1
|
MacDonald N, Loh R, Fenkel JM, Sass DA, Halegoua-DeMarzio D. Pharmacotherapy for primary biliary cholangitis: an assessment of medication candidacy and rates of treatment. BMC Gastroenterol 2024; 24:18. [PMID: 38178006 PMCID: PMC10768361 DOI: 10.1186/s12876-023-03108-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Ursodeoxycholic acid is the preferred first-line therapy for primary biliary cholangitis. Alternative therapies, such as obeticholic acid, are recommended for patients who cannot tolerate ursodeoxycholic acid or who have an inadequate response to ursodeoxycholic acid monotherapy. Prior investigations have suggested that as many as 30% of patients with primary biliary cholangitis may have never received treatment with ursodeoxycholic acid. No prior investigations have examined usage rates of obeticholic acid in the treatment of primary biliary cholangitis. METHODS All patients with an ICD-10 diagnosis of primary biliary cholangitis who had any records within the health system were included. A review of medical records was performed to confirm the diagnosis of primary biliary cholangitis and determine which medications had been prescribed for treatment, as well as candidacy for second-line therapies. RESULTS A total of 495 patients met inclusion criteria. Notably, 95% of patients were taking ursodeoxycholic acid for treatment of their primary biliary cholangitis, with 67% of patients having disease that was well-controlled on ursodeoxycholic acid monotherapy. In total, 8% of patients were taking obeticholic acid (either as combination or monotherapy). Only 3% would benefit from the addition of a second line therapy but had not yet been offered medication. Only 3% of patients were not on any medication for management of their primary biliary cholangitis. CONCLUSIONS Ursodeoxycholic acid is a readily available and generally well-tolerated medication that should be offered to all patients with primary biliary cholangitis as first-line therapy. While prior investigations have suggested that up to 30% of patients with primary biliary cholangitis may never have received treatment for the disorder, the present study suggests that patients are generally being managed according to guidelines. Moreover, a significant proportion of patients with primary biliary cholangitis will qualify for second line therapies and prescribers should be aware of the indications to use these medications.
Collapse
Affiliation(s)
- Nicholas MacDonald
- Department of Medicine, Thomas Jefferson University Hospital, 33 S 9 TH St, Suite 220, 19107, Philadelphia, PA, USA.
| | - Rebecca Loh
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 South 10th Street, Suite 480, 19107, Philadelphia, PA, USA
| | - Jonathan M Fenkel
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 South 10th Street, Suite 480, 19107, Philadelphia, PA, USA
| | - David A Sass
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 South 10th Street, Suite 480, 19107, Philadelphia, PA, USA
| | - Dina Halegoua-DeMarzio
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 South 10th Street, Suite 480, 19107, Philadelphia, PA, USA
| |
Collapse
|
2
|
Loh R, Noverati N, Goldberg I, Josloff K, Schiavone G, Halegoua-DeMarzio D, Schlachterman A. Safe Use of POEM in a Patient With Decompensated Cirrhosis and Severe Achalasia. ACG Case Rep J 2023; 10:e01144. [PMID: 37753108 PMCID: PMC10519461 DOI: 10.14309/crj.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 09/28/2023] Open
Abstract
Patients with both achalasia and decompensated cirrhosis can often present a therapeutic challenge because portal hypertension has generally been considered a contraindication to definitive therapies for achalasia. This case report depicts a patient who presented with progressive dysphagia, weight loss, and large-volume ascites; was diagnosed with type II achalasia and decompensated cirrhosis without esophageal varices; and underwent peroral endoscopic myotomy after preprocedural transjugular intrahepatic portosystemic shunt placement. Our case highlights the importance of multidisciplinary care and need for definitive therapies for these complex patients at high risk of malnutrition and sarcopenia.
Collapse
Affiliation(s)
- Rebecca Loh
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | | | | - Kevan Josloff
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | | | | | |
Collapse
|
3
|
Davidson C, Zaw MK, Loh R, Grout C. 662 ENHANCING CARE BY IMPROVING DISCHARGE SUMMARIES. Age Ageing 2022. [DOI: 10.1093/ageing/afac034.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Within the Geriatric Medicine department at the Lister Hospital, Stevenage, the timeliness and quality of discharge summaries had become a source of complaints. Both primary care practitioners and families reported documentation was inadequate or incorrect. This project aimed to improve the quality of these discharge summaries in accordance with standards generated from previous audit data. Through improving communication it was clear that patient care could be enhanced.
Methods
Each month 15 discharge summaries were selected at random for review. Alongside patient notes these summaries were appraised in regards to standard discharge summary requirements: timeliness of delivery; adequate description of admission; and documentation of the follow up plan. They were also appraised on documentation of specific requirements for older aged adults including cognitive status, mobility status, discharge destination, need for home help, Rockwood Frailty score and resuscitation and escalation plans. Interventions including informal communication with junior doctors, circulation of a ‘Top Tips’ sheet, generation of an information poster and dissemination of information at local teaching sessions, took place, and were assessed, over regular PDSA cycles.
Results
showed a clear, sustained improvement in the quality of the discharge summaries. At the end of data collection, 100% of discharge summaries contained an adequate description of admission and an appropriate follow up plan. There was also significant improvement in documentation of specific requirements. Where documentation was initially very limited, following interventions, most discharge summaries contained details pertaining to discharge destination, need for home support, mobility status and resuscitation and escalation plans.
Conclusion
The relatively simple interventions have been found to have a sustained improvement in the quality of discharge summaries from the Geriatric Medicine Department at Lister Hospital, Stevenage. Whilst more work needs to be done it is hoped that this will already have enhanced patient care.
Collapse
Affiliation(s)
- C Davidson
- Lister Hospital, East and North Hertfordshire NHS Trust
| | - M K Zaw
- Lister Hospital, East and North Hertfordshire NHS Trust
| | - R Loh
- Lister Hospital, East and North Hertfordshire NHS Trust
| | - C Grout
- Lister Hospital, East and North Hertfordshire NHS Trust
| |
Collapse
|
4
|
Alghazo O, Eapen R, Koschel S, Cumberbatch M, Buteau J, Loh R, Lawrentschuk N, Murphy DG. The application of theranostics in different stages of prostate cancer. Future Oncol 2021; 17:3637-3644. [PMID: 34227404 DOI: 10.2217/fon-2020-1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite the remarkable achievements in treating metastatic prostate cancer over the last two decades, castrate-resistant status is still considered the lethal stage of the disease. Theranostics combines a targeting compound (ligand) with a therapeutic radioisotope (radioactive particle) injected into the blood to target the cancer cells. The most studied radioligand is 177Lu-PSMA-617, which targets PSMA, a protein found in prostate cancer cells. This new approach has shown promising results in treating metastatic castration-resistant prostate cancer. Currently, many trials are using PSMA-targeting radioligands in combination with conventional therapies in advanced prostate cancer or even in the earlier stages of the disease. Other preclinical trials are exploring the possibility of using newer ligands or radioisotopes to treat prostate cancer to increase the specificity and efficacy of this treatment.
Collapse
Affiliation(s)
- Omar Alghazo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3000, Australia.,Urology Division, Clinical Sciences Department, Yarmouk University, Irbid 21163, Jordan
| | - Renu Eapen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3000, Australia
| | - Samantha Koschel
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Marcus Cumberbatch
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Department of Academic Urology, University of Sheffield, Sheffield, UK
| | - James Buteau
- Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Molecular Imaging & Nuclear Medicine Therapeutics, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Rebecca Loh
- Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne 3052, Australia.,E J Whitten Prostate Cancer Research Centre, Epworth Healthcare, Victoria 3121, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3000, Australia
| |
Collapse
|
5
|
McGhee-Jez AE, Chervoneva I, Yi M, Ahuja A, Nahar R, Shah S, Loh R, Houtmann S, Shah R, Yeo CJ, Lavu H, Cohen SJ, Halegoua-DeMarzio D, Basu Mallick A. Nonalcoholic Fatty Liver Disease After Pancreaticoduodenectomy for a Cancer Diagnosis. J Pancreat Cancer 2021; 7:23-30. [PMID: 34095739 PMCID: PMC8175252 DOI: 10.1089/pancan.2020.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose: Current literature reports increased incidence of postpancreaticoduodenectomy (PD) nonalcoholic fatty liver disease (NAFLD), a precursor for nonalcoholic steatohepatitis and cirrhosis. The incidence of and risk factors (RFs) for NAFLD in the PD population, however, are not well elucidated. Methods: A cohort of 421 patients from a single institution who underwent PD for carcinoma and followed for at least 6 months were assessed retrospectively for age, gender, pathology, surgical complications (operative blood loss and length of stay [LOS]), comorbidities (diabetes, hypertension, hyperlipidemia, obesity), tobacco use, pre- and postoperative nutritional status (albumin and body mass index [BMI]), use of pancreatic enzyme replacement, and perioperative laboratory values (hemoglobin and liver function test). Cox proportional hazards model was used to examine these potential RFs as predictors of time to development of post-PD NAFLD. Results: Sixty (14.3%) patients developed post-PD NAFLD. Patients with NAFLD were younger (61.10 vs. 65.01 years old) and had higher preoperative BMI (28.92 vs. 26.61). Multivariate Cox proportional hazard model identified higher preoperative BMI, shorter postoperative LOS, and female gender as RFs for post-PD NAFLD. After excluding 12 patients with rare histology, there was a lower unadjusted hazard of developing NAFLD (p-value = 0.018) in the adenocarcinoma group than in the neuroendocrine and periampullary tumor groups. There was no statistically significant association between post-PD NAFLD and other characteristics. Conclusion: Female gender, higher preoperative BMI, and shorter LOS deserve closer monitoring for earlier detection and management of NAFLD.
Collapse
Affiliation(s)
- Amy E McGhee-Jez
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Misung Yi
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amisha Ahuja
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ritu Nahar
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samik Shah
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rebecca Loh
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Houtmann
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rashesh Shah
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Charles J Yeo
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Harish Lavu
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Steven J Cohen
- Division of Hematology/Medical Oncology, Abington/Jefferson Health, Department of Medical Oncology, Thomas Jefferson University Hospital, Willow Grove, Pennsylvania, USA
| | - Dina Halegoua-DeMarzio
- Division of Gastroenterology and Hepatology, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Atrayee Basu Mallick
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Abstract
The ornamental fish industry is growing quickly globally. Asia represents 51% of the export market for this industry and in Singapore alone, it has an estimated market value of US$66 million. Despite the economic importance of this industry for Australasia, aquatic veterinary support for the ornamental fish sector is scarce. In many cases, ornamental fish owners do not seek advice from veterinarians. While the reasons behind this are difficult to elucidate, the low perceived value of fish compared to the cost of consulting a veterinarian, and limited knowledge about the availability of veterinary services for aquatic animals may contribute to the lack of interaction with veterinarians. Considering the growing importance of the ornamental fish industry, more education and data are needed about the services offered by veterinarians with aquatic animal health expertise. Knowledge on aquatic veterinary medicine is limited, reinforcing the need for more educational programmes and dissemination of aquatic veterinary services within the Australasian region.
Collapse
Affiliation(s)
- R Loh
- The Fish Vet, East Victoria Park, Australia
| | - J Vukcevic
- The Fish Vet, East Victoria Park, Australia
| | - G Bastos Gomes
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, People's Republic of China
| |
Collapse
|
7
|
McGhee-Jez A, Ahuja A, Nahar R, Shah S, Loh R, Houtmann S, Shah R, Chervoneva I, Lavu H, Cohen SJ, Halegoua-De Marzio D, Basu Mallick A. Incidence of and risk factors (RFs) for development of non-alcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) for pancreatic cancer: A single institutional review. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.398] [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: 11/20/2022] Open
Abstract
398 Background: PD may increase the risk of development of NAFLD, a precursor for non-alcoholic steatohepatitis and cirrhosis. Studies have not clearly identified consistent RFs for NAFLD, but patients with post-PD NAFLD do not appear to have the traditional RFs for NAFLD such as metabolic syndrome. The primary objective of this study was to identify the incidence of and RFs for post-PD NAFLD. Methods: Retrospective chart review was done on 425 patients who underwent PD for a cancer diagnosis at our institution from 2007 to 2017 and had at least 6 months of postoperative follow up. Cox proportional hazards model was used to examine multiple potential pre-operative RFs for NAFLD including body mass index (BMI), estimated surgical blood loss, LFTs, hemoglobin, albumin, age, sex, comorbidities, and tobacco use as predictors of time to develop post-PD NAFLD. Patients without post-PD NAFLD were considered censored at the time of last follow-up. The proportional hazard assumptions were validated. Post-PD NAFLD was identified by review of radiology reports. Results: Sixty (14.1%) of the 425 patients had post-PD NAFLD. The male to female ratio was 236:189 and median follow up time was 1 year. Median age was 65 years with median time to NAFLD development of 7 months. Multivariate Cox Proportional Hazard model identified higher BMI and female sex as RFs for the development of post-PD NAFLD. Each 1-point increase in BMI implied an 8.43% increase in the hazard of fatty liver (HR = 1.083, 95% CI: 1.032-1.136; p=0.001). Females had 89.7% higher hazard of fatty liver compared to males (HR = 1.897, 95% CI: 1.084 - 3.319; p=0.025). There was no statistically significant association between post-PD NAFLD and other pre-operative characteristics studied. Conclusions: Female sex and higher BMI may be RFs for the development of NAFLD post-PD. No other pre-operative RFs were identified. In conclusion, patients with higher BMI and female gender may need closer monitoring for earlier detection and management of NAFLD. [Table: see text]
Collapse
Affiliation(s)
| | - Amisha Ahuja
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ritu Nahar
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Samik Shah
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Rebecca Loh
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Rashesh Shah
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Harish Lavu
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Steven J. Cohen
- Jefferson Health System/Abington Memorial Hospital, Abington, PA
| | | | | |
Collapse
|
8
|
Vale S, Smith J, Said M, Joshi P, Allen K, Loh R. P54: PREVENTING THE DEVELOPMENT OF FOOD ALLERGY: IMPLEMENTING NEW ASCIA GUIDELINES FOR INFANT FEEDING. Intern Med J 2017. [DOI: 10.1111/imj.54_13578] [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] [Indexed: 11/30/2022]
Affiliation(s)
- S Vale
- National Allergy Strategy; Sydney Australia
- Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney; Australia
| | - J Smith
- National Allergy Strategy; Sydney Australia
| | - M Said
- National Allergy Strategy; Sydney Australia
- Allergy & Anaphylaxis Australia; Sydney Australia
| | - P Joshi
- Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney; Australia
- Allergy & Anaphylaxis Australia; Sydney Australia
- The Childrens Hospital at Westmead; Sydney Australia
| | - K Allen
- National Allergy Strategy; Sydney Australia
- Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney; Australia
- Centre for Food & Allergy Research (CFAR), Victoria; Australia
- Murdoch Childrens Research Institute; Melbourne Australia
| | - R Loh
- National Allergy Strategy; Sydney Australia
- Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney; Australia
- Centre for Food & Allergy Research (CFAR), Victoria; Australia
- Princess Margaret Hospital; Perth Australia
| |
Collapse
|
9
|
Vale S, Loh R, Smith J, Aiken J, Salter S, Said M. P52: 250 K: A YOUTH ALLERGY AWARENESS PROJECT BY THE NATIONAL ALLERGY STRATEGY. Intern Med J 2017. [DOI: 10.1111/imj.52_13578] [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] [Indexed: 11/30/2022]
Affiliation(s)
- S Vale
- National Allergy Strategy; Sydney Australia
- Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney; Australia
| | - R Loh
- National Allergy Strategy; Sydney Australia
- Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney; Australia
- Princess Margaret Hospital; Perth Australia
| | - J Smith
- Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney; Australia
| | - J Aiken
- Allergy & Anaphylaxis Australia; Sydney Australia
| | - S Salter
- University of Western Australia; Perth Australia
| | - M Said
- National Allergy Strategy; Sydney Australia
- Allergy & Anaphylaxis Australia; Sydney Australia
| |
Collapse
|
10
|
Knezevic B, Sprigg D, Seet J, Trevenen M, Trubiano J, Smith W, Jeelall Y, Vale S, Loh R, McLean-Tooke A, Lucas M. The revolving door: antibiotic allergy labelling in a tertiary care centre. Intern Med J 2017; 46:1276-1283. [PMID: 27530619 DOI: 10.1111/imj.13223] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/13/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients frequently report antibiotic allergies; however, only 10% of labelled patients have a true allergy. AIM We investigated the documentation of antibiotic 'allergy' labels (AAL) and the effect of labelling on clinical outcomes, in a West Australian adult tertiary hospital. METHODS Retrospective cross-sectional analysis of patients captured in the 2013 and 2014 National Antimicrobial Prescribing Surveys was carried out. Data were collected on documented antibiotic adverse drug reactions, antibiotic cost, prescribing appropriateness, prevalence of multi-drug resistant organisms, length of stay, intensive care admission and readmissions. RESULTS Of the 687 patients surveyed, 278 (40%) were aged 70 or above, 365 (53%) were male and 279 (41%) were prescribed antibiotics. AAL were recorded in 122 (18%) patients and the majority were penicillin labels (n = 87; 71%). Details of AAL were documented for 80 of 141 (57%) individual allergy labels, with 61 describing allergic symptoms. Patients with beta-lactam allergy labels received fewer penicillins (P = 0.0002) and more aminoglycosides (P = 0.043) and metronidazole (P = 0.021) than patients without beta-lactam labels. Five patients received an antibiotic that was contraindicated according to their allergy status. Patients with AAL had significantly more hospital readmissions within 4 weeks (P = 0.001) and 6 months (P = 0.025) of discharge, compared with unlabelled patients. The majority (81%) of readmitted labelled patients had major infections. CONCLUSIONS AAL are common, but poorly documented in hospital records. Patients with AAL are significantly more likely to require alternative antibiotics and hospital readmissions. There may be a role for antibiotic allergy delabelling to mitigate the clinical and economic burdens for patients with invalid allergy labels.
Collapse
Affiliation(s)
- B Knezevic
- Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - D Sprigg
- Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - J Seet
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - M Trevenen
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia
| | - J Trubiano
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - W Smith
- Department of Immunology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Y Jeelall
- School of Medicine and Pharmacology, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - S Vale
- Drug Allergy Working Party, Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - R Loh
- Department of Clinical Immunology, Princess Margaret Hospital, Perth, Western Australia, Australia.,Pathwest Laboratory, Queen Elizabeth II Campus, Perth, Western Australia, Australia
| | - A McLean-Tooke
- Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia.,Pathwest Laboratory, Queen Elizabeth II Campus, Perth, Western Australia, Australia
| | - M Lucas
- Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia.,Pathwest Laboratory, Queen Elizabeth II Campus, Perth, Western Australia, Australia.,Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia
| |
Collapse
|
11
|
Chin HN, Loh R, Hong YC, Gibson-Kueh S. Case studies of spinal deformities in ornamental koi, Cyprinus carpio L. J Fish Dis 2017; 40:65-71. [PMID: 27260260 DOI: 10.1111/jfd.12496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 06/05/2023]
Abstract
This is a study of vertebral deformities in ornamental koi based on computed radiography and skeletons cleaned by dermestid beetles (Dermestes maculatus). All koi developed gradual onset of swimming abnormalities as adults. Extensive intervertebral osteophyte formation correlated with age of fish and was associated with hindquarter paresis in one koi. Vertebral compression and fusion were the most common spinal deformities occurring at multiple sites, similar to findings in other farmed fish. Site-specific spinal deformities were thought to develop due to differences in swimming behaviour and rates of vertebral growth. One koi had offspring with spinal deformities. Spinal deformities are significant problems in both European and Australian food fish hatcheries. The heritability of vertebral deformities in farmed fish is reportedly low unless there is concurrent poor husbandry or nutritional deficiencies. The specific aetiologies for vertebral deformities in koi in this study could not be ascertained. Current knowledge on spinal deformities in the better studied European food fish species suggests multifactorial aetiologies. Future research should include prospective longitudinal studies of larger numbers of koi from hatch and consideration of all potential risk factors such as husbandry, nutrition, temperature, photoperiod and genetics.
Collapse
Affiliation(s)
- H N Chin
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia
| | - R Loh
- The FishVet P/L, Perth, Western Australia, Australia
| | - Y C Hong
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia
| | - S Gibson-Kueh
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia
| |
Collapse
|
12
|
Choudhary M, Delaviz Y, Loh R, Polasky M, Wan C, Todd DB, Hyun KS, Dey S, Wu F. Measurement of Shear Viscosity and Solubility of Polystyrene Melts Containing Various Blowing Agents. J CELL PLAST 2016. [DOI: 10.1177/0021955x05059036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents measured data on shear viscosity and solubility of HCFC-142b and HFC-134a/ethanol blowing agent laden polystyrene melts at different temperatures. This study establishes the baseline for more novel and innovative blowing agent systems to replace HCFC-142b. The shear viscosity is measured using a helical barrel rheometer. Apparent solubility is determined by observing the onset of gas bubble presence or absence in a specially designed optical cell with sapphire windows using a microscope–CCD camera–monitor/recorder system. The article presents a selection of viscosity and solubility data and, where possible, compares them with measurements carried out by others. The dynamic methods of measuring solubility and viscosity of gas laden polymer melts used in this study are closer to the polymer foam manufacturing practice.
Collapse
Affiliation(s)
- M. Choudhary
- Owens Corning Science & Technology, Granville, OH, USA
| | - Y. Delaviz
- Owens Corning Science & Technology, Granville, OH, USA
| | | | - M. Polasky
- Owens Corning Foam Technology Center, Tallmadge, OH, USA
| | | | | | - K. S. Hyun
- Polymer Processing Institute, Newark, NJ, USA
| | - S. Dey
- SONOCO, Hartsville, SC, USA
| | - F. Wu
- National Institute of Standards and Technology, Gaithersburg, MD, USA
| |
Collapse
|
13
|
Loh R, Bergfeld J, Hayes D, O'hara A, Pyecroft S, Raidal S, Sharpe R. The Pathology of Devil Facial Tumor Disease (DFTD) in Tasmanian Devils (Sarcophilus harrisii). Vet Pathol 2016; 43:890-5. [PMID: 17099145 DOI: 10.1354/vp.43-6-890] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A disfiguring and debilitating neoplastic condition known as devil facial tumor disease (DFTD) has been discovered in wild Tasmanian Devils ( Sarcophilus harrisii) across 51% of its natural range, with population declines of up to 80% in some areas (C. Hawkins, personal communication). Between 2001 and 2004, 91 cases were examined. The tumors presented as large, solid, soft tissue masses usually with flattened, centrally ulcerated, and exudative surfaces. They were typically multicentric, appearing first in the oral, face, or neck regions. Histologically, the tumors were composed of circumscribed to infiltrative nodular aggregates of round to spindle-shaped cells, often within a pseudocapsule and divided into lobules by delicate fibrous septae. They were locally aggressive and metastasized in 65% of cases. There was minimal cytologic differentiation among the tumor cell population under light and electron microscopic examination. The results indicate DFTD to be an undifferentiated soft tissue neoplasm.
Collapse
Affiliation(s)
- R Loh
- Animal Health Laboratory, PO Box 46, Kings Meadows 7249, Tasmania, Australia.
| | | | | | | | | | | | | |
Collapse
|
14
|
Ekici F, Loh R, Waisbourd M, Sun Y, Martinez P, Nayak N, Wizov SS, Hegarty S, Hark LA, Spaeth GL. Relationships Between Measures of the Ability to Perform Vision-Related Activities, Vision-Related Quality of Life, and Clinical Findings in Patients With Glaucoma. JAMA Ophthalmol 2016; 133:1377-85. [PMID: 26425961 DOI: 10.1001/jamaophthalmol.2015.3426] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To our knowledge, few studies have combined an objective measure of vision-related performance (VRP) and subjective measures of vision-related quality of life (VRQoL) with clinically related visual parameters, particularly in a large, prospective, cohort study setting. OBJECTIVE To examine the relationships between clinical visual assessments and both a VRP and 2 self-reported VRQoL measurements. DESIGN, SETTING, AND PARTICIPANTS Patients (N = 161) with moderate-stage glaucoma recruited from the Glaucoma Service at Wills Eye Hospital, Philadelphia, Pennsylvania, were enrolled from May 2012 to May 2014 in an ongoing prospective, 4-year longitudinal observational study. This report includes cross-sectional results from the baseline visit. Patients received a complete ocular examination, automated visual field (VF) test and Cirrus optical coherence tomographic scan. Contrast sensitivity was measured with the Pelli-Robson and the Spaeth-Richman Contrast Sensitivity (SPARCS) tests. Vision-related performance was assessed by the Compressed Assessment of Ability Related to Vision (CAARV) test. Vision-related QoL was assessed by the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) and a modified Glaucoma Symptom Scale (MGSS). MAIN OUTCOMES AND MEASURES Correlations between clinical measures and CAARV, NEI-VFQ-25, and MGSS scores. RESULTS A total of 161 patients were enrolled in the study. The strongest correlation was found between SPARCS score in the better eye and total CAARV score (r = 0.398; 95% CI, 0.235-0.537; P < .001). The CAARV score also correlated with the Pelli-Robson score (r = 0.353; 95% CI, 0.186-0.499; P = .001), VF mean deviation (r = 0.366; 95% CI, 0.200-0.510; P < .001), and VA (r = -0.326, 95% CI = -0.476 to -0.157; P = .003) in the better eye. There were more statistically significant correlations between contrast sensitivity tests and VF mean deviation with VRQoL measurements than with other clinical measures (visual acuity, intraocular pressure, Disc Damage Likelihood Scale, and mean retinal nerve fiber layer thickness). The MGSS scores were lower (worse) in women compared with men (P = .03 for binocular, P = .01 for better eye, and P = .05 for the worse eye). Structural measures (eg, Disc Damage Likelihood Scale, and retinal nerve fiber layer thickness) were generally not informative with respect to VRP or VRQoL. CONCLUSIONS AND RELEVANCE Contrast sensitivity tests and VF mean deviation were associated with both objective measures of the ability to act and subjective measurements of VRQoL. The strongest correlation was between SPARCS score (contrast sensitivity) in the better eye and total CAARV score. Therefore, measurement of contrast sensitivity should be considered when evaluating patients' VRQoL. The results of this study were limited by the patient population and apply only within the bounds of the tested cohort.
Collapse
Affiliation(s)
- Feyzahan Ekici
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Rebecca Loh
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Yi Sun
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Patricia Martinez
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Natasha Nayak
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sheryl S Wizov
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
15
|
Metcalfe JR, D'Vaz N, Makrides M, Gold MS, Quinn P, West CE, Loh R, Prescott SL, Palmer DJ. Elevated IL-5 and IL-13 responses to egg proteins predate the introduction of egg in solid foods in infants with eczema. Clin Exp Allergy 2016; 46:308-16. [DOI: 10.1111/cea.12608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/27/2022]
Affiliation(s)
- J. R. Metcalfe
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
| | - N. D'Vaz
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Telethon KIDS Institute; The University of Western Australia; Perth WA Australia
| | - M. Makrides
- Women's & Children's Health Research Institute; Adelaide SA Australia
- Healthy Mothers, Babies and Children; South Australian Health and Medical Research Institute; Adelaide SA Australia
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - M. S. Gold
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
- Children, Youth and Women's Health Service; Adelaide SA Australia
| | - P. Quinn
- Children, Youth and Women's Health Service; Adelaide SA Australia
| | - C. E. West
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Department of Clinical Sciences; Pediatrics; Umeå University; Umea Sweden
| | - R. Loh
- Department of Immunology; Princess Margaret Hospital; Perth WA Australia
| | - S. L. Prescott
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Telethon KIDS Institute; The University of Western Australia; Perth WA Australia
- Department of Immunology; Princess Margaret Hospital; Perth WA Australia
| | - D. J. Palmer
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Women's & Children's Health Research Institute; Adelaide SA Australia
| |
Collapse
|
16
|
Liu J, Shi Z, Spatz D, Loh R, Sun G, Grisso J. Social and demographic determinants for breastfeeding in a rural, suburban and city area of South East China. Contemp Nurse 2014; 45:234-43. [PMID: 24299252 DOI: 10.5172/conu.2013.45.2.234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Breastfeeding is a traditional practice in China, yet few studies have explored its current trend after socioeconomic reform. This study aims to characterize breastfeeding rates and possible associations with sociodemographic factors using a breastfeeding questionnaire administered to 1,385 mothers of 6-year-old children. Rates were lowest among city residents and negatively associated with parental and grandmother education levels as well as mothers' professional occupational status. These findings highlight the impact of urbanization on maternal and child health and the effect of marketing tactics for breast milk substitutes (BMS). Public health education promoting breastfeeding should target urban families, particularly those educated.
Collapse
Affiliation(s)
- Jianghong Liu
- Family and Community Health Department, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | |
Collapse
|
17
|
Liu J, Shi Z, Spatz D, Loh R, Sun G, Grisso J. Social and demographic determinants for breastfeeding in a rural, suburban and city area of South East China. Contemp Nurse 2013. [DOI: 10.5172/conu.2013.2539] [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: 11/08/2022]
|
18
|
Loh R, Foley D, Ranasinghe W, Austin K, Ranchod P, Berry R. Post-traumatic pelvic extramedullary haemopoetic tissue causing lower urinary tract symptoms. J Surg Case Rep 2012; 2012:17. [PMID: 24960775 PMCID: PMC3649577 DOI: 10.1093/jscr/2012.8.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Extramedullary haemopoiesis (EMH) is the abnormal development and growth of haemopoietic tissue outside the bone marrow. It is usually asymptomatic and occurs in the presence of myelodysplastic syndromes. In this report, we describe the first post-traumatic EMH presenting with lower urinary tract symptoms.
Collapse
Affiliation(s)
- R Loh
- Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC Australia
| | - D Foley
- Department of General Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - W Ranasinghe
- Department of General Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - K Austin
- Department of General Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - P Ranchod
- Department of General Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - R Berry
- Department of General Surgery, Cabrini Hospital, Malvern, VIC, Australia
| |
Collapse
|
19
|
|
20
|
Johannsen H, Nolan R, Pascoe EM, Cuthbert P, Noble V, Corderoy T, Franzmann A, Loh R, Prescott SL. Skin prick testing and peanut-specific IgE can predict peanut challenge outcomes in preschoolchildren with peanut sensitization. Clin Exp Allergy 2011; 41:994-1000. [DOI: 10.1111/j.1365-2222.2011.03717.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
21
|
Loh R, Sprigg L, Noble V, Vale S. Comprehensive Anaphylaxis Management in Schools and Childcare through Resources, Legislation and Adrenaline Autoinjector Provision. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.973] [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: 11/16/2022]
|
22
|
Mullins R, Vale S, Smith J, Dunne G, Smith P, Smith V, Grainger S, Loh R. Anaphylaxis Training Packages for Health Professionals in Australia and New Zealand. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.978] [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: 10/18/2022]
|
23
|
|
24
|
Abstract
Pathological skin picking is characterized by dysfunctional, repetitive and excessive manipulation of the skin resulting in noticeable tissue damage. This study sought to assess the effectiveness of escitalopram in treating pathological skin picking. Twenty-nine individuals with pathological skin picking were enrolled in an 18-week, open-label trial of escitalopram. Study measures assessing skin picking severity and impact, anxiety, depression, and quality of life were given at baseline and weeks 2, 4, 6, 10, 14, and 18. The mean maximally tolerated dose was 25.0 mg (standard deviation=8.4). For the 19 study completers, pre-post-treatment analyses revealed significant improvements (P<0.05) on measures of skin picking severity and impact, quality of life, and self-rated anxiety and depression. Completer as well as intent-to-treat analyses indicated that approximately half of the sample satisfied full medication response criteria and one-quarter were partial medication responders. Correlational analyses indicated that changes in depression, anxiety, and quality of life co-occurred with reductions in skin picking severity but not impact. A high percentage of variance in severity, however, remained unexplained. These results suggest that escitalopram can be an effective agent in reducing pathological skin picking. The lack of medication response in a subset of our sample suggests the possibility of pathological skin picking subtypes.
Collapse
Affiliation(s)
- Nancy J Keuthen
- Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Boston, MA 02114, USA.
| | | | | | | | | | | |
Collapse
|
25
|
Fraguas R, Marci C, Fava M, Iosifescu DV, Bankier B, Loh R, Dougherty DD. Autonomic reactivity to induced emotion as potential predictor of response to antidepressant treatment. Psychiatry Res 2007; 151:169-72. [PMID: 17360044 DOI: 10.1016/j.psychres.2006.08.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [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] [Received: 08/08/2005] [Revised: 08/11/2006] [Accepted: 08/18/2006] [Indexed: 10/23/2022]
Abstract
Distinct factors have been identified as potential predictors of antidepressant treatment response. Although autonomic function changes have been described in depressive subjects, their value as predictors of antidepressant response has not been systematically evaluated. Eight un-medicated patients with major depressive order (MDD) have their skin conductance (SC) and heart rate variability (HRV) measured at basal condition and during four induced emotional states: happy, angry, sad and neutral. The high frequency (HF) and low frequency (LF) power parameters of HRV were assessed. Subsequently, patients were treated with fluoxetine 20 mg/day for 8 weeks. The antidepressant response was measured with the Beck Depression Inventory (BDI). The BDI percentage reduction correlated significantly with HRV responses during sad condition in LF power, and during happy condition with LF/HF ratio. The BDI percentage reduction also correlated significantly with HR responses in happy and in neutral conditions, and also with SC responses in neutral condition. These preliminary findings indicate that automatic responses to induced emotions may predict antidepressant response in MDD patients. Confirmatory studies are warranted.
Collapse
Affiliation(s)
- Renerio Fraguas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | |
Collapse
|
26
|
Loh R, Hayes D, Mahjoor A, O'Hara A, Pyecroft S, Raidal S. The immunohistochemical characterization of devil facial tumor disease (DFTD) in the Tasmanian Devil (Sarcophilus harrisii). Vet Pathol 2007; 43:896-903. [PMID: 17099146 DOI: 10.1354/vp.43-6-896] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Immunohistochemical techniques were used to characterize the disfiguring and debilitating fatal neoplastic disease, devil facial tumor disease (DFTD), which has recently affected a significant proportion of the wild population of Tasmanian Devils (Sarcophilus harrisii). The diagnostic values of a number of immunohistochemical stains were employed to further characterize 50 representative cases. The neoplasms were negative for cytokeratin (0/48), epithelial membrane antigen (0/42), von Willebrand factor (vWF) (0/11), smooth muscle actin (SMA) (0/26), desmin (0/47), glial fibrillary acid protein (0/13), CD16 (0/13), CD57 (0/43), CD3 (0/18), and LSP1 (0/16). DFTD cells were positive for vimentin (50/50), S-100 (41/48), melan A (11/39), neuron specific enolase (35/35), chromogranin A (12/12) and synaptophysin (29/30). The cells were negative for amyloid (0/30) and stained negatively with Singh's silver (0/34) but were weakly argyrophilic (3/40) using Grimelius histochemical stain. These staining characteristics are consistent with cells of neuroectodermal origin.
Collapse
Affiliation(s)
- R Loh
- Animal Health Laboratory, PO Box 46, Kings Meadows, 7249 Tasmania, Australia.
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
BACKGROUND Trichotillomania is a psychiatric condition characterized by chronic hair pulling. Both cognitive behavioral therapy (CBT) and the selective serotonin reuptake inhibitors (SSRIs) have shown promise in the treatment of trichotillomania, with comparison studies favoring CBT over pharmacotherapy. However, no randomized, controlled studies to date have compared the efficacy of individual SSRI or CBT treatment to the combination of both treatment modalities. METHOD In this study, which ran from February 2000 through April 2003, subjects who met DSM-IV criteria for trichotillomania were randomly assigned to treatment with sertraline or placebo in a double-blind study design. Following 12 weeks of active pharmacotherapy, subjects not demonstrating significant trichotillomania symptom improvement had habit reversal training (HRT) added to their treatment regimen. Primary outcome measures were the Hair Pulling Scale and the Clinical Global Impressions scale. RESULTS Thirteen subjects completing the 22-week study received single modality treatment of either sertraline or HRT, and 11 received both modalities of treatment. Trichotillomania symptoms in both groups improved, although the dual modality treatment group demonstrated larger gains and were much more likely to reach responder status at final evaluation. CONCLUSION These results suggest that the combination of sertraline and HRT may be more efficacious in the treatment of trichotillomania than either approach alone.
Collapse
Affiliation(s)
- Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | | | | | | |
Collapse
|
28
|
Hofmann SG, Loh R. The Tridimensional Personality Questionnaire: changes during psychological treatment of social phobia. J Psychiatr Res 2006; 40:214-20. [PMID: 15935382 DOI: 10.1016/j.jpsychires.2005.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Revised: 03/31/2005] [Accepted: 03/31/2005] [Indexed: 11/27/2022]
Abstract
Thirty-nine individuals completed 12 weekly group sessions of psychological therapy for social phobia (social anxiety disorder). Before and after treatment, participants filled out the Tridimensional Personality Questionnnaire (TPQ, [Cloninger C.R., 1987a. A systematic method for clinical description and classification of personality variants. Archives of General Psychiatry, 44, 573-58]) and measures of social anxiety and depression. Treatment led to a significant reduction in social anxiety, depression, harm avoidance, and reward dependence. However, only pre-post changes in harm avoidance and depression were significantly correlated with pre-post changes in social anxiety. These results suggest that harm avoidance shows state-dependent changes during the course of treatment for social phobia. The implications of these findings for the trait/state distinction of the TPQ scales are discussed.
Collapse
Affiliation(s)
- Stefan G Hofmann
- Department of Psychology, Boston University, Boston, MA 02215 2002, USA.
| | | |
Collapse
|
29
|
Gershuny BS, Keuthen NJ, Gentes EL, Russo AR, Emmott EC, Jameson M, Dougherty DD, Loh R, Jenike MA. Current posttraumatic stress disorder and history of trauma in trichotillomania. J Clin Psychol 2006; 62:1521-9. [PMID: 16897695 DOI: 10.1002/jclp.20303] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Though some researchers and clinicians postulate that trauma and posttraumatic stress disorder (PTSD) may be implicated in the etiologic underpinnings of trichotillomania (TTM), very little research to date has examined such postulations. To address this gap in the literature, the current study assessed the prevalence of trauma and PTSD in 42 individuals seeking treatment for TTM. Relations between symptoms of PTSD and TTM also were examined, as were differences in TTM symptoms between those with and without PTSD. Findings revealed that approximately 76% reported a history of at least one traumatic event, and 19% met criteria for PTSD. Furthermore, negative correlations were demonstrated between symptoms of PTSD and characteristics of TTM, and the PTSD group reported less severe TTM characteristics. Findings suggest that the prevalence of PTSD in TTM may be higher than in the general population and that a history of greater number of types of traumas is associated with a longer duration of hair pulling as well as the scalp as the primary pulling site. The authors also speculate that in traumatized individuals, TTM may represent a form of coping vis-à-vis self-soothing or self-harm.
Collapse
Affiliation(s)
- Beth S Gershuny
- Department of Psychology, Skidmore College, 815 N. Broadway, Saratoga Springs, NY 12866, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Deckersbach T, Savage CR, Dougherty DD, Bohne A, Loh R, Nierenberg A, Sachs G, Rauch SL. Spontaneous and directed application of verbal learning strategies in bipolar disorder and obsessive-compulsive disorder. Bipolar Disord 2005; 7:166-75. [PMID: 15762858 DOI: 10.1111/j.1399-5618.2004.00168.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [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: 11/30/2022]
Abstract
OBJECTIVES Individuals with bipolar disorder exhibit neuropsychological impairments when they are euthymic (neither depressed nor manic). One of the most consistently reported cognitive problems in euthymic individuals with bipolar disorder is impairment in verbal episodic memory. Recent findings suggest that episodic memory difficulties in these individuals are attributable to difficulties using organizational strategies during encoding. The purpose of the present study was (i) to investigate whether difficulties using organizational strategies in bipolar disorder are due to a failure in spontaneously initiating verbal organization strategies or are due to difficulties implementing such strategies, and (ii) to compare the characteristics of verbal organizational impairment in bipolar disorder with those observed in individuals with obsessive-compulsive disorder (OCD). METHODS Study participants were 20 individuals with bipolar I disorder (BP-I), 20 individuals with OCD, and 20 healthy control participants matched for age, gender, and education. Participants completed a verbal encoding paradigm that involved spontaneous and directed use of verbal organization strategies during encoding of word lists. RESULTS Compared with control subjects, both BP-I and OCD participants showed impaired verbal organization in the spontaneous encoding condition. In the directed encoding condition, OCD patients organized the word lists as well as control participants whereas BP-I participants exhibited lower verbal organization than both control and OCD participants. OCD and BP-I participants' free recall performance did not differ from that of control participants in the spontaneous encoding condition. In the directed encoding condition, BP-I participants recalled fewer words than OCD or control participants. CONCLUSIONS Episodic memory difficulties in OCD are associated with difficulties spontaneously initiating verbal organization strategies during encoding whereas the ability to implement verbal organization when instructed to do so is preserved. BP-I participants, on the other hand, exhibit difficulties in both spontaneously initiating verbal organization strategies and in the ability to implement such strategies when instructed to do so.
Collapse
Affiliation(s)
- Thilo Deckersbach
- Harvard Bipolar Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Rowe J, Poolman JT, Macaubas C, Sly PD, Loh R, Holt PG. Enhancement of vaccine-specific cellular immunity in infants by passively acquired maternal antibody. Vaccine 2005; 22:3986-92. [PMID: 15364448 DOI: 10.1016/j.vaccine.2004.03.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Revised: 03/02/2004] [Accepted: 03/31/2004] [Indexed: 11/30/2022]
Abstract
The known protective effects of passively acquired maternal antibody on the resistance of newborns to infections have prompted widespread interest in maternal vaccination. However, a range of animal model and human studies indicate potential inhibitory effects of maternal antibody on vaccine-specific humoral responses in infants. In the present study we have examined the relationship between maternally acquired TT-specific IgG present before DTaP vaccination and subsequent TT-specific T-cell memory responses at 12 and 18 months, in a cohort of 118 infants. We demonstrate a strong positive association between TT-specific cellular immunity as evidenced by increased IL-4, IL-5 and IL-13 responses, and maternal TT-specific IgG.
Collapse
Affiliation(s)
- J Rowe
- The University of Western Australia, West Perth, WA 6872, Australia
| | | | | | | | | | | |
Collapse
|
32
|
Baumgart K, Brown S, Gold M, Kemp A, Loblay R, Loh R, Mitrou D, Mullins R, Peake J, Ruhno J, Said M, Sinclair J, Smith V, Smith W, Solley G, Soutter V, Tang M, Ziegler J. ASCIA guidelines for prevention of food anaphylactic reactions in schools, preschools and child-care centres. J Paediatr Child Health 2004; 40:669-71. [PMID: 15569280 DOI: 10.1111/j.1440-1754.2004.00509.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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: 11/30/2022]
Abstract
These guidelines have been developed by the anaphylaxis working party of the Australasian Society of Clinical Immunology and Allergy to provide advice for minimizing the risk of food-induced anaphylaxis in schools, preschools and child-care centres. The guidelines outline four steps for the prevention of food anaphylactic reactions in children at risk and food policy measures specific to school age and preschool age children.
Collapse
Affiliation(s)
- K Baumgart
- Department of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Dougherty DD, Rauch SL, Deckersbach T, Marci C, Loh R, Shin LM, Alpert NM, Fischman AJ, Fava M. Ventromedial prefrontal cortex and amygdala dysfunction during an anger induction positron emission tomography study in patients with major depressive disorder with anger attacks. ACTA ACUST UNITED AC 2004; 61:795-804. [PMID: 15289278 DOI: 10.1001/archpsyc.61.8.795] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Although a variety of functional neuroimaging studies have used emotion induction paradigms to investigate the neural basis of anger in control subjects, no functional neuroimaging studies using anger induction have been conducted in patient populations. OBJECTIVE To study the neural basis of anger in unmedicated patients with major depressive disorder with anger attacks (MDD + A), unmedicated patients with MDD without anger attacks (MDD - A), and controls. DESIGN We used positron emission tomography, psychophysiologic measures, and autobiographical narrative scripts in the context of an anger induction paradigm. SETTING Academic medical center. PARTICIPANTS Thirty individuals, evenly divided among the 3 study groups. INTERVENTIONS In separate conditions, participants were exposed to anger and neutral autobiographical scripts during the positron emission tomography study. Subjective self-report and psychophysiologic data were also collected. MAIN OUTCOME MEASURES Voxelwise methods were used for analyses of regional cerebral blood flow changes for the anger vs neutral contrast within and between groups. RESULTS Controls showed significantly (P<.001) greater regional cerebral blood flow increases in the left ventromedial prefrontal cortex during anger induction than patients with MDD + A, whereas these differences were not present in other between-group analyses. Also, in controls, an inverse relationship was demonstrated between regional cerebral blood flow changes during anger induction in the left ventromedial prefrontal cortex and left amygdala, whereas in patients with MDD + A there was a positive correlation between these brain regions during anger induction. There was no significant relationship between these brain regions during anger induction in patients with MDD - A. CONCLUSION These results suggest a pathophysiology of MDD + A that is distinct from that of MDD - A and that may be responsible for the unique clinical presentation of patients with MDD + A.
Collapse
Affiliation(s)
- Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
There is growing interest in the potential interactions between infant vaccination and risk for development of atopic disease. The aspect of this issue which has dominated this debate concerns suggestions that infant vaccination may stimulate allergic sensitisation. These suggestions derive from retrospective epidemiological analyses and will remain speculative unless they can be confirmed in prospective studies, particularly as conflicting findings have been reported. However, there is a potentially more important issue surfacing in this debate, which entails the converse situation, i.e. that genetic risk for atopy influences capacity to respond to vaccination during infancy. Support for the latter possibility comes from recent studies on the role of developmental factors which determine immune competence during infancy, and attendant risk for inflammatory and infectious diseases. The relevant findings are reviewed briefly below.
Collapse
Affiliation(s)
- P G Holt
- Telethon Institute for Child Health Research, and Centre for Child Health Research, The University of Western Australia, P.O. Box 855, Perth,WA 6872, Australia.
| | | | | | | |
Collapse
|
35
|
Abstract
Bereavement is a risk factor for a wide range of well-documented negative outcomes. As such, a range of sensitive and appropriate interventions are needed to support people adjusting to their new roles and change in identity. Writing has proven to be useful for people adjusting to traumatic experiences. Translating experiences into language and constructing a coherent narrative of the event enables thoughts and feelings to be integrated, leading to a sense of resolution and less negative feelings associated with the experience. Using a writing therapy intervention tailored specifically for bereaved individuals in Western Australia, this study asked: "Does a writing therapy intervention reduce grief, lead to greater health and wellbeing and lead to greater self care for bereaved individuals?" The results indicate that for grief and General Health Questionnaire-30 (GHQ-30) scores there was an overall improvement for all participants regardless of whether participants received the intervention or not. The results for the effect of writing therapy on self-care demonstrate that there is a greater increase in self-care for the intervention group than for the control group; however, this trend does not reach statistical significance. Writing therapy offers a useful, cost-effective, and private way of supporting bereaved individuals who may not practice self-care. The main limitation of the current research is the low number of participants, which limits the generalizability of the results. Future research could be directed toward evaluating the intervention for recently bereaved people or those identified by screening as being particularly vulnerable.
Collapse
Affiliation(s)
- Moira O'Connor
- School of Psychology, Edith Cowan University, Western Australia.
| | | | | | | | | |
Collapse
|
36
|
Rowe J, Macaubas C, Monger T, Holt BJ, Harvey J, Poolman JT, Loh R, Sly PD, Holt PG. Heterogeneity in diphtheria-tetanus-acellular pertussis vaccine-specific cellular immunity during infancy: relationship to variations in the kinetics of postnatal maturation of systemic th1 function. J Infect Dis 2001; 184:80-8. [PMID: 11398113 DOI: 10.1086/320996] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2000] [Revised: 03/29/2001] [Indexed: 11/04/2022] Open
Abstract
Cellular immunity to vaccines is highly variable during infancy. This study addressed the hypothesis that these responses are governed by the pace of maturational changes in adaptive immune competence, in particular, cellular functions that underlie the postnatal transition from Th2 to Th1 "bias." Tetanus-specific cytokine responses were tracked in peripheral blood mononuclear cells collected from infants at months 2, 4, 6, 12, and 18. These were compared with polyclonal responses. Results show that the Th2 component of the vaccine response develops rapidly and remains stable, unlike interferon (IFN)-gamma production, which also is initiated early but commonly declines after the final priming dose at 6 months. However, between 12 and 18 months, the IFN-gamma component of the vaccine-specific response has a spontaneous resurgence that coincides with a parallel increase in overall IFN-gamma production capacity. The Th2 component of vaccine-specific responses was more prominent in children with atopic family history.
Collapse
Affiliation(s)
- J Rowe
- TVW Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Holt PG, Rudin A, Macaubas C, Holt BJ, Rowe J, Loh R, Sly PD. Development of immunologic memory against tetanus toxoid and pertactin antigens from the diphtheria-tetanus-pertussis vaccine in atopic versus nonatopic children. J Allergy Clin Immunol 2000; 105:1117-22. [PMID: 10856144 DOI: 10.1067/mai.2000.105804] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent findings suggest that a hallmark of the atopic phenotype is reduced capacity to respond to vaccine antigens, as well as to environmental allergens, during infancy. This deficiency, which is most marked for the cytokine IFN-gamma, appears transient but can result in a long-lasting imbalance within T helper cell (T(H)) memory responses to allergens. Indirect evidence suggests that parallel effects may occur within immunologic memory responses against vaccine antigens in atopic children. OBJECTIVE Our purpose was to compare vaccine antigen-specific T(H) memory responses in atopic and nonatopic children. METHODS We analyzed specific serum IgG and cytokine responses to pertactin and tetanus antigens as well as to mitogen (PHA) and house dust mite (HDM) allergen in 25 HDM-sensitized atopic and 25 nonatopic 6-year-old children who were vaccinated and boosted with diphtheria-tetanus-pertussis (DTP) vaccine. RESULTS PBMCs from the atopic subjects produced higher levels of T(H)1 and T(H)2 cytokines to HDM allergen and PHA. Vaccine antibody titers were normal in the atopic subjects; vaccine-specific T(H)2 responses were rarely detectable, yet T(H)1 (IFN-gamma) responses, in particular against tetanus, were frequent and higher in the atopic subjects (121.5 [SE 64.3] vs 8.0 [3.5] pg/mL culture fluid, P =.04). Corresponding pertactin responses were comparable in both groups. CONCLUSIONS At the completion of the full primer-booster DTP vaccination regimen, levels of vaccine-specific immunity in atopic 6-year-old children are at least equivalent to their nonatopic counterparts, indicating that the transient atopy-associated deficiency in T(H)1 function in childhood can be successfully overcome by appropriate vaccination and boosting regimens.
Collapse
Affiliation(s)
- P G Holt
- Departments of Microbiology and Paediatrics, University of Western Australia
| | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
PURPOSE To compare the incidence of anterior intraocular lens (IOL) precipitates on silicone and poly(methyl methacrylate) (PMMA) IOLs after phacotrabeculetomy. SETTING District general hospital in the United Kingdom. METHODS Ninety-five consecutive eyes of 77 patients who had combined phacotrabeculectomy between April 1992 and October 1996 were retrospectively studied. A slitlamp biomicroscope was used to look for precipitates. RESULTS Mean patient age was 75 years (range 51 to 89 years). Preoperatively, mean intraocular pressure (IOP) was 26 mm Hg +/- 5.26 (SD). Thirty plate-haptic silicone IOLs and 65 PMMA IOLs were implanted. Six months postoperatively, median corrected Snellen acuity improved from 6/18 to 6/9. The mean number of antiglaucoma medications dropped from 1.46 preoperatively to 0.29 postoperatively; 73 eyes (76.8%) had an IOP of less than 22 mm Hg with no medication. In 1 surgeon's experience, lens precipitates appeared in 10 of 59 cases (16.9%), with 7 of 14 (50.0%) in the silicone IOL group and 3 of 45 (6.7%) in the PMMA IOL group. The difference was statistically significant (P <.001, chi-square). CONCLUSION The incidence of anterior IOL precipitates was significantly higher in patients with a silicone IOL than in those with a PMMA IOL, suggesting that use of silicone IOLs may increase the incidence of postoperative IOL precipitates.
Collapse
Affiliation(s)
- B Y Chang
- Department of Ophthalmology, Bradford Royal Infirmary, Bradford, United Kingdom
| | | | | | | |
Collapse
|
39
|
Meissner HC, Groothuis JR, Rodriguez WJ, Welliver RC, Hogg G, Gray PH, Loh R, Simoes EA, Sly P, Miller AK, Nichols AI, Jorkasky DK, Everitt DE, Thompson KA. Safety and pharmacokinetics of an intramuscular monoclonal antibody (SB 209763) against respiratory syncytial virus (RSV) in infants and young children at risk for severe RSV disease. Antimicrob Agents Chemother 1999; 43:1183-8. [PMID: 10223933 PMCID: PMC89130 DOI: 10.1128/aac.43.5.1183] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/1998] [Accepted: 02/25/1999] [Indexed: 11/20/2022] Open
Abstract
We conducted a multicenter, double-blind, placebo-controlled, randomized trial of a humanized monoclonal antibody against a respiratory syncytial virus (RSV) fusion protein (SB 209763) to evaluate its safety, pharmacokinetics, and fusion inhibition and neutralization titers. Forty-three infants who were either delivered prematurely (=35 weeks' gestation) or exhibited bronchopulmonary dysplasia were administered either single or repeat (two doses, 8 weeks apart) intramuscular injections of SB 209763 at a concentration of 0.25, 1.25, 5.0, or 10.0 mg/kg or of a placebo. Four of 229 adverse events were considered related to the study drug, including purpura (n = 3) and thrombocytosis (n = 1). No subject developed a detectable level of anti-SB 209763 antibody. Approximately 1 week after administration of the second dose of SB 209763 at 10 mg/kg, the mean plasma concentration (n = 9) was 68.5 micrograms/ml. The terminal half-life (T1/2) determined by noncompartmental analysis ranged from 22 to 50 days. The population pharmacokinetics for SB 209763 following intramuscular administration was appropriately described by a one-compartment model with first-order input and elimination. Higher values for clearance and volume of distribution at steady state were observed for younger patients, with values decreasing to 0.143 (ml/h)/kg and 161 mL/kg, respectively, by a mean age of 298 days (approximately 10 months). The mean T1/2 of SB 209763 for the study population was 32.5 days. No other factor (dose, weight, gender, race, premature birth, or bronchopulmonary dysplasia) was observed to alter the population pharmacokinetics of SB 209763 in this study of infants and young children. The mean neutralization titer on day 6 was 286, and the mean fusion inhibition titer was 36. At least 57% of subjects dosed at 1.25 to 10.0 mg of SB 209763 per kg of body weight who were seronegative at baseline experienced a fourfold or greater increase in fusion inhibition titer. Nine RSV infections were documented during the 16-week course of the study; the numbers of RSV infections were similar for the different regimens, including the placebo. The doses of SB 209763 studied may have been insufficient to confer protection against RSV lower respiratory tract disease; these results suggest that additional trials using higher doses of monoclonal antibody for immunoprophylaxis should be considered.
Collapse
Affiliation(s)
- H C Meissner
- Department of Pediatrics, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Prescott SL, Macaubas C, Smallacombe T, Holt BJ, Sly PD, Loh R, Holt PG. Reciprocal age-related patterns of allergen-specific T-cell immunity in normal vs. atopic infants. Clin Exp Allergy 1998; 28 Suppl 5:39-44; discussion 50-1. [PMID: 9988446 DOI: 10.1046/j.1365-2222.1998.028s5039.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
By adulthood there is almost universal immunological memory to aeroallergens, and the presence of allergic disease appears to be related to the nature of the underlying T-helper (Th) cell cytokine responses. The hypothesis of this study is that adult patterns of allergen specific Th-cell memory (Th-2 polarized in atopics vs. Th1 in non-atopics) can be determined in early infancy. Mononuclear cell cytokine responses to house-dust mite were measured at 6-monthly intervals from birth to 2 years of age, using ELISA (IL-10, IL-13, IFN-gamma) and sqRT/PCR (IL-4, IL-5, IL-9, IFN-gamma) in normal infants (n = 14) with no family history or allergic symptoms, and infants with a family history and definite atopy by 2 years (n = 16). Both normals and atopics showed low-level Th2 skewed allergen-specific responses at birth with little accompanying IFN-gamma. The Th2 responses to house-dust mite were higher in normal newborns, who then show a rapid downregulation of these responses in the first year of life. Atopic infants instead show a consolidation of their neonatal patterns of Th2 polarized allergen specific immunity. Earlier studies indicate that neonates at high risk of atopy display diminished capacity for production of the Th1 cytokine IFN-gamma. The present study suggests for the first time that neonates who subsequently develop atopy also initially have reduced capacity to mount Th2 responses. However, in contrast to non-atopics who selectively downregulate their fetal Th2 polarized allergen-specific responses, atopic children display age-associated upregulation of Th2 immunity.
Collapse
Affiliation(s)
- S L Prescott
- TVW Telethon Institute for Child Health Research, West Perth, Western Australia, Australia
| | | | | | | | | | | | | |
Collapse
|
41
|
Prescott SL, Macaubas C, Holt BJ, Smallacombe TB, Loh R, Sly PD, Holt PG. Transplacental priming of the human immune system to environmental allergens: universal skewing of initial T cell responses toward the Th2 cytokine profile. J Immunol 1998; 160:4730-7. [PMID: 9590218] [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: 02/07/2023]
Abstract
The expression of Th2-skewed immunity against soluble protein Ags present in the normal environment is recognized as the primary cause of allergic inflammation in atopics. In contrast, nonallergic normal individuals display low level Th1-skewed immunity against the same Ags ("allergens"), which is perceived as conferring protection against Th2-dependent allergic sensitization. The type of T cell memory that develops against these Ags is currently believed to be the result of complex interactions between environmental and genetic susceptibility factors, which occur postnatally when the naive immune system directly confronts the outside environment. The results of the present study challenge this general concept. We demonstrate here for the first time that Th2-skewed responses to common environmental allergens, comprising IL-4, IL-5, IL-6, IL-9, and IL-13, are present in virtually all newborn infants and are dominated by high level production of IL-10. Moreover, these responses are demonstrable within 24 h of culture initiation, arguing against a significant contribution from covert in vitro T cell priming and/or differentiation. These findings imply that the key etiologic factor in atopic disease may not be the initial acquisition of allergen-specific Th2-skewed immunity per se, but instead may be the efficiency of immune deviation mechanisms, which in normal (nonatopic) individuals redirect these fetal immune responses toward the Th1 cytokine phenotype.
Collapse
Affiliation(s)
- S L Prescott
- Division of Cell Biology, TVW Telethon Institute for Child Health Research, Perth, Western Australia, Australia
| | | | | | | | | | | | | |
Collapse
|
42
|
Prescott SL, Macaubes C, Yabuhara A, Venaille TJ, Holt BJ, Habre W, Loh R, Sly PD, Holt PG. Developing patterns of T cell memory to environmental allergens in the first two years of life. Int Arch Allergy Immunol 1997; 113:75-9. [PMID: 9130488 DOI: 10.1159/000237512] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Several recent studies have demonstrated cord blood mononuclear cell (CBMC) proliferation in response to food and inhalant allergens, suggesting that initial T-cell-priming may occur in utero. The findings below from an ongoing prospective study on 60 subjects provide initial information on the nature of accompanying T cell cytokine responses. We demonstrate CBMC proliferation following culture with house dust mite and ovalbumin (OVA) in 47 and 42% of subjects, respectively, compared to an overall rate of 3% for tetanus toxoid; the frequencies of these responses were comparable in neonates with and without atopic family history (FH). With the exception of IL-10, analysis of cytokine responses in allergen-stimulated cultures of CBMCs required the use of semiquantitative RT-PCR, which revealed low-level IL-4 and/or IL-5 mRNA production, in particular a 50% IL-5 response rate to OVA in FH-positive neonates. IFN-gamma responses were less frequent and required higher PCR cycle numbers for detection. Preliminary analysis of culture supernatants from a subgroup of CBMCs indicate high-level allergen-specific IL-10 responses in both FH-negative and -positive subjects, detectable by ELISA. Parallel PCR studies on MCs from 27 children (mean age 18 months) indicated a clear segregation at this age on the basis of FH, with Th0-like or mixed Th1/Th2 responses (IL-5 plus IFN-gamma) which were mainly restricted to the FH-positive group.
Collapse
Affiliation(s)
- S L Prescott
- Division of Cell Biology, TVW Telethon Institute for Child Health Research, West Perth, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Ziegler JB, Blanche S, Loh R. Managing HIV. Part 6: People living with HIV. 6.3 Children with HIV. Med J Aust 1996; 164:672-9. [PMID: 8657032] [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
Sometimes the diagnosis of HIV in a child is the first sign that other family members are affected by the virus. The immature immune system of children responds to HIV infection differently to that of adults. Disease progression is rapid in some, but most progress to AIDS at a similar or slower rate than do adults. A lack of developed immunity to various pathogens means that children are at special risk of opportunistic infection, demanding alert clinical management.
Collapse
Affiliation(s)
- J B Ziegler
- Department of Immunology and Allergy, Sydney Children's Hospital, NSW
| | | | | |
Collapse
|
44
|
Jabara HH, Loh R, Ramesh N, Vercelli D, Geha RS. Sequential switching from mu to epsilon via gamma 4 in human B cells stimulated with IL-4 and hydrocortisone. The Journal of Immunology 1993. [DOI: 10.4049/jimmunol.151.9.4528] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
The molecular events leading to IgE synthesis in human B cells stimulated with IL-4 and hydrocortisone were analyzed. IL-4, but not hydrocortisone, induced C epsilon germ line transcription. However, hydrocortisone increased the levels of IL-4-induced germ line C epsilon transcripts by twofold and delivered the signal required for transcription of mature C epsilon mRNA. Nested primer polymerase chain reaction of high m.w. DNA revealed deletional switch recombination occurring in B cells sorted for lack of expression of surface IgE and stimulated with both IL-4 and hydrocortisone, but not in B cells stimulated with IL-4 alone or hydrocortisone alone. DNA sequence analysis of 10 switch fragments revealed direct joining of S mu to S epsilon in eight fragments, one of which exhibited an 876-bp deletion in S mu. The ninth fragment contained a 50-bp insertion at the S mu/S epsilon junction, which was likely to be derived from S gamma 4. The sequence of the 10th fragment was consistent with either a 17-bp insertion at the S mu/S epsilon junction derived from S gamma 4 or with a complex 38-bp deletion within S epsilon. Mapping of the switch junction sites showed "hot spots" for recombination within S mu but not within S epsilon. These findings indicate that hydrocortisone induces S mu-S epsilon deletional switch recombination in IL-4-treated B cells, and support a model of sequential isotype switching from IgM to IgE via IgG4.
Collapse
Affiliation(s)
- H H Jabara
- Division of Immunology, Children's Hospital, Boston, MA 02115
| | - R Loh
- Division of Immunology, Children's Hospital, Boston, MA 02115
| | - N Ramesh
- Division of Immunology, Children's Hospital, Boston, MA 02115
| | - D Vercelli
- Division of Immunology, Children's Hospital, Boston, MA 02115
| | - R S Geha
- Division of Immunology, Children's Hospital, Boston, MA 02115
| |
Collapse
|
45
|
Jabara HH, Loh R, Ramesh N, Vercelli D, Geha RS. Sequential switching from mu to epsilon via gamma 4 in human B cells stimulated with IL-4 and hydrocortisone. J Immunol 1993; 151:4528-33. [PMID: 8409416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The molecular events leading to IgE synthesis in human B cells stimulated with IL-4 and hydrocortisone were analyzed. IL-4, but not hydrocortisone, induced C epsilon germ line transcription. However, hydrocortisone increased the levels of IL-4-induced germ line C epsilon transcripts by twofold and delivered the signal required for transcription of mature C epsilon mRNA. Nested primer polymerase chain reaction of high m.w. DNA revealed deletional switch recombination occurring in B cells sorted for lack of expression of surface IgE and stimulated with both IL-4 and hydrocortisone, but not in B cells stimulated with IL-4 alone or hydrocortisone alone. DNA sequence analysis of 10 switch fragments revealed direct joining of S mu to S epsilon in eight fragments, one of which exhibited an 876-bp deletion in S mu. The ninth fragment contained a 50-bp insertion at the S mu/S epsilon junction, which was likely to be derived from S gamma 4. The sequence of the 10th fragment was consistent with either a 17-bp insertion at the S mu/S epsilon junction derived from S gamma 4 or with a complex 38-bp deletion within S epsilon. Mapping of the switch junction sites showed "hot spots" for recombination within S mu but not within S epsilon. These findings indicate that hydrocortisone induces S mu-S epsilon deletional switch recombination in IL-4-treated B cells, and support a model of sequential isotype switching from IgM to IgE via IgG4.
Collapse
Affiliation(s)
- H H Jabara
- Division of Immunology, Children's Hospital, Boston, MA 02115
| | | | | | | | | |
Collapse
|
46
|
Fuleihan R, Ramesh N, Loh R, Jabara H, Rosen RS, Chatila T, Fu SM, Stamenkovic I, Geha RS. Defective expression of the CD40 ligand in X chromosome-linked immunoglobulin deficiency with normal or elevated IgM. Proc Natl Acad Sci U S A 1993; 90:2170-3. [PMID: 7681587 PMCID: PMC46047 DOI: 10.1073/pnas.90.6.2170] [Citation(s) in RCA: 282] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
B lymphocytes from patients with X chromosome-linked immunoglobulin deficiency with normal or elevated serum IgM are unable to switch from the synthesis of IgM/IgD to that of other immunoglobulin isotypes. Isotype switch recombination was evaluated in three affected males by examining interleukin 4-driven IgE synthesis. T-cell-dependent IgE synthesis was completely absent in the B lymphocytes of the patients. In contrast, CD40 mAb plus interleukin 4 induced the patients' B cells to synthesize IgE and to undergo deletional switch recombination. Because interaction between CD40 and its ligand on activated T cells is critical for T-cell-driven isotype switching, we examined CD40 ligand expression. In contrast to normal T cells, lymphocytes from the patients expressed no detectable CD40 ligand on their surface after stimulation with phorbol 12-myristate 13-acetate and ionomycin, although the mRNA of the ligand was expressed normally. These results suggest that defective expression of the CD40 ligand underlies the failure of isotype switching in this disease.
Collapse
Affiliation(s)
- R Fuleihan
- Division of Immunology, Children's Hospital, Boston, MA
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Epstein JB, Loh R, Stevenson-Moore P, McBride BC, Spinelli J. Chlorhexidine rinse in prevention of dental caries in patients following radiation therapy. Oral Surg Oral Med Oral Pathol 1989; 68:401-5. [PMID: 2797737 DOI: 10.1016/0030-4220(89)90136-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Patients who receive cancer radiotherapy, which compromises salivary gland function, may develop xerostomia. These patients are at increased risk to develop rampant dental caries. Streptococcus mutans and species of lactobacillus have been associated with dental caries. Quantitative counts of these organisms demonstrated high caries risk in 85% of patients studied. The use of chlorhexidine rinse to reduce the counts of S. mutans and lactobacillus was studied. A modest reduction in S. mutans was seen, but little effect was demonstrated on lactobacillus counts. Caries activity was shown to be related to lactobacillus count.
Collapse
Affiliation(s)
- J B Epstein
- Cancer Control Agency of British Columbia, Vancouver, Canada
| | | | | | | | | |
Collapse
|
48
|
Abstract
A 5-month-old infant presented with high fever, irritability, and poor feeding. Examination revealed an enlarged liver and neutropaenia. Ultrasonography was unhelpful, but a diagnosis of liver abscess was confirmed by computed tomography on day 4 of the illness. Gallium scan was normal on day 4 but showed a resolving liver abscess on day 6. Staphylococcus aureus was grown in blood culture. The infant recovered with antibiotic treatment alone.
Collapse
|