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Yong PFK, Coulter T, El-Shanawany T, Garcez T, Hackett S, Jain R, Kiani-Alikhan S, Manson A, Noorani S, Stroud C, Symons C, Sargur R, Steele C, Alachkar H, Anantharachagan A, Arkwright PD, Bernatoniene J, Bhole M, Brown L, Buckland M, Burns S, Chopra C, Darroch J, Drewe E, Edmonds J, Ekbote A, Elkhalifa S, Goddard S, Grosse-Kreul D, Gurugama P, Hague R, Herriot R, Herwadkar A, Hughes SM, Jones L, Lear S, McDermott E, Kham Murng SH, Price A, Redenbaugh V, Richter A, Riordan A, Shackley F, Stichbury J, Springett D, Tarzi MD, Thomas M, Vijayadurai P, Worth A. A National Survey of Hereditary Angioedema and Acquired C1 Inhibitor Deficiency in the United Kingdom. J Allergy Clin Immunol Pract 2023; 11:2476-2483. [PMID: 37146882 DOI: 10.1016/j.jaip.2023.04.035] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Detailed demographic data on people with hereditary angioedema (HAE) and acquired C1 inhibitor deficiency in the United Kingdom are relatively limited. Better demographic data would be beneficial in planning service provision, identifying areas of improvement, and improving care. OBJECTIVE To obtain more accurate data on the demographics of HAE and acquired C1 inhibitor deficiency in the United Kingdom, including treatment modalities and services available to patients. METHODS A survey was distributed to all centers in the United Kingdom that look after patients with HAE and acquired C1 inhibitor deficiency to collect these data. RESULTS The survey identified 1152 patients with HAE-1/2 (58% female and 92% type 1), 22 patients with HAE with normal C1 inhibitor, and 91 patients with acquired C1 inhibitor deficiency. Data were provided by 37 centers across the United Kingdom. This gives a minimum prevalence of 1:59,000 for HAE-1/2 and 1:734,000 for acquired C1 inhibitor deficiency in the United Kingdom. A total of 45% of patients with HAE were on long-term prophylaxis (LTP) with the most used medication being danazol (55% of all patients on LTP). Eighty-two percent of patients with HAE had a home supply of acute treatment with C1 inhibitor or icatibant. A total of 45% of patients had a supply of icatibant and 56% had a supply of C1 inhibitor at home. CONCLUSIONS Data obtained from the survey provide useful information about the demographics and treatment modalities used in HAE and acquired C1 inhibitor deficiency in the United Kingdom. These data are useful for planning service provision and improving services for these patients.
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Affiliation(s)
- Patrick F K Yong
- Department of Allergy and Clinical Immunology, Frimley Health NHS Foundation Trust, Frimley, United Kingdom.
| | - Tanya Coulter
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Tariq El-Shanawany
- Department of Immunology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Tomaz Garcez
- Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Scott Hackett
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rashmi Jain
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Ania Manson
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sadia Noorani
- Department of Immunology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Catherine Stroud
- Regional Department of Immunology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Christine Symons
- Department of Clinical Immunology and Allergy, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Ravishankar Sargur
- Department of Clinical Immunology and Allergy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Cathal Steele
- Department of Clinical Immunology, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Hana Alachkar
- Department of Immunology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Ariharan Anantharachagan
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Peter D Arkwright
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Jolanta Bernatoniene
- Department of Paediatric Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Malini Bhole
- Department of Immunology, The Dudley Group NHS Foundation Trust, Dudley, United Kingdom
| | - Lindsay Brown
- Department of Immunology and infectious Diseases, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | - Matthew Buckland
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Siobhan Burns
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Charu Chopra
- Department of Clinical Immunology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - James Darroch
- Department of Immunology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Elizabeth Drewe
- Department of Clinical Immunology and Allergy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jillian Edmonds
- Department of Clinical Immunology, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Anjali Ekbote
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Shuayb Elkhalifa
- Department of Clinical Immunology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Goddard
- Department of Clinical Immunology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Dorothea Grosse-Kreul
- Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Padmalal Gurugama
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rosie Hague
- Department of Paediatric Immunology and Infectious Diseases, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Richard Herriot
- Department of Immunology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Archana Herwadkar
- Department of Clinical Immunology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen M Hughes
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Laura Jones
- Department of Immunology and infectious Diseases, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | - Sara Lear
- Department of Clinical Immunology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Elizabeth McDermott
- Department of Clinical Immunology and Allergy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Sai Hurng Kham Murng
- Department of Clinical Immunology, Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Arthur Price
- Department of Clinical Immunology and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Vyanka Redenbaugh
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Alex Richter
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Riordan
- Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Fiona Shackley
- Department of Immunology and Infectious Diseases, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Julia Stichbury
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Debbie Springett
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michael D Tarzi
- Department of Immunology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Moira Thomas
- Department of Clinical Immunology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Pavaladurai Vijayadurai
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Austen Worth
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Ahuja M, Dorr A, Bode E, Boulton APR, Buckland M, Chee S, Dalley C, Denman S, Ekbote A, Elkhalifa S, El-Shanawany T, Eren E, Herwadkar A, Garcez T, Ghanta H, Grammatikos A, Grigoriadou S, Jain R, Lorenzo L, Manson A, Moon E, Murng S, Murphy A, Mutlu L, Peters N, Sooriyakumar K, Stroud C, Townsend K, Yellon RL, Yong P, Kiani-Alikhan S. Berotralstat for the prophylaxis of hereditary angioedema-Real-world evidence data from the United Kingdom. Allergy 2023; 78:1380-1383. [PMID: 36609839 DOI: 10.1111/all.15641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Manisha Ahuja
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | | | | | | | | | - Samuel Chee
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - Anjali Ekbote
- University Hospitals Birmingham NHSFT, Birmingham, UK
| | | | | | - Efrem Eren
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Tomaz Garcez
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | | | | | | | - Ania Manson
- Cambridge University Hospitals NHSFT, Cambridge, UK
| | - Emily Moon
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Sai Murng
- St Helier University Hospitals, Carshalton, Morden, UK
| | | | - Leman Mutlu
- University Hospitals Birmingham NHSFT, Birmingham, UK
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Shields AM, Anantharachagan A, Arumugakani G, Baker K, Bahal S, Baxendale H, Bermingham W, Bhole M, Boules E, Bright P, Chopra C, Cliffe L, Cleave B, Dempster J, Devlin L, Dhalla F, Diwakar L, Drewe E, Duncan C, Dziadzio M, Elcombe S, Elkhalifa S, Gennery A, Ghanta H, Goddard S, Grigoriadou S, Hackett S, Hayman G, Herriot R, Herwadkar A, Huissoon A, Jain R, Jolles S, Johnston S, Khan S, Laffan J, Lane P, Leeman L, Lowe DM, Mahabir S, Lochlainn DJM, McDermott E, Misbah S, Moghaddas F, Morsi H, Murng S, Noorani S, O'Brien R, Patel S, Price A, Rahman T, Seneviratne S, Shrimpton A, Stroud C, Thomas M, Townsend K, Vaitla P, Verma N, Williams A, Burns SO, Savic S, Richter AG. Outcomes following SARS-CoV-2 infection in patients with primary and secondary immunodeficiency in the UK. Clin Exp Immunol 2022; 209:247-258. [PMID: 35641155 PMCID: PMC8807296 DOI: 10.1093/cei/uxac008] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/16/2021] [Accepted: 01/25/2022] [Indexed: 12/29/2022] Open
Abstract
In March 2020, the United Kingdom Primary Immunodeficiency Network (UKPIN) established a registry of cases to collate the outcomes of individuals with PID and SID following SARS-CoV-2 infection and treatment. A total of 310 cases of SARS-CoV-2 infection in individuals with PID or SID have now been reported in the UK. The overall mortality within the cohort was 17.7% (n = 55/310). Individuals with CVID demonstrated an infection fatality rate (IFR) of 18.3% (n = 17/93), individuals with PID receiving IgRT had an IFR of 16.3% (n = 26/159) and individuals with SID, an IFR of 27.2% (n = 25/92). Individuals with PID and SID had higher inpatient mortality and died at a younger age than the general population. Increasing age, low pre-SARS-CoV-2 infection lymphocyte count and the presence of common co-morbidities increased the risk of mortality in PID. Access to specific COVID-19 treatments in this cohort was limited: only 22.9% (n = 33/144) of patients admitted to the hospital received dexamethasone, remdesivir, an anti-SARS-CoV-2 antibody-based therapeutic (e.g. REGN-COV2 or convalescent plasma) or tocilizumab as a monotherapy or in combination. Dexamethasone, remdesivir, and anti-SARS-CoV-2 antibody-based therapeutics appeared efficacious in PID and SID. Compared to the general population, individuals with PID or SID are at high risk of mortality following SARS-CoV-2 infection. Increasing age, low baseline lymphocyte count, and the presence of co-morbidities are additional risk factors for poor outcome in this cohort.
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Affiliation(s)
- Adrian M Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | | | - Gururaj Arumugakani
- Department of Clinical Immunology and Allergy, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Kenneth Baker
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sameer Bahal
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | | | | | - Malini Bhole
- The Dudley Group NHS Foundation Trust, Birmingham, UK
| | - Evon Boules
- Clinical Immunology and Allergy Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Philip Bright
- Clinical Immunology, North Bristol NHS Trust, Bristol, UK
| | - Charu Chopra
- Department of Haematology & Immunology, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Lucy Cliffe
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Betsy Cleave
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - John Dempster
- Specialist Allergy and Clinical Immunology, University College London Hospitals, London, UK
| | - Lisa Devlin
- Regional Immunology Service, The Royal Hospitals, Belfast, UK
| | - Fatima Dhalla
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lavanya Diwakar
- Department of Immunology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Elizabeth Drewe
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Christopher Duncan
- Translational and Clinical Research Institute, Immunity and Inflammation Theme, Newcastle University, Newcastle upon Tyne, UK
| | | | - Suzanne Elcombe
- Regional Department of Clinical Immunology & Allergy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Shuayb Elkhalifa
- Immunology Department, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew Gennery
- Translational and Clinical Research Institute, Newcastle University, and Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Harichandrana Ghanta
- Department of Allergy and Clinical Immunology, University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Sarah Goddard
- Department of Immunology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Sofia Grigoriadou
- Immunology Department, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Scott Hackett
- Paediatric Immunology Department, University Hospitals of Birmingham, Birmingham, UK
| | - Grant Hayman
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Richard Herriot
- Immunology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Archana Herwadkar
- Immunology Department, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Aarnoud Huissoon
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rashmi Jain
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Sarah Johnston
- Clinical Immunology, North Bristol NHS Trust, Bristol, UK
| | - Sujoy Khan
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - James Laffan
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Peter Lane
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Lucy Leeman
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David M Lowe
- Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Shanti Mahabir
- Clinical Immunology and Allergy Department, Leicester Royal Infirmary, Leicester, UK
| | | | - Elizabeth McDermott
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Siraj Misbah
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Hadeil Morsi
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sai Murng
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Sadia Noorani
- Clinical Immunology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Rachael O'Brien
- Department of Clinical Immunology, Frimley Park Hospital, Frimley, Surrey, UK
| | - Smita Patel
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Arthur Price
- Clinical Immunology and Allergy Department, Leicester Royal Infirmary, Leicester, UK
| | - Tasneem Rahman
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | | | - Anna Shrimpton
- Clinical Immunology and Allergy Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Catherine Stroud
- Regional Department of Clinical Immunology & Allergy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Moira Thomas
- Clinical Immunology Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Katie Townsend
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Prashantha Vaitla
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Nisha Verma
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Anthony Williams
- Department of Allergy and Clinical Immunology, University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
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Morsi H, Grammatikos A, Steele C, Stroud C, Chopra C, Eren E, Moon E, Hayman G, Ghanta H, Bourne H, Dempster J, Townsend K, Ahuja M, Frleta-Gilchrist M, Zhang M, Thomas M, Herriot R, Murng S, Drinkwater S, Elcombe S, Coulter T, El-shanawany T, Garcez T, Yong P, Jain R. A Multicentre UK-Based Audit on Acquired C1 Inhibitor Deficiency 2021. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.557] [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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Weightman J, Griffiths B, Pandit R, Stroud C, Price AD, Lorenzi AR. P15 An audit of the management of Behçet's disease in a tertiary referral centre against guidelines from EULAR and the National Centres of Excellence. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.014] [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] Open
Abstract
Abstract
Background
BD patients are managed equivalently by multiple medical specialties in our trust. Failure to switch from IV to s/c antiTNFalpha therapies was noted and our use of methotrexate, hydroxychloroquine and cyclophosphamide deviates from guidelines. Whether this effects outcome is unknown it but seems likely to be considered clinically useful. A national audit would determine if our management is an anomaly or in keeping with standard practice in the UK prompting review of our treatment algorithm.
Methods
Involved specialities provided details of BD patients in their care. Electronic case records from January 2009 to July 2019 were reviewed. Data were extracted using standard pro-forma classifying patients into 3 groups determined by their most severe manifestation: less severe (predominant musculoskeletal, mucocutaneous); ophthalmic (all eye disease) and severe disease (predominant CNS and vascular disease). Medication was assessed against guidelines for escalation and de-escalation protocols.
Results
50 patients (representing approximately 7% of the national BD population) were identified from 4 specialties (Table 1). 23 were female; 45 identified as White British. 26 were regularly reviewed by 2 or more specialties, 4 had discontinued follow up. 26/50 had used antiTNFalpha therapies and 9/50 had received IV cyclophosphamide. Adherence to guidelines was determined by specialty and disease severity (Table 1). The EULAR guideline was followed least well by Rheumatology; low rates of adherence to the national guideline reflected frequent use of methotrexate and hydroxychloroquine in the less severe group and failure to switch to from IV to sub-cutaneous antiTNFalpha therapies. Deviations from national and EULAR guidelines in the ‘severe’ category related to the first line use of IV cyclophosphamide for acute organ/sight threatening disease.
Conclusion
BD patients are managed equivalently by multiple medical specialties in our Trust. Failure to switch from IV to s/c antiTNFalpha therapies was noted and our use of methotrexate, hydroxychloroquine and cyclophosphamide deviates from guidelines. Whether this effects outcome is unknown it but seems likely to be considered clinically useful. A national audit would determine if our management is an anomaly or in keeping with standard practice in the UK prompting review of our treatment algorithm.
Disclosures
J. Weightman None. B. Griffiths None. R. Pandit None. C. Stroud None. A.D. Price None. A.R. Lorenzi None.
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Affiliation(s)
- Jessica Weightman
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Rheumatology, Newcastle Upon Tyne, UNITED KINGDOM
| | - Bridget Griffiths
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Rheumatology, Newcastle Upon Tyne, UNITED KINGDOM
| | - Ranjeet Pandit
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Medical Ophthalmology, Newcastle Upon Tyne, UNITED KINGDOM
| | - Catherine Stroud
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Immunology, Newcastle Upon Tyne, UNITED KINGDOM
| | - Ashleigh D Price
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Infectious Diseases, Newcastle Upon Tyne, UNITED KINGDOM
| | - Alice R Lorenzi
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Rheumatology, Newcastle Upon Tyne, UNITED KINGDOM
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Bryan BA, Battersby A, Shillitoe BMJ, Barge D, Bourne H, Flood T, Cant AJ, Stroud C, Gennery AR. Respiratory Health and Related Quality of Life in Patients with Congenital Agammaglobulinemia in the Northern Region of the UK. J Clin Immunol 2016; 36:472-9. [PMID: 27091141 PMCID: PMC4896978 DOI: 10.1007/s10875-016-0284-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/05/2016] [Indexed: 11/23/2022]
Abstract
Introduction Patients with congenital agammaglobulinemia, characterized by a defect in B lymphocyte differentiation causing B alymphocytosis, require life-long IgG replacement. There is scant literature regarding the effectiveness of IgG treatment at preventing mucosal (particularly sinopulmonary tract) infection and whether current management adequately restores “normal” health and quality of life (QoL). We aimed to document infective episodes pre- and post-commencing IgG replacement, determine any change in lung function and structure and assess respiratory status and QoL in a cohort of patients treated in Newcastle. Methods Clinical data were extracted from medical records of 15 patients identified from the immunology database, focusing on infective episodes, serial chest CT and spirometry results. Thirteen patients completed a selection of standardized and validated questionnaires assessing physical health, respiratory health and QoL. Results Pediatric patients on IgG therapy suffered fewer infections per patient year (0.74) than adults (2.13). 6/14 patients showed deteriorating respiratory status despite adequate therapy. Health questionnaires revealed a significant burden of respiratory disease on a patient’s life. Conclusion Clinical data showed patients with congenital agammaglobulinemia receiving immunoglobulin therapy retained a higher than average infection rate, most of which affected mucosal barriers. Most patients self-reported worse respiratory symptoms, a lower respiratory-related QoL and a lower general health QoL relative to a healthy population. Most participants had progressive structural lung damage and decreased lung function. These results suggest that current management is not entirely effective at preventing deterioration of respiratory health or restoring QoL.
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Affiliation(s)
- Branwen A Bryan
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Medical School, Framlington Place, Newcastle upon Tyne, E2 4HH, UK
| | - Alex Battersby
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Medical School, Framlington Place, Newcastle upon Tyne, E2 4HH, UK
| | - Benjamin Martin James Shillitoe
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Medical School, Framlington Place, Newcastle upon Tyne, E2 4HH, UK
| | - Dawn Barge
- Paediatric Immunology, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Helen Bourne
- Paediatric Immunology, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Terry Flood
- Paediatric Immunology, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Andrew J Cant
- Paediatric Immunology, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Catherine Stroud
- Paediatric Immunology, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Andrew R Gennery
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Medical School, Framlington Place, Newcastle upon Tyne, E2 4HH, UK. .,Great North Children's Hospital, Clinical Resource Building, Level 4, Block 2, Newcastle upon Tyne, NE1 4LP, UK.
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Saleh A, Hurst J, Davison J, Stroud C, Lowe D, De Soyza A. P79 Bronchiectasis Severity In Primary Immunodeficiency - A Two Centre Study. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.220] [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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Greenwood M, Meechan JG, Stroud C. General medicine and surgery for dental practitioners: part 5. Immunological disease and dental practice. Br Dent J 2014; 217:129-32. [DOI: 10.1038/sj.bdj.2014.647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 11/09/2022]
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Abstract
This review looks at the main issues around immediate hypersensitivity and the role and limitations of testing. The majority of literature on antibiotic hypersensitivity relates to β-lactam antibiotics, mainly because of the heavy usage of this class of drugs. Concerns around cross-reactivity always worry clinicians, particularly in the emergency situation. Reasonable data now exist in relation to β-lactam antibiotics and derivatives, which enable appropriate risk management to be undertaken. The available literature for other classes of antibiotics is also discussed.
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Affiliation(s)
- Andrew McLean-Tooke
- Department of Immunology, Fremantle Hospital and PathWest Laboratory Medicine, Fremantle, Perth, Australia.
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Liggio J, Li SM, Vlasenko A, Sjostedt S, Chang R, Shantz N, Abbatt J, Slowik JG, Bottenheim JW, Brickell PC, Stroud C, Leaitch WR. Primary and secondary organic aerosols in urban air masses intercepted at a rural site. ACTA ACUST UNITED AC 2010. [DOI: 10.1029/2010jd014426] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Park SH, Gong SL, Zhao TL, Vet RJ, Bouchet VS, Gong W, Makar PA, Moran MD, Stroud C, Zhang J. Simulation of entrainment and transport of dust particles within North America in April 2001 (“Red Dust Episode”). ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2007jd008443] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Tarasick DW, Moran MD, Thompson AM, Carey-Smith T, Rochon Y, Bouchet VS, Gong W, Makar PA, Stroud C, Ménard S, Crevier LP, Cousineau S, Pudykiewicz JA, Kallaur A, Moffet R, Ménard R, Robichaud A, Cooper OR, Oltmans SJ, Witte JC, Forbes G, Johnson BJ, Merrill J, Moody JL, Morris G, Newchurch MJ, Schmidlin FJ, Joseph E. Comparison of Canadian air quality forecast models with tropospheric ozone profile measurements above midlatitude North America during the IONS/ICARTT campaign: Evidence for stratospheric input. ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2006jd007782] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
A 59-year-old lady presented with recurrent angioedema without urticaria. The clinical history and examination were consistent with an acquired C1 esterase deficiency secondary to lymphoproliferative disease. Despite a low C1 esterase level, the C4 level assayed by nephelometry on our automated analyser was normal. Analysis using different nephelometric analysers revealed consistently low C4, despite consistent normal readings in our analyser. Further investigation revealed an IgM-kappa paraprotein that seemed to interfere with both this and haematology coagulation assays. Splenic marginal zone lymphoma was confirmed on bone marrow biopsy. Monoclonal paraproteins may interfere with nephelometric, turbidimetric and immunological assays in a non-antibody-specific manner and should be considered when there are unusual or unexpected results, particularly in a patient with lymphoproliferative disease.
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Affiliation(s)
- Andrew McLean-Tooke
- Department of Immunology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Kovacs TA, Brune WH, Harder H, Martinez M, Simpas JB, Frost GJ, Williams E, Jobson T, Stroud C, Young V, Fried A, Wert B. Direct measurements of urban OH reactivity during Nashville SOS in summer 1999. J Environ Monit 2003; 5:68-74. [PMID: 12619758 DOI: 10.1039/b204339d] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Emissions of volatile chemicals control the hydroxyl radical (OH), the atmosphere's main cleansing agent, and thus the production of secondary pollutants. Accounting for all of these chemicals can be difficult, especially in environments with mixed urban and forest emissions. The first direct measurements of the atmospheric OH reactivity, the inverse of the OH lifetime, were made as part of the Southern Oxidant Study (SOS) at Cornelia Fort Airpark in Nashville, TN in summer 1999. Measured OH reactivity was typically 11 s(-1). Measured OH reactivity was 1.4 times larger than OH reactivity calculated from the sum of the products of measured chemical concentrations and their OH reaction rate coefficients. This difference is statistically significant at the 1sigma uncertainty level of both the measurements and the calculations but not the 2sigma uncertainty level. Measured OH reactivity was 1.3 times larger than the OH reactivity from a model that uses measured ambient concentrations of volatile organic compounds (VOCs), NO, NO2, SO2, and CO. However, it was within approximately 10% of the OH reactivity from a model that includes hydrocarbon measurements made in a Nashville tunnel and scaled to the ambient CO at Cornelia Fort Airpark. These comparisons indicate that 30% of the OH reactivity in Nashville may come from short-lived highly reactive VOCs that are not usually measured in field intensive studies or by US EPA's Photochemical Assessment Monitoring Stations.
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Affiliation(s)
- T A Kovacs
- Department of Meteorology, The Pennsylvania State University, University Park, PA, USA
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Affiliation(s)
- G P Spickett
- Regional Department of Immunology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, United Kingdom.
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Shortland GJ, Walter JH, Stroud C, Fleming PJ, Speidel BD, Marlow N. Randomised controlled trial of L-carnitine as a nutritional supplement in preterm infants. Arch Dis Child Fetal Neonatal Ed 1998; 78:F185-8. [PMID: 9713029 PMCID: PMC1720799 DOI: 10.1136/fn.78.3.f185] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the effect of L-carnitine supplementation (25 mg/kg/d) on the growth and incidence of hypoglycaemia in preterm infants. METHODS A double blind, placebo controlled randomised trial, stratified for gestational age, was conducted of 86 preterm infants between 28 and 34 gestational weeks. The median gestational ages in the carnitine group and placebo groups were 30.7 weeks (range 28.0 to 33.6) and 31.4 weeks (range 28.0 to 33.9), respectively. The median birthweights were 1.557 kg (range 0.944 to 2.275) and 1.645 kg (range 0.885 to 2.545), respectively. RESULTS Mean plasma free carnitine concentrations were below values for normal term infants in both groups on day 1 (carnitine group 44.8 mumol/l, placebo group 25.5 mumol/l) in the placebo group on day 7 (50.7 mumol/l), but in neither group on days 14 and 28. Total, free, and acylcarnitine concentrations were significantly increased in both urine and blood in the L-carnitine group. There was no significant difference between the placebo and carnitine supplemented groups in growth rate, as assessed by weight, length, skinfold thickness and head circumference measurements, or in the incidence of episodes of hypoglycaemia. CONCLUSION The addition of carnitine as a nutritional supplement at a dose of 25 mg/kg/day did not improve growth in our group of preterm infants nor protect them from episodes of hypoglycaemia.
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Affiliation(s)
- G J Shortland
- Department of Child Health, University Hospital of Wales, Heath Park, Cardiff
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Abstract
We consider coherent control of the shape of an atomic electron's wavefunction using a train of short transform-limited laser pulses. This type of control is experimentally demonstrated by exciting with a train of three pulses and measuring the resulting quantum state distribution. We also present a general theory for control with a train of N pulses in the weak field limit and discuss the extension of this theory to the strong field limit.
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Abstract
We present classical and quantum studies of the scattering dynamics of Rydberg electron wave packets from the electronic core of alkali atoms. In quantum systems an ideal state for studying such effects is an angularly localized wavepacket in which the primary effect of the scattering is to cause precession. The scattering is enhanced by the application of an external dc electric field. We calculate and animate the field-induced dynamics of both hydrogenic and alkali wavepackets and compare them to classical atomic models. We end that in alkali systems the scattered wave function can be divided into two components: one whose nearly hydrogenic behavior is due to quantum interference near the core, and another which exhibits the orbital precession found in classical models of nonhydrogenic atoms.
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Abstract
There is no consensus on the role of antibody-dependent cell-mediated cytotoxicity (ADCC) in autoimmune thyroid disease; recent reports have suggested that antibodies mediating ADCC are found particularly in patients with primary myxoedema, occur less frequently in Hashimoto's thyroiditis and are absent in Graves' disease. Using an ADCC assay with a single source of effector and target cells, and expressing results as lytic units, we have found antibodies capable of mediating ADCC in 9 of 17 patients with primary myxoedema, 9 of 22 patients with Hashimoto's thyroiditis and 6 of 22 patients with Graves' disease. There was no significant difference between the groups in this distribution. Mean levels of ADCC activity were not significantly different comparing primary myxoedema and Hashimoto's thyroiditis patients, although levels were lower in Graves' disease patients compared to those with Hashimoto's thyroiditis (P < 0.05). There was no correlation between TPO antibodies (total IgG or IgG subclasses) measured by ELISA and ADCC activity. These results suggest that thyroid antigens besides TPO are involved in ADCC and that antibodies mediating ADCC are not restricted to subgroups of patients with autoimmune thyroid disease.
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Affiliation(s)
- R A Metcalfe
- Department of Medicine, University of Sheffield Clinical Sciences Centre, Northern General Hospital, UK
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21
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Abstract
OBJECTIVE To determine surfactant profiles of tracheal secretions in mechanically ventilated children with respiratory failure secondary to bacterial pneumonia, viral pneumonitis, adult respiratory distress syndrome (ARDS), and cardiopulmonary bypass. DESIGN Prospective, cohort study. SETTING Tertiary, multidisciplinary, pediatric intensive care unit. PATIENTS One hundred twenty pediatric patients with respiratory failure requiring mechanical ventilation. INTERVENTIONS Routine tracheal aspirates were collected from children with bacterial pneumonia, viral pneumonitis, ARDS, postcardiopulmonary bypass, and a postsurgical control group. Samples were obtained on days 1, 2, 3, after every week of intubation and on the day of extubation. MEASUREMENTS AND MAIN RESULTS The tracheal aspirates were analyzed by high-performance liquid chromatography for lecithin/sphingomyelin rations and by enzyme-linked immunosorbent assay for surfactant proteins A and B. Lung compliance and the oxygenation index were measured on each day of sample collection. On day 1, patients with bacterial pneumonia, viral pneumonitis, and ARDS had decreased lecithin/sphingomyelin ration (p < .001), and those patients with bacterial pneumonia and viral pneumonitis had decreased surfactant protein A/protein concentration (p < .001). The lecithin/sphingomyelin ratios and surfactant protein A/protein concentration were significantly different among the groups (p < .001), with the bacterial pneumonia and viral pneumonitis groups having higher lecithin/sphingomyelin ratios and increased surfactant protein concentrations before extubation. Pulmonary compliance was lower and the oxygenation index was higher than controls (p < .001) in patients with bacterial pneumonia, viral pneumonitis, and ARDS. Pulmonary compliance was correlated weakly with lecithin/sphingomyelin ratio (r2 = .11, p < .001) and surfactant protein A/protein concentration (r2 = .03, p < .05). Surfactant protein B was similar in the diagnostic groups. Surfactant content in tracheal secretions from cardiopulmonary bypass patients was equivalent to controls. CONCLUSION Abnormal tracheal aspirate surfactant phospholipids and surfactant protein A were noted in children with bacterial pneumonia, viral pneumonitis, and ARDS, but not in children on cardiopulmonary bypass.
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Affiliation(s)
- A M LeVine
- Section of Critical Care Medicine, Children's National Medical Center, Washington, DC, USA
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Mitchell A, Hunter D, Blackhurst D, Stroud C, Lee B. Hospice care: the cheaper alternative. JAMA 1994; 271:1576-7. [PMID: 8182805] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Reuben JM, LaRocco JM, Gschwind CR, Stroud C, Rios A, Hersh EM, Mansell PW. Relationship of exposure to human T lymphotropic virus and T helper cells in homosexual men. AIDS Res 1986; 2:117-26. [PMID: 3013220 DOI: 10.1089/aid.1.1986.2.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The detection of serum antibodies (Ab) against HTLV-III in individuals with AIDS and related symptoms (ARC) has unambiguously defined the association of the virus infection to AIDS. This study was done to determine the extent of exposure to HTLV-III in homosexual men by measuring (Ab) and relating it to the stage of disease and T cell subsets. We found Ab in 89.5% of the 492 men with the median titers by stage of disease being 1600 for symptom-free, 6400 for ARC or Kaposi's sarcoma, and 4800 for opportunistic infection (OI), respectively. There was no correlation between Ab titers and either absolute or relative T helper cells (T4+), even though these cells decreased with disease severity. More specifically, however, symptom free patients had a normal distribution of the helpers of suppression (T4+/Leu8+), whereas, in symptomatic men, there was a significant decrease suggesting that the target cell for the virus is a subpopulation of the T helper cell.
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Schatten G, Stroud C, Simerly C, Schatten H. Fertilization, development and spicule formation in sea urchins under conditions of constant reorientation relative to the gravitation axis. Physiologist 1985; 28:S89-90. [PMID: 3834500] [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: 01/07/2023]
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Mellanby J, Strawbridge P, Collingridge GI, George G, Rands G, Stroud C, Thompson P. Behavioural correlates of an experimental hippocampal epileptiform syndrome in rats. J Neurol Neurosurg Psychiatry 1981; 44:1084-93. [PMID: 7199563 PMCID: PMC491226 DOI: 10.1136/jnnp.44.12.1084] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Experiments are reported describing assessment of abnormal behaviour of rats in which a chronic epileptiform syndrome has been induced by the injection of tetanus toxin bilaterally into their hippocampi. The abnormal behaviour included hyper-reactivity to a novel environment, intermittent aggression on handling, and abnormally passive response to a strange rat introduced into their home cage. In animals with unilateral injection of toxin, electrical records from the hippocampi have been obtained. They illustrated bilaterally simultaneous discharges and also some independence between the two hippocampi. The discharges were accompanied by overt signs of complex partial seizures during the first few weeks of the syndrome but later occurred without motor signs. In this later stage the rats were somewhat resistant to the convulsant effects of pentylenetetrazol.
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Sathyamurthy N, Duff JW, Stroud C, Raff LM. On the origin of the dynamical differences on the diatomics‐in‐molecules and spline‐fittedabinitiosurfaces for the He+H2+reaction. J Chem Phys 1977. [DOI: 10.1063/1.435355] [Citation(s) in RCA: 41] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stroud C, Sathyamurthy N, Rangarajan R, Raff L. Quantum mechanical scattering calculations on a spline-fitted ab initio surface: the He + H+2 (ν = 0, 1, 2) → HeH+ + H reaction. Chem Phys Lett 1977. [DOI: 10.1016/0009-2614(77)80330-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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