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Vaughan AM, Cenciarelli O, Colombe S, Alves de Sousa L, Fischer N, Gossner CM, Pires J, Scardina G, Aspelund G, Avercenko M, Bengtsson S, Blomquist P, Caraglia A, Chazelle E, Cohen O, Diaz A, Dillon C, Dontsenko I, Kotkavaara K, Fafangel M, Ferraro F, Firth R, Fonager J, Frank C, Carrasco MG, Gkolfinopoulou K, Grenersen MP, Guzmán Herrador BR, Henczkó J, Hoornenborg E, Igoe D, Ilić M, Jansen K, Janță DG, Johansen TB, Kasradze A, Koch A, Kyncl J, Martins JV, McAuley A, Mellou K, Molnár Z, Mor Z, Mossong J, Novacek A, Orlikova H, Pem Novosel I, Rossi MK, Sadkowska-Todys M, Sawyer C, Schmid D, Sîrbu A, Sondén K, Tarantola A, Tavares M, Thordardottir M, Učakar V, Van Ewijk C, Varjas J, Vergison A, Vivancos R, Zakrzewska K, Pebody R, Haussig JM. A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. Euro Surveill 2022; 27. [PMID: 36082686 PMCID: PMC9461311 DOI: 10.2807/1560-7917.es.2022.27.36.2200620] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following the report of a non-travel-associated cluster of monkeypox cases by the United Kingdom in May 2022, 41 countries across the WHO European Region have reported 21,098 cases and two deaths by 23 August 2022. Nowcasting suggests a plateauing in case notifications. Most cases (97%) are MSM, with atypical rash-illness presentation. Spread is mainly through close contact during sexual activities. Few cases are reported among women and children. Targeted interventions of at-risk groups are needed to stop further transmission.
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Affiliation(s)
- Aisling M Vaughan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | | | - Soledad Colombe
- Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium.,Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | | | - Natalie Fischer
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Celine M Gossner
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jeff Pires
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Giuditta Scardina
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Gudrun Aspelund
- Centre for Health Security and Communicable Disease Control, The Directorate of Health, Reykjavik, Iceland
| | - Margarita Avercenko
- Infectious Disease Prevention and Control Unit, Department of Infectious Risks Analysis and Prevention, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Sara Bengtsson
- Unit for Diagnostics Preparedness of Notifiable and High Consequence Pathogens, Public Health Agency of Sweden, Solna, Sweden
| | - Paula Blomquist
- Field Services, United Kingdom Health Security Agency, London, United Kingdom
| | - Anna Caraglia
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | - Emilie Chazelle
- Santé publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Orna Cohen
- Division of Epidemiology, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Asuncion Diaz
- National Centre of Epidemiology, Carlos III Health Institute, CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Christina Dillon
- Health Services Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Irina Dontsenko
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Katja Kotkavaara
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mario Fafangel
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Federica Ferraro
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | | | - Jannik Fonager
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Christina Frank
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mireia G Carrasco
- Ministry of Health, Government of Andorra, Andorra la Vella, Andorra
| | - Kassiani Gkolfinopoulou
- Surveillance Coordination Department. Hellenic National Public Health Organization (EODY), Athens, Greece
| | | | - Bernardo R Guzmán Herrador
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Judit Henczkó
- Department of Microbiological Reference Laboratory, National Public Health Center, Budapest, Hungary
| | - Elske Hoornenborg
- Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, the Netherlands
| | - Derval Igoe
- Health Services Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Maja Ilić
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Klaus Jansen
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Denisa-Georgiana Janță
- National Centre of Surveillance and Control of Communicable Disease, National Institute of Public Health Romania, Bucharest, Romania
| | | | - Ana Kasradze
- Head of Public Health Emergency Preparedness and Response Division, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Anders Koch
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
| | - João Vieira Martins
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Andrew McAuley
- Public Health Scotland, Edinburgh, Scotland, United Kingdom
| | - Kassiani Mellou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, Hellenic National Public Health Organization (EODY), Athens, Greece
| | - Zsuzsanna Molnár
- Department of Communicable Disease Epidemiology and Infection Control, National Public Health Center, Budapest, Hungary
| | - Zohar Mor
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel.,Public Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Alina Novacek
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Hana Orlikova
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
| | | | - Maria K Rossi
- Public Health Scotland, Edinburgh, Scotland, United Kingdom
| | | | - Clare Sawyer
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - Daniela Schmid
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Anca Sîrbu
- National Centre of Surveillance and Control of Communicable Disease, National Institute of Public Health Romania, Bucharest, Romania
| | - Klara Sondén
- Unit for Diagnostics Preparedness of Notifiable and High Consequence Pathogens, Public Health Agency of Sweden, Solna, Sweden
| | - Arnaud Tarantola
- Santé publique France Regional Office, Saint-Denis, Île-de-France, France
| | - Margarida Tavares
- National Program for Sexually Transmitted Infections and HIV Infection, Directorate-General of Health, Lisbon, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), and EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Emerging Infectious Diseases Unit, Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marianna Thordardottir
- Centre for Health Security and Communicable Disease Control, The Directorate of Health, Reykjavik, Iceland
| | - Veronika Učakar
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Catharina Van Ewijk
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.,National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Juta Varjas
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | | | - Roberto Vivancos
- Field Services, United Kingdom Health Security Agency, London, United Kingdom
| | - Karolina Zakrzewska
- National Institute of Public Health (NIH) - National Research Institute, Warsaw, Poland
| | - Richard Pebody
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Joana M Haussig
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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Hobson G, Adamson J, Adler H, Firth R, Gould S, Houlihan C, Johnson C, Porter D, Rampling T, Ratcliffe L, Russell K, Shankar AG, Wingfield T. Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021. Euro Surveill 2021; 26:2100745. [PMID: 34387184 PMCID: PMC8365177 DOI: 10.2807/1560-7917.es.2021.26.32.2100745] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/20/2022] Open
Abstract
Most reported cases of human monkeypox occur in Central and West Africa, where the causing virus is endemic. We describe the identification and public health response to an imported case of West African monkeypox from Nigeria to the United Kingdom (UK) in May 2021. Secondary transmission from the index case occurred within the family to another adult and a toddler. Concurrent COVID-19-related control measures upon arrival and at the hospital, facilitated detection and limited the number of potential contacts.
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Affiliation(s)
- Gemma Hobson
- Health Protection, Public Health Wales, Cardiff, United Kingdom
| | - James Adamson
- Health Protection, Public Health Wales, Cardiff, United Kingdom
| | - Hugh Adler
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Departments of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Richard Firth
- Health Protection, Public Health Wales, Cardiff, United Kingdom
| | - Susan Gould
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Departments of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Catherine Houlihan
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, Salisbury, United Kingdom
- Department of Virology, University College Hospital London, London, United Kingdom
| | | | - David Porter
- Department of Paediatric Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Tommy Rampling
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, Salisbury, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Libuse Ratcliffe
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Katherine Russell
- Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | | | - Tom Wingfield
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Departments of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Affiliation(s)
- Andrew G Terrell
- Defence Public Health Unit, Headquarters Surgeon General, Lichfield, United Kingdom
| | - Mike E Forde
- Army Health Unit, Army Medical Directorate, Camberley, United Kingdom
| | - Richard Firth
- Army Health Unit, Army Medical Directorate, Camberley, United Kingdom
| | - David A Ross
- Army Health Unit, Army Medical Directorate, Camberley, United Kingdom
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Terrell AG, Forde ME, Firth R, Ross DA. Malaria Chemoprophylaxis and Self-Reported Impact on Ability to Work: Mefloquine Versus Doxycycline. J Travel Med 2015; 22:383-8. [PMID: 26424621 DOI: 10.1111/jtm.12232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 12/08/2014] [Revised: 04/08/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is well known that both mefloquine and doxycycline are commonly associated with adverse effects when taken for malaria chemoprophylaxis. However, the relative impact of these on travelers' ability to work is not so well understood. The aim of this study was to identify which drug has a lesser impact on the ability to work as measured by self-reported severity of adverse effects via a questionnaire. METHODS This was a questionnaire-based two-arm cohort study. Participants were soldiers selected from 10 consecutive units training in Kenya during 2012 and 2013. The exposure was either doxycycline or mefloquine and the main outcome measure was impact upon ability to work. Each cohort was advised to take doxycycline or mefloquine with exceptions at the individual level where medically or occupationally advised. RESULTS Significantly more (p < 0.0001) doxycycline users reported that one or more adverse effects had interfered with their ability to do their job than mefloquine users. Of the 867 mefloquine users, who reported on the impact of adverse effects, 109 (12.6%) reported that one or more adverse effects had impacted upon their ability to do their job, compared to 152 (22.2%) of the 685 doxycycline users who had reported on the impact of any adverse effects. Doxycycline symptoms were predominantly gastrointestinal and dermatological, whereas mefloquine symptoms were neuropsychiatric. CONCLUSIONS Self-reported symptoms were common in those that responded and, while the true background rate of adverse effects (off any medication) is unknown, doxycycline had a significantly increased rate compared with mefloquine and was associated with a greater occupational impact. Therefore, this study supports the view that, for organizations which provide malaria chemoprophylaxis to employees free of charge, mefloquine should be the first-choice antimalarial drug where the only alternative is doxycycline.
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Affiliation(s)
- Andrew G Terrell
- Defence Public Health Unit, Headquarters Surgeon General, Lichfield, United Kingdom
| | - Mike E Forde
- Army Health Unit, Army Medical Directorate, Camberley, United Kingdom
| | - Richard Firth
- Army Health Unit, Army Medical Directorate, Camberley, United Kingdom
| | - David A Ross
- Army Health Unit, Army Medical Directorate, Camberley, United Kingdom
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5
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Dorhout Mees SM, Algra A, Wong GKC, Poon WS, Bradford CM, Saver JL, Starkman S, Rinkel GJE, van den Bergh WM, van Kooten F, Dirven CM, van Gijn J, Vermeulen M, Rinkel GJE, Boet R, Chan MTV, Gin T, Ng SCP, Zee BCY, Al-Shahi Salman R, Boiten J, Kuijsten H, Lavados PM, van Oostenbrugge RJ, Vandertop WP, Finfer S, O'Connor A, Yarad E, Firth R, McCallister R, Harrington T, Steinfort B, Faulder K, Assaad N, Morgan M, Starkman S, Eckstein M, Stratton SJ, Pratt FD, Hamilton S, Conwit R, Liebeskind DS, Sung G, Kramer I, Moreau G, Goldweber R, Sanossian N. Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage: Individual Patient Data Meta-Analysis. Stroke 2015; 46:3190-3. [PMID: 26463689 DOI: 10.1161/strokeaha.115.010575] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 06/24/2015] [Accepted: 09/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be more effective, but individual trials had not enough power for such a subanalysis. We performed an individual patient data meta-analysis to study whether magnesium is effective when given within different time frames within 24 hours after the SAH. METHODS Patients were divided into categories according to the delay between symptom onset and start of the study medication: <6, 6 to 12, 12 to 24, and >24 hours. We calculated adjusted risk ratios with corresponding 95% confidence intervals for magnesium versus placebo treatment for poor outcome and DCI. RESULTS We included 5 trials totaling 1981 patients; 83 patients started treatment<6 hours. For poor outcome, the adjusted risk ratios of magnesium treatment for start <6 hours were 1.44 (95% confidence interval, 0.83-2.51); for 6 to 12 hours 1.03 (0.65-1.63), for 12 to 24 hours 0.84 (0.65-1.09), and for >24 hours 1.06 (0.87-1.31), and for DCI, <6 hours 1.76 (0.68-4.58), for 6 to 12 hours 2.09 (0.99-4.39), for 12 to 24 hours 0.80 (0.56-1.16), and for >24 hours 1.08 (0.88-1.32). CONCLUSIONS This meta-analysis suggests no beneficial effect of magnesium treatment on poor outcome or DCI when started early after SAH onset. Although the number of patients was small and a beneficial effect cannot be definitively excluded, we found no justification for a new trial with early magnesium treatment after SAH.
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Affiliation(s)
- Sanne M Dorhout Mees
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Ale Algra
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - George K C Wong
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Wai S Poon
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Celia M Bradford
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Jeffrey L Saver
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Sidney Starkman
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Gabriel J E Rinkel
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.)
| | - Walter M van den Bergh
- From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.).
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Bacon S, Schmid J, McCarthy A, Edwards J, Fleming A, Kinsley B, Firth R, Byrne B, Gavin C, Byrne MM. The clinical management of hyperglycemia in pregnancy complicated by maturity-onset diabetes of the young. Am J Obstet Gynecol 2015; 213:236.e1-7. [PMID: 25935773 DOI: 10.1016/j.ajog.2015.04.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/01/2015] [Accepted: 04/27/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Women with maturity-onset diabetes of the young (MODY) are often first identified and diagnosed with diabetes during pregnancy. Genetics and hyperglycemia play an important role in determining fetal size in MODY pregnancies. The principal objective of the current study is to determine the outcomes and clinical management of hyperglycemia in pregnancies complicated by glucokinase gene (GCK) and hepatocyte nuclear factor (HNF)-1α MODY mutations. STUDY DESIGN A retrospective chart review of 37 women with a GCK/HNF-1α mutation was conducted. Data on variables such as birthweight, mode of delivery, and the treatment of hyperglycemia were available on 89 pregnancies. RESULTS The birthweight in unaffected GCK offspring was significantly higher than in the affected GCK offspring (4.8 [4.1-5.2] kg vs 3.2 [3.1-3.7] kg; P = .01). Seven-point home blood glucose monitoring over a 7-day period in each trimester demonstrated higher fasting and postprandial glycemic excursions in the first trimester of GCK pregnancies when compared to HNF-1α pregnancies (fasting 104 [90-115] mg/dL vs 84 [77-88] mg/dL; P = .01 and postprandial 154 [135-196] mg/dL vs 111 [100-131] mg/dL; P = .04) despite insulin treatment. There was a higher percentage of miscarriages in the GCK group when compared to the HNF-1α MODY group (33.3% vs 14%; P = .07), which was similar to the background population. Insulin initiated at an early gestation appeared to lower the incidence of macrosomia in GCK unaffected offspring. CONCLUSION Hyperglycemia in HNF-1α pregnancies is easily managed with current insulin protocols; in contrast, glycemic excursions are difficult to manage in GCK pregnancies. There was an increased percentage of miscarriages in GCK pregnancies highlighting the importance of a diagnosis of GCK-MODY in women prior to conception and the necessity for preconception care.
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Affiliation(s)
- Siobhan Bacon
- Diabetes Day Center, Mater Misericordiae University Hospital, Dublin, Ireland; Rotunda Maternity Hospital, Dublin, Ireland
| | - Jasmin Schmid
- Center for Systems Medicine and Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ailbhe McCarthy
- Diabetes Day Center, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Brendan Kinsley
- Diabetes Day Center, Mater Misericordiae University Hospital, Dublin, Ireland; Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - Bridgette Byrne
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Claire Gavin
- Diabetes Day Center, Mater Misericordiae University Hospital, Dublin, Ireland; National Maternity Hospital, Dublin, Ireland
| | - Maria M Byrne
- Diabetes Day Center, Mater Misericordiae University Hospital, Dublin, Ireland; Rotunda Maternity Hospital, Dublin, Ireland.
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Whiting DL, Simpson GK, Koh ES, Wright KM, Simpson T, Firth R. A multi-tiered intervention to address behavioural and cognitive changes after diagnosis of primary brain tumour: a feasibility study. Brain Inj 2012; 26:950-61. [PMID: 22630044 DOI: 10.3109/02699052.2012.661912] [Citation(s) in RCA: 15] [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: 12/13/2022]
Abstract
PURPOSE Untreated behavioural and cognitive changes after primary brain tumour (PBT) can result in challenging behaviours (CBs), with limited documentation on treatment approaches. This study explored the feasibility of employing a Behavioural Consultancy approach to manage CBs, targeting individuals with PBT, family and treating staff. METHODS Participants were patients and families of two hospitals and health professionals from cancer/neurological services. A single-case experimental design piloted skill-based training and environmental changes in managing socio-behavioural impairments in a person with a low grade astrocytoma. A half-day workshop to train family members (n = 7) in compensatory strategy use to manage CBs after PBT was piloted. Finally, a 1-day workshop was provided to 43 health professionals in managing CBs after PBT. For both workshops, a pre-post impact evaluation was conducted employing a purpose-designed Strategies Use Measure. RESULTS All three interventions demonstrated positive results. The single case showed a 71% decrease in the target behaviour (time spent talking) post-intervention. Some attrition to these gains was observed at two follow-up time points (3 and 5 months). Participants from both workshops demonstrated significant post-intervention increases in perceived knowledge of Strategy Use (family members z = 2.03, p < 0.05; health professionals z = 4.95, p < 0.00; Wilcoxon signed-rank test). CONCLUSIONS These initial studies highlight the potential of employing an integrated multi-tiered intervention based on a Behavioural Consultancy model to manage CBs after PBT.
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Affiliation(s)
- D L Whiting
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia.
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8
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Firth R, Doran J. Hugh Sutherland Dodd. West J Med 2009. [DOI: 10.1136/bmj.b1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Russell N, Foley M, Kinsley B, Firth R, Coffey M, Mcauliffe F. 56: Effect of pre-gestational diabetes on fetal heart function and structure. Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2007.10.063] [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: 10/22/2022]
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10
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Higgins M, Russell N, Foley ME, Firth R, Coffey M, McAuliffe F. 360: The role of middle cerebral artery doppler in diabetic pregnancy. Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2007.10.377] [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: 10/22/2022]
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11
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Foley M, Sheridan C, McAuliffe F, Coffey M, Kinsley B, Firth R. To prevent recurrence of macrosomia (>4500g), women with a history of gestational diabetes (GDM) and macrosomia should be treated early in pregnancy without re-screening. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.487] [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: 10/23/2022]
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Nolan JJ, O'Halloran D, McKenna TJ, Firth R, Redmond S. The cost of treating type 2 diabetes (CODEIRE). Ir Med J 2006; 99:307-10. [PMID: 17274175] [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: 05/13/2023]
Abstract
Diabetes mellitus is the most common chronic metabolic disease and a major source of morbidity and mortality. Type 2 diabetes (T2D) is by far the most prevalent form of diabetes accounting for around 90% of cases worldwide. In recent years it has become apparent that a diabetes epidemic is unfolding as a result of increasing obesity, sedentary lifestyles and an ageing population. The enormity of the diabetes epidemic raises concern about the total cost to healthcare systems. This study was undertaken to investigate the direct healthcare costs of managing T2D in Ireland. Data was captured on 701 diabetes patients attending four diabetes centres. A bottom-up, prevalence-based design was used, which collected data on hospital resource use and clinical outcome measures over a 12-month period (1999/2000). The study was observational in nature, focusing on usual care of patients with T2D. Although the true prevalence of T2D in Ireland is unknown, conservative estimates are 3.9% for diagnosed diabetes and 6% for both diagnosed and undiagnosed diabetes. Using these figures the annual total direct cost was estimated at 377.2 million euro for diagnosed diabetes and 580.2 million euro for both diagnosed and undiagnosed diabetes. This corresponds to 4.1% and 6.4% of total healthcare expenditure respectively. Hospitalisations were the main driver of costs, accounting for almost half of overall costs, while ambulatory and drug costs accounted for 27% and 25% respectively. Hospitalisation costs were high because 60% of patients had developed complications. The most common microvascular and macrovascular complications were neuropathy and angina respectively. The annual cost of care for patients with microvascular and macrovascular complications were 1.8 and 2.9 times the cost of treating those without clinical evidence of complications respectively. The figure for patients with both types of complications was 3.8. This study shows that T2D is a very costly disease, largely due to the cost of and the management of complications. Many diabetes related complications are preventable, therefore it would appear a cost-effective approach for government to invest in the prevention of T2D and diabetes related complications.
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Affiliation(s)
- J J Nolan
- Department of Endocrinology, St. James's Hospital, Dublin 8, Ireland
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Foley ME, Daly L, Coffey M, Firth R, Kinsley B, O'Herlihy C. Recurrence of fetal macrosomia (> 4500G) in gestational diabetes is less frequent than in non-diabetic pregnancies. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2004.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
One hundred and forty-eight patients with well controlled insulin dependent diabetes that were allowed to labour spontaneously from 1981 to 1994 were reviewed. There were 2 perinatal deaths, giving a perinatal mortality rate of 13.5/1000. One hundred and twenty-four patients (84 per cent) had a normal vaginal delivery, 13 (9 per cent) forceps delivery and 11 (7 per cent) caesarean section. Twenty-one infants (14 per cent) required admission to a Special Care Baby Unit. One third of infants weighed 4 Kg or more, however there was only 1 case of shoulder dystocia. We compared these results with those of the general hospital population of 1987. The 2 main differences are; 1) the Caesarean section rate in labour was higher for this diabetic group than for the general hospital population, 7 per cent versus 3.4 per cent, 2) the birth weight was heavier, 33 per cent of infants of the diabetic group weighed 4 Kg or more versus 18 per cent of the general hospital population. The other parameters were comparable. We conclude that conservative management of pregnancy in well controlled diabetic women is advantageous, resulting in a high vaginal delivery rate without an increase in shoulder dystocia, and a low perinatal morbidity and mortality rate.
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Abstract
AIM To determine the prevalence of diabetic retinopathy in patients with Down's syndrome and diabetes mellitus. METHODS Nine patients with Down's syndrome and diabetes mellitus were assessed. Factors recorded included type and duration of diabetes, level of diabetic control, blood pressure, urinalysis, and results of ophthalmological examination. RESULTS The duration of diabetes ranged from 8 to 41 years (mean 17.6 years). All had satisfactory glycaemic control and blood pressure measurements on the low side of normal (mean 106.6/70 mm Hg). One patient had early background diabetic retinopathy. The remainder had no evidence of diabetic retinopathy. CONCLUSION The low prevalence of diabetic retinopathy in these Down's syndrome patients, despite the long duration, is an interesting finding. It suggests some inherent protective factor against the development of diabetic retinopathy in this patient subgroup.
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Affiliation(s)
- T Fulcher
- Department of Ophthalmology, Mater Misericordiae Hospital, Dublin, Ireland
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Cahill M, Halley A, Codd M, O'Meara N, Firth R, Mooney D, Acheson RW. Prevalence of diabetic retinopathy in patients with diabetes mellitus diagnosed after the age of 70 years. Br J Ophthalmol 1997; 81:218-22. [PMID: 9135386 PMCID: PMC1722137 DOI: 10.1136/bjo.81.3.218] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [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: 02/04/2023]
Abstract
AIMS/BACKGROUND A hospital based prevalence study was undertaken to estimate the prevalence of diabetic retinopathy (DR) in patients diagnosed as having diabetes mellitus after the age of 70 years. The prevalence of visually threatening retinopathy at the time of diagnosis of diabetes was also determined. The association between prevalence of DR and duration of diabetes mellitus, mode of treatment, HbA1c levels, presence of hypertension, and sex of patient was examined and a comparison was drawn between this study and earlier prevalence studies of DR in older type II diabetics. METHODS Using data on the Irish Diabetic Retinopathy Register located in the Mater Misericordiae Hospital, Dublin, all patients who were diagnosed as having type II diabetes mellitus after the age of 70 years were invited to attend for ophthalmic review. Medical records were examined to determine the duration of diabetes mellitus, mode of treatment, recent HbA1c levels, and the presence of systemic hypertension. RESULTS Of the 150 patients examined, 21 (14%) had some form of DR and 10 of these patients (6.6%) had visually threatening retinopathy or previously treated visually threatening retinopathy. Five patients (3.3%) presented with visually threatening retinopathy at the time of diagnosis of diabetes. Those patients with DR had a significantly higher median duration of diabetes (5.0 years) compared with those patients without DR (3.5 years). A significantly higher proportion of patients with DR required treatment with insulin and a correspondingly lower proportion of patients without DR were controlled on diet alone. There was no significant association between prevalence of DR and HbA1c levels, systemic hypertension, or sex of patient. There was a lower overall prevalence of DR in comparison with earlier studies. CONCLUSIONS The prevalence of DR in these elderly type II diabetics is lower than than previously reported in patients with type II disease but a small percentage of patients had visually threatening retinopathy at presentation. Longer duration of diabetes and insulin use were associated with a significantly increased prevalence of DR. All elderly type II diabetic patients require thorough ophthalmic examination near to the time of first presentation and thereafter at regular intervals.
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Affiliation(s)
- M Cahill
- Institute of Ophthalmology, Mater Misericordiae Hospital, Dublin
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Marchiori DM, Firth R. Tethered cord syndrome. J Manipulative Physiol Ther 1996; 19:265-7. [PMID: 8734402] [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: 02/01/2023]
Abstract
OBJECTIVE To briefly discuss a case of tethered spinal cord syndrome, and to acquaint the reader with one of many important differential considerations among patients presenting with low back and leg pain. FEATURES A 32-yr-old woman sought treatment at a private chiropractic clinic for a 6-month history of low back pain with intermittent diffuse bilateral leg pain and numbness. Plain films of the lumbar spine revealed no abnormality. Magnetic resonance imaging demonstrated a tethered spinal cord. INTERVENTION The abbreviated filum terminale was surgically corrected. CONCLUSIONS Tethered cord syndrome, a significant finding, is likely to have been responsible for the patient's signs and symptoms. Magnetic resonance imaging is particularly helpful in evaluating spinal cord deformity, and may provide important information on patients not responding to chiropractic care.
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Affiliation(s)
- D M Marchiori
- Palmer Research Institute, Davenport, Iowa 52803, USA
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Zhang Y, Cook JT, Hattersley AT, Firth R, Saker PJ, Warren-Perry M, Stoffel M, Turner RC. Non-linkage of the glucagon-like peptide 1 receptor gene with maturity onset diabetes of the young. Diabetologia 1994; 37:721-4. [PMID: 7958545 DOI: 10.1007/bf00417698] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Glucagon-like peptide-1 (GLP-1) is a hormone derived from the preproglucagon molecule that is secreted by intestinal L cells and stimulates insulin secretion from beta cells. The GLP-1 receptor is a candidate gene for diabetes mellitus, as mutations may induce the impaired insulin response that is a characteristic feature of NIDDM. To study the relationship between the GLP-1 receptor gene and NIDDM, linkage of a microsatellite polymorphism flanking the GLP-1 receptor gene with diabetes was investigated in three Caucasian families with MODY and in the nuclear families of 12 NIDDM probands. A cumulative LOD score -8.50 excludes linkage in these MODY pedigrees. A LOD score of -1.24 in the NIDDM nuclear pedigrees makes linkage improbable. Mutations in or near the GLP-1 receptor gene are unlikely to be the major cause of the inherited predisposition to NIDDM in Caucasian pedigrees, but we cannot exclude a role for this locus in a polygenic model or a major role in some pedigrees.
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Affiliation(s)
- Y Zhang
- Diabetes Research Laboratories, Radcliffe Infirmary, Oxford, UK
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20
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Marchiori DM, McLean I, Firth R, Tatum R. A comparison of radiographic signs of degeneration to corresponding MRI signal intensities in the lumbar spine. J Manipulative Physiol Ther 1994; 17:238-45. [PMID: 8046279] [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: 01/28/2023]
Abstract
OBJECTIVES To evaluate plain film radiographic findings of lumbar intervertebral disk degeneration. DESIGN A cross-sectional observational design was employed. Contingency tables were constructed to evaluate the relationships between radiographic findings of degeneration and the corresponding MRI signal intensities of the inner intervertebral disk. SETTING Twenty-four consecutive cases were retrospectively selected from an MRI imaging center. PATIENTS No exclusion was made on the basis of age or sex. MAIN OUTCOME MEASURES Radiographic findings of IVD degeneration include: Narrowed disk space, osteophyte formation, end-plate sclerosis, vacuum phenomenon, end-plate irregularity and Schmorl's node formation. The inner IVD signal intensity of the sagittal T2-weighted MRI image was visually categorized by three radiologists. The signal intensities were divided into low, medium and high categories. MAIN RESULTS Visually reduced disk height, osteophytes and eburnation all demonstrate significant relationships with MRI signal intensity. Due to their infrequency, no significant relationships could be found with vacuum phenomena, end-plate irregularity, and Schmorl's nodes when compared to MRI signal intensity. CONCLUSIONS In conclusion, visually reduced disk height is frequently associated with decreased signal intensity and, therefore, significantly indicates internal disk derangement. Osteophytes are more commonly present when the signal intensity is low. However, high signal intensity is associated with osteophytic change as well. Therefore, osteophytic change is less sensitive and accurate to early inner disk degenerative change. When osteophytes and reduced disk height are present together, a stronger prediction of degeneration is possible then when either finding is present alone. Due to their infrequency, eburnation, vacuum phenomena, end-plate irregularity and Schmorl's nodes are less helpful indicators of degeneration.
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Affiliation(s)
- D M Marchiori
- Department of Radiology, Palmer College of Chiropractic, Davenport, IA 52803
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21
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Dimitriadis E, Owens D, Collins P, Johnson A, Tomkin G, Cronin CC, Barry D, Crowley B, Ferriss JB, Hetherton AM, Smith DF, O’Herlihy C, Smyth PPA, Fiad TM, Culliton M, Dunbar J, Cunningham SK, McKenna TJ, Heaney AP, Loughrey GL, McCance DR, Mcllrath E, Hadden DR, Kennedy L, Sheridan B, Ferris JB, Whyte A, Cleary PE, McAuley DJ, Mathew B, Bailey IC, Curtin A, Lenehan K, Deegan P, Henry M, Stapleton M, Baker H, Duggan PF, Mitchell TH, O’Hare JA, Geoghegan M, Abuaisha F, Fearon U, Clarke D, Roberts RN, Traub AI, Thompson W, Whitehead H, Holmes J, Roberts R, Al-Mandhari NA, Greer A, Carson D, Traub T, Hadden D, Heaney AP, Ferguson T, Atkinson AB, O’Keeffe S, Devlin JG, Donnellan C, Russell CR, Kennedy TL, Kennedy AL, Atkinson AB, Long HA, Conway DJ, Mercer PM, Murphy D, Stokes M, Sheahan K, O’Higgins NJ, Dunne FP, Ratcliffe WA, Mansour P, Heath DA, O’Meara NM, Sturis J, Herold KC, Polonsky KS, Beatty OL, Ritchie CM, Bell PM, Kennedy AL, Clarke D, Fearon U, Levy JC, Turkington E, Hadden DW, Harper R, Ennis CN, Johnston GD, Scanlan P, Foley M, Stronge J, Firth R, Hanson RL, Jacobsson LTH, Bennett PH, Bishop DT, Knowler WC. Irish endocrine society. Ir J Med Sci 1994. [DOI: 10.1007/bf02943261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Scanlan P, Dowling M, Dervan P, Corrigan T, Heffernan S, Firth R. Fine needle aspiration cytology of thyroid nodules: review of 36 months experience. Ir J Med Sci 1993; 162:177-9. [PMID: 8335454 DOI: 10.1007/bf02945179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 01/30/2023]
Abstract
Studies suggest that fine needle aspiration of thyroid nodules is a sensitive and specific tool for the detection of thyroid cancers thus preventing unnecessary operations. This technique was introduced in our institution in 1987 and performed where indicated under strictly defined criteria. We reviewed the aspirates performed over a 36 month period to critically evaluate the role of this procedure. Review was limited to F.N.A.s of nodules considered to be potentially malignant by conventional criteria and hence all the following criteria needed to be fulfilled: (1) solitary or dominant nodules in a multinodular goitre, (2) cold on isotope scanning, (3) solid or complex cystic nodule on ultrasonography. During the period May 1987 to May 1990 88 aspiration procedures were performed on 77 patients. 93% of the 77 patients had adequate aspirates and of these approximately 30% were considered suspicious or malignant. The overall resection rate was 23.4% which is approximately one third of the rate expected should suspicion have been based solely on conventional imaging criteria. The yield of neoplasia (adenoma and carcinoma) at resection was 89%. We found FNA to be a very useful adjunct in the management of nodular thyroid disease when used in conjunction with clinical laboratory and radiological evaluation. It is safe, inexpensive and provides useful additional information towards making appropriate decisions in an area beset with uncertainty.
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Affiliation(s)
- P Scanlan
- Department of Endocrinology, Mater Misericordiae Hospital, Dublin
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Abstract
The approach of term in the pregnancy of a diabetic woman is a time of anxiety for patient and physician alike. The impact of a conservative approach to the timing of delivery is outlined in this review of the clinical course and outcome of 276 pregnancies of diabetic women, delivered at the National Maternity Hospital, Dublin between 1981 and 1990. The mean gestation at delivery was 39 weeks, 229 patients (83%) delivered at or beyond 38 weeks and 112 patients (41%) delivered at or beyond 40 weeks. The overall induction of labour rate was 27% and the elective Caesarean section rate was 19%. Sixty seven percent of patients achieved a normal delivery, the forceps rate was 5%, and 28% of patients were delivered by Caesarean section. There were 16 perinatal deaths in the series, with 7 due to lethal malformations. There were 5 deaths of normally formed infants occurring at or beyond 38 weeks' gestation. All of these 5 deaths had been preceded by clinically apparent polyhydramnios or macrosomia and recognized poor control. This study stresses the value of strict diabetic control in the management of diabetic pregnancy and highlights the significance of polyhydramnios and macrosomia as indicators of risk approaching term in diabetic pregnancy.
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Murphy H, Marmion F, Jauch B, Fox D, Connolly K, Loftus BG, Maguire S, McDonagh B, O’Kane D, Nepalata S, Tunney PJ, Turner MJ, Keane D, Firth R, Foley ME, Stronge JM, Rollins MD, Halliday HL, Lappin TRJ, Afrasiabi M, Ali Hassan OM, Murnaghan D, Jenkins DM, Connolly R, Barton DPJ, McCarthy C, Tunney P, Herlihy CO, Sheppard BL, Gleeson N, Boyle C, Daly L, Jordan M, Bonnar J, Clarke T, Counahan R, Bell AH, Shields MD, Wallace I, McClure G, McC Reid M, Sim DAJ, Dornan JC, Burke G, Stuart B, Crowley P, NiScanaill S, Drumm J, Tubman TRJ, Cuillinane C, Kelehan P, Murphy J, Gorman W, O”Brien NG. Irish perinatal society. Ir J Med Sci 1989. [DOI: 10.1007/bf02942072] [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: 10/21/2022]
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Ritchie CM, Hadden DR, Kennedy AL, Sheridan B, Atkinson AB, Murray DP, Ferriss JB, O’Sullivan DJ, Sheridan B, Leslie HCP, Roberts G, McCance DR, McKnight JA, Atkinson AB, McLaughlin B, Barrett P, Devlin JG, Fitzpatrick SC, McKenna TJ, Lappin TRJ, Elder GE, Brown JH, Taylor T, Bridges JM, O’Shea D, Byrne M, Powell D, Cunningham SK, McKenna TJ, Moles KW, Varghese A, Buchanan KD, Atkinson AB, Carson D, Atkinson AB, McCance DR, McKnight JA, Laverty S, Sheridan B, McKane WR, Stevens AB, Duly E, Andrews WJ, Bell PM, Hayes JR, Henry RW, Bell PM, Firth RG, Rizza RA, O’Hare JA, Minaker KL, Keneilly GS, Rowe JW, Pallotta JA, Young JB, Firth R, Bell P, Hansen I, Rizza R, Corcoran AE, Smyth PPA, Cranny A, Cullen MJ, O’Brien CJ, Vento S, Cundy T, Eddleston ALWF, Folan J, Gosling JP, Fottrell PF, Finn MM, Stevens AB, McKane WR, Bell PM, King DJ, Hayes JR, Murray DP, Keenan P, Gayer E, Salmon P, Tomkin GH, Drury MI, O’Sullivan DJ. Proceedings of the 12th Annual Meeting of the Irish Endocrine Society, Belfast, October 23rd and 24th 1987. Ir J Med Sci 1988. [DOI: 10.1007/bf02948350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
To determine the contribution of obesity to the insulin resistance of non-insulin-dependent diabetes mellitus, insulin dose response curves for suppression of glucose production and stimulation of glucose utilization were generated in lean and obese diabetic patients and compared to those observed in weight-matched nondiabetic subjects. Glucose utilization during 0.4, 1.0, and 10.0 mU/kg x min insulin infusions (producing insulin concentrations ranging from approximately 50 to 2,000 microU/mL) was lower (p less than .02 to .001) in lean and obese diabetic patients compared to weight-matched nondiabetic subjects indicating insulin resistance. Glucose utilization was not correlated with obesity in the diabetic subjects. Suppression of glucose production was impaired (P less than .03 and .001) in both the lean and obese diabetic subjects at physiologic but not supraphysiologic insulin concentrations. We conclude that patients with NIDDM have both hepatic and extrahepatic insulin resistance, the severity of which appears to be independent of the degree of obesity.
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Affiliation(s)
- R Firth
- Endocrine Research Unit, Mayo Clinic and Foundation, Rochester, MN
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Firth R, Bell P, Marsh M, Rizza RA. Effects of tolazamide and exogenous insulin on pattern of postprandial carbohydrate metabolism in patients with non-insulin-dependent diabetes mellitus. Results of randomized crossover trial. Diabetes 1987; 36:1130-8. [PMID: 3308584 DOI: 10.2337/diab.36.10.1130] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To determine whether therapy with exogenous insulin or sulfonylureas results in a postprandial pattern of carbohydrate metabolism in patients with non-insulin-dependent diabetes mellitus (NIDDM) that resembles that in nondiabetic individuals, we employed a dual-isotope technique combined with forearm catheterization to examine meal disposition in NIDDM patients, before and after 3 mo of therapy with tolazamide and after 3 mo of therapy with exogenous insulin, with a randomized crossover design. Results were compared with those observed in nondiabetic subjects. Although both forms of therapy improved chronic glycemic control (glycosylated hemoglobin concentration went from 9.6 +/- 0.7 to 7.6 +/- 0.5 and 7.1 +/- 0.2%, respectively, P less than .01), exogenous insulin resulted in a lower postprandial glycemic response than tolazamide (P less than .001). Both agents comparably increased (P less than .01) fasting and integrated postprandial insulin concentrations. However, the initial rate of postprandial increase was greater with exogenous insulin (P less than .05). Tolazamide (P less than .05) but not exogenous insulin increased postprandial C-peptide concentrations. However, tolazamide did not improve the deficient early insulin release. Both agents (P less than .05) lowered postabsorptive hepatic glucose release (from 2.8 +/- 0.3 to 2.3 +/- 0.2 mg . kg-1 . min-1), but not to normal rates (1.8 +/- 0.1 mg . kg-1 . min-1).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Firth
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
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Hansen I, Firth R, Haymond M, Cryer P, Rizza R. The role of autoregulation of the hepatic glucose production in man. Response to a physiologic decrement in plasma glucose. Diabetes 1986; 35:186-91. [PMID: 2867944 DOI: 10.2337/diab.35.2.186] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In man, a decrease in plasma glucose concentration results in a compensatory increase in hepatic glucose release. Studies in vitro have suggested that a low glucose concentration per se may directly stimulate hepatic glucose release, an effect often referred to as autoregulation. Whether autoregulation occurs in man in response to a physiologic decrement in blood glucose is not known. Therefore, seven healthy, nonobese subjects were studied on two occasions to determine the role of autoregulation in mediating the increase in glucose production that accompanies a physiologic decrement in plasma glucose concentration. On both occasions, plasma glucose concentrations were clamped successively at 95, 65, and 95 mg/dl for 2 h each. Insulin (approximately 14 microU/ml) and glucagon (approximately 70 pg/ml) were maintained constant on both occasions by an infusion of somatostatin and insulin. Phentolamine and propranolol also were infused on one occasion to produce combined alpha- and beta-adrenergic blockade. In the absence of adrenergic blockade, glucose production increased by approximately 1.3 mg/kg X min when the plasma glucose concentration was decreased from 95 to 65 mg/dl and decreased by approximately 1.5 mg/kg X min when glucose was increased from 65 to 95 mg/dl. In the presence of adrenergic blockade, the increase and decrease in glucose production averaged 0 and 0.5 mg/kg X min, respectively, representing 70-100% inhibition. We conclude that, in the presence of low physiologic insulin concentrations, autoregulation is not a major contributor to the hepatic response to a physiologic decrement in plasma glucose concentration in man.
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Broadbridge AT, Bayliss SG, Firth R, Farrell G. Visual evoked response changes following intrathecal injection of water-soluble contrast media: A possible method of assessing neurotoxicity and a comparison of metrizamide and iopamidol. Clin Radiol 1984; 35:371-3. [PMID: 6547888 DOI: 10.1016/s0009-9260(84)80187-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An investigation was carried out to ascertain if there was a change in visual evoked responses following the intrathecal injection of water-soluble contrast media for myeloradiculography and if this change provided an indication of neurotoxicity as assessed by the onset of headache during a period of 20 h following the radiological examination. The patients were unselected and examined, when facilities for measuring the visual evoked response were available, immediately before and at 1 and 20 h after the examination. Control readings were carried out before, 1 h and 20 h after lumbar puncture in patients who did not have an injection of contrast medium. The first 25 patients in the series received metrizamide; when iopamidol became available a change to the newer medium was made and iopamidol was used on all subsequent patients. All the injections were carried out by the same radiologist and the patients were kept in hospital overnight and interviewed the next morning, avoiding a specific reference to headache unless the patient denied all symptoms. It was found that the latency of the visual evoked response was affected in some cases by the presence of contrast medium in the cerebrospinal fluid and that there was a correlation between the severity of headaches and the delay in the visual evoked response at the 20 h post-myelogram measurement, but not at 1 h after the examination. It would appear, therefore, that the visual evoked response measurement is a valid method of assessing, in the short term, the neurotoxicity of intrathecal water-soluble contrast media and that, on this evidence, iopamidol is less neurotoxic than metrizamide. We are not aware of any long-term complications resulting from the use of either contrast medium.
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Abstract
A family having two affected siblings with congenital dyserythropoietic anaemia type II (HEMPAS) is described. The proband was diagnosed after referral for investigation of haemolytic anaemia. Clinical evaluation and in vivo red cell (RBC) survival and the sequestration studies in the proband indicated that the anaemia was due to a combination of ineffective erythropoiesis and premature destruction of RBCs in the spleen. Scanning electron microscopic examination of peripheral RBCs was undertaken and is reported. The polypeptide composition of RBC membranes was also examined using polyacrylamide gel electrophoresis after solubilisation in sodium dodecyl sulphate. These results are also reported.
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MESH Headings
- Anemia, Dyserythropoietic, Congenital/blood
- Anemia, Dyserythropoietic, Congenital/genetics
- Anemia, Hemolytic, Congenital/genetics
- Child
- Electrophoresis, Polyacrylamide Gel
- Erythrocyte Aging
- Erythrocyte Membrane/analysis
- Erythrocytes, Abnormal/pathology
- Humans
- Male
- Membrane Proteins/analysis
- Microscopy, Electron, Scanning
- Pedigree
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Firth R. Medical sociology and anthropology: a necessary dialogue. Soc Sci Med 1978; 12:235. [PMID: 741228 DOI: 10.1016/0160-7987(78)90039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Firth R, Storrie J. Measuring the arm of a social services department. Health Soc Serv J 1978; 88:637-8. [PMID: 10307525] [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: 04/13/2023]
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Abstract
A good deal of the best-known work on the relationships between the sexes among humans has concentrated mainly on two aspects of this subject: either the physical or the psychological implications of sexual interaction have been quite widely discussed in literature easily available and often popularly presented. Without wishing to minimize the importance in its time of the work of Alfred Kinsey and his colleagues, one cannot help feeling, as Richards (1969) has recently observed in this journal, that since all primates copulate in much the same way, one is not going to achieve great insights by examining this in much detail. It is the humanity, not the animality, of man which provides the most significant part of his behaviour in this field. No one can write on this theme without paying due tribute to the work of Margaret Mead (1950), but much of it has concentrated on looking at ways in which upbringing in different societies makes people feel differently about their male and female roles.
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Abstract
In view of the drawbacks in the use of the Kahn test for large-scale screening of blood donors, mainly those of human error through work overload and fatiguability, an attempt was made to adapt an existing automated complement-fixation technique for this purpose. This paper reports the successful results of that adaptation.
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