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McCall SJ, Bonnet MP, Äyräs O, Vandenberghe G, Gissler M, Zhang WH, Van Leeuw V, Deneux-Tharaux C, Kurinczuk JJ, Knight M. Anaphylaxis in pregnancy: a population-based multinational European study. Anaesthesia 2020; 75:1469-1475. [PMID: 32463487 DOI: 10.1111/anae.15069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 02/06/2023]
Abstract
Anaphylaxis in pregnancy is a rare but severe complication for both mother and infant. Population-based data on anaphylaxis in pregnancy are lacking from mainland European countries. This multinational study presents the incidence, causative agents, management and maternal and infant outcomes of anaphylaxis in pregnancy. This descriptive multinational study used a combination of retrospective (Finnish medical registries) and prospective population-based studies (UK, France, Belgium and the Netherlands) to identify cases of anaphylaxis. Sixty-five cases were identified among 4,446,120 maternities (1.5 per 100,000 maternities; 95%CI 1.1-1.9). The incidence did not vary between countries. Approximately three-quarters of reactions occurred at the time of delivery. The most common causes were antibiotics in 27 women (43%), and anaesthetic agents in 11 women (17%; including neuromuscular blocking drugs, 7), which varied between countries. Anaphylaxis had very poor outcomes for one in seven mothers and one in seven babies; the maternal case fatality rate was 3.2% (95%CI 0.4-11.0) and the neonatal encephalopathy rate was 14.3% (95%CI 4.8-30.3). Across Europe, anaphylaxis related to pregnancy is rare despite having a multitude of causative agents and different antibiotic prophylaxis protocols.
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Affiliation(s)
- S J McCall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK.,Center for Research on Population and Health, American University of Beirut, Lebanon
| | - M-P Bonnet
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOPé, INSERM U1153, Paris, France.,Department of Anesthesiology and Critical Care, Hôpital Armand Trousseau, Assistance Publique des Hôpitaux de Paris, France.,Société Française d'Anesthésie et de Réanimation Research Network, Paris, France
| | - O Äyräs
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - G Vandenberghe
- Department of Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - M Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - W-H Zhang
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research Laboratory for Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - V Van Leeuw
- Perinatal Epidemiology Center (CEpiP), Brussels, Belgium
| | - C Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOPé, INSERM U1153, Paris, France
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - M Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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McCall SJ, Bunch KJ, Brocklehurst P, D'Arcy R, Hinshaw K, Kurinczuk JJ, Lucas DN, Stenson B, Tuffnell DJ, Knight M. The incidence, characteristics, management and outcomes of anaphylaxis in pregnancy: a population-based descriptive study. BJOG 2018; 125:965-971. [PMID: 29193647 PMCID: PMC6033185 DOI: 10.1111/1471-0528.15041] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to estimate the incidence of anaphylaxis in pregnancy and describe the management and outcomes in the UK. DESIGN A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS). SETTING All consultant-led maternity units in the UK. POPULATION All pregnant women who had anaphylaxis between 1 October 2012 and 30 September 2015. Anaphylaxis was defined as a severe, life-threatening generalised or systemic hypersensitivity reaction. METHODS Prospective case notification using UKOSS. MAIN OUTCOME MEASURES Maternal mortality, severe maternal morbidity, neonatal mortality and severe neonatal morbidity. RESULTS There were 37 confirmed cases of anaphylaxis in pregnancy, giving an estimated incidence of 1.6 (95% CI: 1.1-2.2) per 100 000 maternities. Four cases of anaphylaxis were in women with known penicillin allergies: two received co-amoxiclav and two cephalosporins. Twelve women had anaphylaxis following prophylactic use of antibiotics at the time of a caesarean delivery. Prophylactic use of antibiotics for Group B streptococcal infection accounted for anaphylaxis in one woman. Two women died (5%), 14 (38%) women were admitted to intensive care and seven women (19%) had one or more additional severe maternal morbidities, which included three haemorrhagic events, two cardiac arrests, one thrombotic event and one pneumonia. No infants died; however, in those infants whose mother had anaphylaxis before delivery (n = 18) there were seven (41%) neonatal intensive care unit admissions, three preterm births and one baby was cooled for neonatal encephalopathy. CONCLUSIONS Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration. This study highlights the seriousness of the outcomes of this condition for the mother. The low incidence is reassuring given the large proportion of the pregnant population that receive prophylactic antibiotics during delivery. TWEETABLE ABSTRACT Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration.
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Affiliation(s)
- SJ McCall
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - KJ Bunch
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - P Brocklehurst
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Birmingham Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | - R D'Arcy
- Nuffield Department of Obstetrics and GynaecologyJohn Radcliffe HospitalUniversity of OxfordOxfordUK
| | - K Hinshaw
- Department of Obstetrics and GynaecologySunderland Royal HospitalSunderlandUK
| | - JJ Kurinczuk
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - DN Lucas
- Department of AnaestheticsNorthwick Park HospitalLondonUK
| | - B Stenson
- Neonatal UnitRoyal Infirmary of EdinburghEdinburghUK
| | - DJ Tuffnell
- Teaching Hospitals Foundation NHS TrustBradfordUK
| | - M Knight
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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Siena S, Sartore-Bianchi A, Marsoni S, Hurwitz HI, McCall SJ, Penault-Llorca F, Srock S, Bardelli A, Trusolino L. Targeting the human epidermal growth factor receptor 2 (HER2) oncogene in colorectal cancer. Ann Oncol 2018; 29:1108-1119. [PMID: 29659677 PMCID: PMC5961091 DOI: 10.1093/annonc/mdy100] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) is an oncogenic driver, and a well-established therapeutic target in breast and gastric cancers. Using functional and genomic analyses of patient-derived xenografts, we previously showed that a subset (approximately 5%) of metastatic colorectal cancer (CRC) tumors is driven by amplification or mutation of HER2. This paper reviews the role of HER2 amplification as an oncogenic driver, a prognostic and predictive biomarker, and a clinically actionable target in CRC, considering the specifics of HER2 testing in this tumor type. While the role of HER2 as a biomarker for prognosis in CRC remains uncertain, its relevance as a therapeutic target has been established. Indeed, independent studies documented substantial clinical benefit in patients treated with biomarker-driven HER2-targeted therapies, with an impact on response rates and duration of response that compared favorably with immunotherapy and other examples of precision oncology. HER2-targeted therapeutic strategies have the potential to change the treatment paradigm for a clinically relevant subgroup of metastatic CRC patients.
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MESH Headings
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Biopsy
- Chemotherapy, Adjuvant/methods
- Clinical Trials as Topic
- Colorectal Neoplasms/genetics
- Colorectal Neoplasms/mortality
- Colorectal Neoplasms/pathology
- Colorectal Neoplasms/therapy
- Disease-Free Survival
- Gene Amplification
- Genetic Testing
- Humans
- Molecular Targeted Therapy/methods
- Neoadjuvant Therapy/methods
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Precision Medicine/methods
- Prognosis
- Progression-Free Survival
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/antagonists & inhibitors
- Receptor, ErbB-2/genetics
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Affiliation(s)
- S Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan.
| | - A Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan
| | - S Marsoni
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan; Precision Oncology, IFOM - The FIRC Institute of Molecular Oncology, Milan, Italy
| | - H I Hurwitz
- Duke Cancer Institute, Duke University School of Medicine, Durham, USA
| | - S J McCall
- Duke Cancer Institute, Duke University School of Medicine, Durham, USA
| | - F Penault-Llorca
- Department of Surgical Pathology, Jean-Perrin Comprehensive Cancer Centre, UMR INSERM 1240, University Clermont Auvergne, Clermont-Ferrand, France
| | - S Srock
- Global Product Development Medical Affairs, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - A Bardelli
- Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Turin; Department of Oncology, University of Torino, Turin, Italy
| | - L Trusolino
- Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Turin; Department of Oncology, University of Torino, Turin, Italy
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Abstract
OBJECTIVE This study aimed to examine the factors associated with maternal mortality among women aged ≥35 years. DESIGN Unmatched population based case-control study. SETTING United Kingdom. POPULATION Between 2009 and 2012, 105 cases of maternal deaths aged ≥35 years were extracted from the surveillance database of the MBRRACE-UK confidential enquiries into maternal deaths in the UK. In addition, 766 controls aged ≥35 years were identified from the UK Obstetric Surveillance System (2005-2012). METHODS Risk factors known to be associated with maternal mortality and morbidity and for which data were available were examined for their association with maternal mortality among women ≥35 years using logistic regression analysis. MAIN OUTCOME MEASURES Odds ratios and 95% confidence intervals associated with maternal death. RESULTS Five factors were found to be significantly associated with increased odds of death among women aged ≥35 years: smoking during pregnancy (adjusted odds ratio (aOR) 2.06, 95% CI 1.13-3.75), inadequate use of antenatal care (aOR 23.62, 95% CI 8.79-63.45), medical co-morbidities (aOR 5.92, 95% CI 3.56-9.86) and previous pregnancy problems (aOR 2.06, 95% CI 1.23-3.45). The odds associated with death increased by 12% per year increase in age (aOR 1.12, 95% CI 1.02-1.22). CONCLUSION Age was associated with maternal mortality even after adjusting for other known risk factors. Importantly, this study showed an association between maternal mortality and smoking among women aged 35 years or older. It emphasises the importance of public health action to reduce smoking levels and address trends in rising maternal age. TWEETABLE ABSTRACT Smoking is a risk factor for maternal death for those aged over 35 years.
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Affiliation(s)
- SJ McCall
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - M Nair
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - M Knight
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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Adekunle-Olarinde IR, McCall SJ, Barlas RS, Wood AD, Clark AB, Bettencourt-Silva JH, Metcalf AK, Bowles KM, Soiza RL, Potter JF, Myint PK. Addition of sodium criterion to SOAR stroke score. Acta Neurol Scand 2017; 135:553-559. [PMID: 27397108 DOI: 10.1111/ane.12634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine the usefulness of including sodium (Na) levels as a criterion to the SOAR stroke score in predicting inpatient and 7-day mortality in stroke. MATERIALS AND METHODS Data from the Norfolk and Norwich University Hospital Stroke & TIA register (2003-2015) were analysed. Univariate and then multivariate models controlling for SOAR variables were used to assess the association between admission sodium levels and inpatient and 7-day mortality. The prognostic ability of the SOAR and SOAR Na scores for mortality outcomes at both time points were then compared using the Area Under the Curve (AUC) values from the Receiver Operating Characteristic curves. RESULTS A total of 8493 cases were included (male=47.4%, mean (SD) 77.7 (11.6) years). Compared with normonatremia (135-145 mmol/L), hypernatraemia (>145 mmol/L) was associated with inpatient mortality and moderate (125-129 mmol/L) and severe hypontraemia (<125 mmol/L) with 7-day mortality after adjustment for stroke type, Oxfordshire Community Stroke Project classification, age, prestroke modified Rankin score and sex. The SOAR and SOAR-Na scores both performed well in predicting inpatient mortality with AUC values of .794 (.78-.81) and .796 (.78-.81), respectively. 7-day mortality showed similar results. Both scores were less predictive in those with chronic kidney disease (CKD) and more so in those with hypoglycaemia. CONCLUSION The SOAR-Na did not perform considerably better than the SOAR stroke score. However, the performance of SOAR-Na in those with CKD and dysglycaemias requires further investigation.
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Affiliation(s)
- I. R. Adekunle-Olarinde
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - S. J. McCall
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
- Nuffield Department of Population Health; University of Oxford; Oxford UK
| | - R. S. Barlas
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - A. D. Wood
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - A. B. Clark
- Norwich Medical School; University of East Anglia; Norwich UK
| | - J. H. Bettencourt-Silva
- Clinical Informatics; Department of Medicine; University of Cambridge; Cambridge UK
- Norfolk and Norwich University Hospital; Norwich UK
| | | | - K. M. Bowles
- Norwich Medical School; University of East Anglia; Norwich UK
- Norfolk and Norwich University Hospital; Norwich UK
| | - R. L. Soiza
- Health Services Research Unit; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
- Academic Department of Medicine for the Elderly; Aberdeen Royal Infirmary; NHS Grampian; Aberdeen UK
| | - J. F. Potter
- Norwich Medical School; University of East Anglia; Norwich UK
- Norfolk and Norwich University Hospital; Norwich UK
| | - P. K. Myint
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
- Academic Department of Medicine for the Elderly; Aberdeen Royal Infirmary; NHS Grampian; Aberdeen UK
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McCall SJ, Nur Ibrahim U, Imamura M, Okpo E, Flett G, Bhattacharya S. PP25 Exploring the determinant factors for repeat abortion: A systematic review. J Epidemiol Community Health 2014. [DOI: 10.1136/jech-2014-204726.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bowes MJ, Ings NL, McCall SJ, Warwick A, Barrett C, Wickham HD, Harman SA, Armstrong LK, Scarlett PM, Roberts C, Lehmann K, Singer AC. Nutrient and light limitation of periphyton in the River Thames: implications for catchment management. Sci Total Environ 2012; 434:201-12. [PMID: 22035560 DOI: 10.1016/j.scitotenv.2011.09.082] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/01/2011] [Accepted: 09/07/2011] [Indexed: 05/07/2023]
Abstract
Soluble reactive phosphorus (SRP) concentrations in the River Thames, south east England, have significantly decreased from an annual maximum of 2100 μg l(-1) in 1997 to 344 in 2010, primarily due to the introduction of phosphorus (P) removal at sewage treatment works within the catchment. However, despite this improvement in water quality, phytoplankton biomass in the River Thames has greatly increased in recent years, with peak chlorophyll concentrations increasing from 87 μg l(-1) in the period 1997 to 2002, to 328 μg l(-1) in 2009. A series of within-river flume mesocosm experiments were performed to determine the effect of changing nutrient concentrations and light levels on periphyton biomass accrual. Nutrient enrichment experiments showed that phosphorus, nitrogen and silicon were not limiting or co-limiting periphyton growth in the Thames at the time of the experiment (August-September 2010). Decreasing ambient SRP concentration from 225 μg l(-1) to 173 μg l(-1) had no effect on periphyton biomass accrual rate or diatom assemblage. Phosphorus limitation became apparent at 83 μg SRP l(-1), at which point a 25% reduction in periphyton biomass was observed. Diatom assemblage significantly changed when the SRP concentration was reduced to 30 μg l(-1). Such stringent phosphorus targets are costly and difficult to achieve for the River Thames, due to the high population density and intensive agriculture within the Thames basin. Reducing light levels by shading reduced the periphyton accrual rate by 50%. Providing shading along the River Thames by planting riparian tree cover could be an effective measure to reduce the risk of excessive algal growth. If the ecology of the Thames is to reach the WFD's "good ecological status", then both SRP concentration reductions (probably to below 100 μg l(-1)) and increased shading will be required.
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Affiliation(s)
- M J Bowes
- Centre for Ecology and Hydrology, Crowmarsh Gifford, Wallingford, Oxfordshire, UK.
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