that these procedures produce reliable evoked potential measures of trigeminal nerve function noninvasively which can provide an objective index of treatment efficacy.
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Affiliation(s)
- D J Dalessio
- Department of Neuropharmacology, Scripps Clinic and Research Foundation, La Jolla, CA 92037
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Polich J, Aung M, Dalessio DJ. Long latency auditory evoked potentials: intensity, inter-stimulus interval, and habituation. Pavlov J Biol Sci 1988; 23:35-40. [PMID: 3357711] [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: 01/05/2023]
Abstract
Experiment 1 elicited the P1, N1, P2, and N2 components of the long latency auditory evoked potential (AEP) using a 1000 Hz tone presented at 30, 50, or 70 dB SPL and 1-, 3-, or 5-second inter-stimulus intervals to assess the relative effects of the combination of these variables on component amplitude and latency. Four blocks of 16 tone presentations each were recorded from each subject to determine if changes in the AEP would occur because of short-term habituation. Both stimulus factors interacted significantly in a systematic fashion for the amplitude measures, with increases in latency also associated with increases in intensity and inter-stimulus interval. Only minor changes across the four trial blocks for either the amplitude or latency measures were observed over the various stimulus presentation conditions. Experiment 2 employed the same tone stimulus presented at 50 dB SPL and a 3-second inter-stimulus interval. Eight blocks of 64 trials were recorded from each subject on each day for four days to investigate long-term habituation effects. No substantial changes in any of the component amplitudes or latencies were obtained across the 32 trial blocks. It was concluded that intensity and inter-stimulus interval interact to determine AEP amplitude as well as latency values and that the constituent components do not change appreciably with repeated stimulus presentations, even after several days.
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Affiliation(s)
- J Polich
- Division of Preclinical Neuroscience, Scripps Clinic and Research Foundation, La Jolla, California 92037
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Bickford RE, Fleming N, Stewart L, Aung M. Proceedings: Compressed spectral displays in epileptic patients. Epilepsia 1972; 13:347-8. [PMID: 4680338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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