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Vu VA, Bhayana S, Sweiss H, Castro N, Hall R, Nelson J. Impact of Cumulative 6 mg/kg Antithymocyte Globulin on Early Posttransplant Outcomes in Kidney Transplant Recipients with Delayed Graft Function. Prog Transplant 2024; 34:47-52. [PMID: 38465633 PMCID: PMC11080378 DOI: 10.1177/15269248241237816] [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] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Introduction: Delayed graft function in kidney transplant is associated with an increased risk of rejection and graft loss. Use of rabbit antithymocyte globulin induction in delayed graft function has been correlated with less rejection compared to basiliximab, but optimal dosing remains unknown. Program Evaluation Aims: The purpose of this evaluation was to retrospectively assess the short-term effectiveness and tolerability of a clinical protocol that increased the net state of immunosuppression in delayed graft function kidney transplant recipients using cumulative 6 mg/kg rabbit antithymocyte globulin induction. Design: This retrospective cohort included 88 kidney transplant recipients with delayed graft function, transplanted between January 2017 and March 2021, who either received cumulative 4.5 mg/kg pre-protocol or 6 mg/kg post-protocol rabbit antithymocyte globulin. Outcomes evaluated were biopsy-proven acute rejection and incidence of graft loss, infection, and cytopenia at 6 months. Results: A significant reduction of biopsy-proven acute rejection incidence occurred post-protocol implementation (10/33, 30.3% vs 6/55, 10.9%; P = .04). Of those with rejection, significantly less post-protocol patients were classified as acute cellular rejection (9/10, 90.0% vs 2/6, 33.3%; P = .04). No death-censored graft loss was observed in either group. Rates of cytopenia and infection were similar pre- versus post-protocol implementation. Conclusion: Increasing the exposure to rabbit antithymocyte globulin and maintenance immunosuppression in delayed graft function kidney transplant recipients was tolerable and significantly reduced rejection occurrence at 6 months.
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Affiliation(s)
- Van Anh Vu
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA
- College of Pharmacy, Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health Transplant Institute, San Antonio, TX, USA
| | - Suverta Bhayana
- University Health Transplant Institute, San Antonio, TX, USA
- Department of Nephrology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Helen Sweiss
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA
- College of Pharmacy, Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health Transplant Institute, San Antonio, TX, USA
| | - Nohely Castro
- Pharmacy Services, Children's Health, Dallas, TX, USA
| | - Reed Hall
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA
- College of Pharmacy, Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health Transplant Institute, San Antonio, TX, USA
| | - Joelle Nelson
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA
- College of Pharmacy, Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health Transplant Institute, San Antonio, TX, USA
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Kenway S, Pamminger F, Yan G, Hall R, Lam K, Skinner R, Olsson G, Satur P, Allan J. Opportunities and challenges of tackling Scope 3 "Indirect" emissions from residential hot water. Water Res X 2023; 21:100192. [PMID: 37693826 PMCID: PMC10485153 DOI: 10.1016/j.wroa.2023.100192] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023]
Abstract
The water sector could play a major role towards a Net Zero greenhouse gas (GHG) future if Scope 3 emissions were embraced and operationalised. Significant opportunities and challenges exist in tackling Scope 3 emissions including those associated with customer hot water use. Present GHG emission reduction practices predominantly focus on Scope 1 "within utility" and Scope 2 "purchased energy" emissions. In the urban water cycle, Scope 3 "indirect" emissions dominate, and water use is only one example of Scope 3 emissions. Over 90% of all water cycle GHG emissions can be attributed to water use in residential, industrial and commercial premises, collectively some 7% of global GHG emissions. One possibility is for water utilities to actively support efficient hot water use such as new ultra-low flow shower heads. Scope 3 opportunities also offer a range of cost-effective emissions-reduction opportunities, particularly when the wider perspective of "community value" is considered and not just a "business financial perspective". Hot water efficiency is additionally essential to Net Zero carbon futures, even with decarbonised grids, because most major Net Zero roadmaps require energy efficiency gains. Scientific and management advance needed includes: accounting methodologies, clear roles, collaboration, new business models, and clear definitions. The water sector has the opportunity to play a significant role in achieving Net Zero cities. The decision how much is yet to be made.
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Affiliation(s)
- S.J. Kenway
- Australian Centre for Water and Environmental Biotechnology, The University of Queensland, St. Lucia, QLD 4067, Australia
| | | | - G. Yan
- Australian Centre for Water and Environmental Biotechnology, The University of Queensland, St. Lucia, QLD 4067, Australia
| | - R. Hall
- Australian Centre for Water and Environmental Biotechnology, The University of Queensland, St. Lucia, QLD 4067, Australia
| | - K.L. Lam
- Division of Natural and Applied Sciences, Duke Kunshan University, Kunshan, Jiangsu 215316, China
| | - R. Skinner
- Monash Sustainable Development Institute, Monash University, Clayton, Australia
| | - G. Olsson
- Division of Industrial Electrical Engineering and Automation (IEA), Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - P. Satur
- Monash Sustainable Development Institute, Monash University, Clayton, Australia
| | - J. Allan
- Australian Centre for Water and Environmental Biotechnology, The University of Queensland, St. Lucia, QLD 4067, Australia
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Sweiss H, Hall R, Bhayana S, Patel R, Flores M, Long C. Novel Pharmacy Model: Pharmacy Diabetes Clinic in Abdominal Transplant Recipients. Diabetes Spectr 2023; 37:170-174. [PMID: 38756424 PMCID: PMC11093761 DOI: 10.2337/ds23-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Helen Sweiss
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, TX
- University Health Transplant Institute, University Health System, San Antonio, TX
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX
- Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, TX
| | - Reed Hall
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, TX
- University Health Transplant Institute, University Health System, San Antonio, TX
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX
- Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, TX
| | - Suverta Bhayana
- University Health Transplant Institute, University Health System, San Antonio, TX
- Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Rupal Patel
- University Health Transplant Institute, University Health System, San Antonio, TX
- Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Marcus Flores
- The University of Incarnate Word, Feik School of Pharmacy, San Antonio, TX
| | - Christina Long
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, TX
- University Health Transplant Institute, University Health System, San Antonio, TX
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX
- The University of Incarnate Word, Feik School of Pharmacy, San Antonio, TX
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Deane AM, Alhazzani W, Guyatt G, Finfer S, Marshall JC, Myburgh J, Zytaruk N, Hardie M, Saunders L, Knowles S, Lauzier F, Chapman MJ, English S, Muscedere J, Arabi Y, Ostermann M, Venkatesh B, Young P, Thabane L, Billot L, Heels-Ansdell D, Al-Fares AA, Hammond NE, Hall R, Rajbhandari D, Poole A, Johnson D, Iqbal M, Reis G, Xie F, Cook DJ. REVISE: Re- Evaluating the Inhibition of Stress Erosions in the ICU: a randomised trial protocol. BMJ Open 2023; 13:e075588. [PMID: 37968012 PMCID: PMC10660838 DOI: 10.1136/bmjopen-2023-075588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The Re-Evaluating the Inhibition of Stress Erosions (REVISE) Trial aims to determine the impact of the proton pump inhibitor pantoprazole compared with placebo on clinically important upper gastrointestinal (GI) bleeding in the intensive care unit (ICU), 90-day mortality and other endpoints in critically ill adults. The objective of this report is to describe the rationale, methodology, ethics and management of REVISE. METHODS AND ANALYSIS REVISE is an international, randomised, concealed, stratified, blinded parallel-group individual patient trial being conducted in ICUs in Canada, Australia, Saudi Arabia, UK, US, Kuwait, Pakistan and Brazil. Patients≥18 years old expected to remain invasively mechanically ventilated beyond the calendar day after enrolment are being randomised to either 40 mg pantoprazole intravenously or an identical placebo daily while mechanically ventilated in the ICU. The primary efficacy outcome is clinically important upper GI bleeding within 90 days of randomisation. The primary safety outcome is 90-day all-cause mortality. Secondary outcomes include rates of ventilator-associated pneumonia, Clostridioides difficile infection, new renal replacement therapy, ICU and hospital mortality, and patient-important GI bleeding. Tertiary outcomes are total red blood cells transfused, peak serum creatinine level in the ICU, and duration of mechanical ventilation, ICU and hospital stay. The sample size is 4800 patients; one interim analysis was conducted after 2400 patients had complete 90-day follow-up; the Data Monitoring Committee recommended continuing the trial. ETHICS AND DISSEMINATION All participating centres receive research ethics approval before initiation by hospital, region or country, including, but not limited to - Australia: Northern Sydney Local Health District Human Research Ethics Committee and Mater Misericordiae Ltd Human Research Ethics Committee; Brazil: Comissão Nacional de Ética em Pesquisa; Canada: Hamilton Integrated Research Ethics Board; Kuwait: Ministry of Health Standing Committee for Coordination of Health and Medical Research; Pakistan: Maroof Institutional Review Board; Saudi Arabia: Ministry of National Guard Health Affairs Institutional Review Board: United Kingdom: Hampshire B Research Ethics Committee; United States: Institutional Review Board of the Nebraska Medical Centre. The results of this trial will inform clinical practice and guidelines worldwide. TRIAL REGISTRATION NUMBER NCT03374800.
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Affiliation(s)
- Adam M Deane
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Waleed Alhazzani
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Simon Finfer
- Critical Care Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - John C Marshall
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - John Myburgh
- Critical Care Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Nicole Zytaruk
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Miranda Hardie
- Critical Care Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Lois Saunders
- Research Institute, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Serena Knowles
- Critical Care Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Francois Lauzier
- Departments of Anesthesiology, Medicine & Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval, Laval, Quebec, Canada
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shane English
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada
| | - Yaseen Arabi
- Intensive Care Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | | | - Paul Young
- Intensive Care Department, Wellington Hospital, London, UK
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Laurent Billot
- Statistics Division, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Abdulrahman A Al-Fares
- Departments of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Naomi E Hammond
- Critical Care Medicine, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - R Hall
- Departments of Anesthesia, Critical Care and Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dorrilyn Rajbhandari
- Critical Care Medicine, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Alexis Poole
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Daniel Johnson
- Departments of Critical Care and Anesthesia, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mobeen Iqbal
- Intensive Care Department, Maroof International Hospital, Islamabad, Pakistan
| | - Gilmar Reis
- Cardresearch-Cardiologia Assistencial e de Pesquisa LTDA, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Feng Xie
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
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Sweiss H, Selznick L, Contreras J, Long C, Hall R, Bhayana S, Patel R, Klein K. Safety and Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Solid Organ Transplant Recipients. Prog Transplant 2023; 33:261-265. [PMID: 37491859 DOI: 10.1177/15269248231189880] [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] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) may be effective in reducing body weight and hemoglobin A1c (HbA1c) post-kidney transplantation. Limited literature exists on use of these agents outside of kidney transplant. The purpose of this program evaluation was to evaluate the safety and efficacy of SGLT2i in kidney, liver, and lung transplant recipients. Methods: This was a retrospective program evaluation of adult kidney, liver, and lung transplant recipients between August 31, 2016 and July 31, 2021. Patients initiated on SGLT2i for diabetes for a minimum of 90 days with at least 1 follow-up appointment were screened for inclusion. Outcomes were compared between SGLT2i initiation to nadir values 3-12-months post-initiation. Outcomes included change in hemoglobin A1c, fasting blood glucose, actual body weight, and body mass index. Safety outcomes included adverse effects, cardiovascular events, death-censored graft loss, and all-cause mortality. Results: Forty-nine patients met inclusion criteria, (26 liver, 18 kidney, 4 lung, and 1 simultaneous liver-kidney recipient). The median time from transplant to SGLT2i initiation was 1216 days (IQR 524-2256). Glycemic and weight loss outcomes showed a statistically significant benefit from SGLT2i use. Total safety outcome incidence was minimal at 12 months. No patient experienced myocardial infarctions, graft loss, or mortality at 3-12 months. One incidence of urinary tract infection and stroke occurred each. The most common adverse effects included hypotension and hypoglycemia. Conclusion: This program evaluation demonstrated that SGLT2i can be used safely in solid organ transplant recipients. These agents can provide an additional non-insulin agent for post-transplant diabetes mellitus management in solid organ transplant.
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Affiliation(s)
- Helen Sweiss
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA
- University Health Transplant Institute, University Health System, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Leah Selznick
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA
- University Health Transplant Institute, University Health System, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Jillian Contreras
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA
- University Health Transplant Institute, University Health System, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Christina Long
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA
- University Health Transplant Institute, University Health System, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Feik School of Pharmacy, The University of Incarnate Word, San Antonio, TX, USA
| | - Reed Hall
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA
- University Health Transplant Institute, University Health System, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Suverta Bhayana
- University Health Transplant Institute, University Health System, San Antonio, TX, USA
- Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Rupal Patel
- University Health Transplant Institute, University Health System, San Antonio, TX, USA
- Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kelsey Klein
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA
- University Health Transplant Institute, University Health System, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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Gentzler R, Mohindra N, Jalal S, Reckamp K, Hall R, Hanna N, Chae Y, Koczywas M, Helenowski I, Patel J. PP01.44 Long-Term Survival and Outcomes by Race from the Phase I/II trial of Carboplatin, Nab-paclitaxel, and Pembrolizumab for Advanced NSCLC: HCRN LUN13-175. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.070] [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: 01/30/2023]
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Sweiss H, Kincaide E, Levine D, Hall R. Effect of Isavuconazonium Sulfate and Posaconazole Delayed Release Tablets on Tacrolimus Dose-to-Concentration Ratios. Prog Transplant 2023; 33:90-94. [PMID: 36503331 DOI: 10.1177/15269248221145036] [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: 12/14/2022]
Abstract
INTRODUCTION Limited evidence exists on the effect of isavuconazonium sulfate and posaconazole delayed release tablets on tacrolimus dose-to-concentration ratios in lung transplant recipients. PROJECT AIMS The purpose of this evaluation was to assess the impact of novel triazoles on tacrolimus dose-to-concentration ratios. DESIGN This retrospective review included lung transplant recipient ≥18 years of age from January 1, 2017 to October 1, 2020 who received either posaconazole delayed release tablets or isavuconazonium sulfate for. A paired analysis evaluated outcomes pre-triazole and post-triazole initiation. RESULTS Forty-one patients met evaluation criteria for inclusion. A total of 34 of 41 patients received posaconazole delayed release tablets. Of these patients, 22 of 34 were transitioned from previous triazole to posaconazole delayed release tablets and experienced a 47% reduction in tacrolimus dose-to-concentration ratio. Twelve patients were newly initiated on posaconazole delayed release tablets and experienced a 50% reduction in tacrolimus dose-to-concentration ratios. Although not statistically significant, a 30% reduction in tacrolimus dose-to-concentration ratio was observed when transitioning to isavuconazonium sulfate from previous triazole therapy. CONCLUSION Limited data exists to provide guidance on tacrolimus dose adjustments with initiation and conversion of novel triazoles, however, this evaluation provides more knowledge on the drug interaction with novel triazoles and tacrolimus.
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Affiliation(s)
- Helen Sweiss
- Department of Pharmacotherapy & Pharmacy Services, 43159University Health System, San Antonio, TX, USA.,University Health Transplant Institute, 43159University Health System, San Antonio, TX, USA.,Pharmacotherapy Education and Research Center, 14742The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | - Elisabeth Kincaide
- Department of Pharmacotherapy & Pharmacy Services, 43159University Health System, San Antonio, TX, USA.,University Health Transplant Institute, 43159University Health System, San Antonio, TX, USA.,Pharmacotherapy Education and Research Center, 14742The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | - Deborah Levine
- University Health Transplant Institute, 43159University Health System, San Antonio, TX, USA.,Department of Medicine Pulmonology and Critical Care Medicine, 14742The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Reed Hall
- Department of Pharmacotherapy & Pharmacy Services, 43159University Health System, San Antonio, TX, USA.,University Health Transplant Institute, 43159University Health System, San Antonio, TX, USA.,Pharmacotherapy Education and Research Center, 14742The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
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Milling TJ, Middeldorp S, Xu L, Koch B, Demchuk A, Eikelboom JW, Verhamme P, Cohen AT, Beyer-Westendorf J, Michael Gibson C, Lopez-Sendon J, Crowther M, Shoamanesh A, Coppens M, Schmidt J, Albaladejo P, Connolly SJ, Bastani A, Clark C, Concha M, Cornell J, Dombrowski K, Fermann G, Fulmer J, Goldstein J, Kereiakes D, Milling T, Pallin D, Patel N, Refaai M, Rehman M, Schmaier A, Schwarz E, Shillinglaw W, Spohn M, Takata T, Venkat A, Welker J, Welsby I, Wilson J, Van Keer L, Verschuren F, Blostein M, Eikelboom J, Althaus K, Berrouschot J, Braun G, Doeppner T, Dziewas R, Genth-Zotz S, Greinacher P, Hamann F, Hanses F, Heide W, Kallmuenzer B, Kermer P, Poli S, Royl G, Schellong S, Schnupp S, Schwarze J, Spies C, Thomalla G, von Mering M, Weissenborn K, Wollenweber F, Gumbinger C, Jaschinski U, Maschke M, Mochmann HC, Pfeilschifter W, Pohlmann C, Zahn R, Bouzat P, Schmidt J, Vallejo C, Floccard B, Coppens M, van Wissen S, Arellano-Rodrigo E, Valles E, Alikhan R, Breen K, Hall R, Crowther M, Albaladejo P, Cohen A, Demchuk A, Schmidt J, Wyse D, Garcia D, Prins M, Nakamya J, Büller H, Mahaffey KW, Alexander JH, Cairns J, Hart R, Joyner C, Raskob G, Schulman S, Veltkamp R, Meeks B, Zotova E, Ahmad S, Pinto T, Baker K, Dykstra A, Holadyk-Gris I, Malvaso A, Demchuk A. Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors. Circulation 2023; 147:1026-1038. [PMID: 36802876 DOI: 10.1161/circulationaha.121.057844] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented. METHODS Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society of Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome. RESULTS There were 479 patients enrolled (mean age, 78 years; 54% male, 86% White; 81% anticoagulated for atrial fibrillation at a median time of 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94-93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95-93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82-65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79-67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75-84]). In the safety population, thrombotic events occurred in 50 patients (10%); in 16 patients, this occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54-0.70]) and correlated with lower mortality in patients <75 years of age (adjusted P=0.022; unadjusted P=0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors. CONCLUSIONS In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02329327.
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Affiliation(s)
- Truman J Milling
- Seton Dell Medical School Stroke Institute, Dell Medical School, University of Texas at Austin (T.J.M.)
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Nijmegenthe Netherlands (S.M.)
| | - Lizhen Xu
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Bruce Koch
- Alexion, AstraZeneca Rare Disease, BostonMA (B.K.)
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, AlbertaCanada (A.D.)
| | - John W Eikelboom
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, University of Leuven, Belgium (P.V.)
| | | | - Jan Beyer-Westendorf
- Department of Medicine I, Division of Hematology and Hemostasis, University Hospital Dresden, Germany (J.B-W.)
| | | | - Jose Lopez-Sendon
- Instituto de Investigación Hospital Universitario, La PazMadridSpain (J. L-S.)
| | - Mark Crowther
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Ashkan Shoamanesh
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (M. Coppens)
| | - Jeannot Schmidt
- Centre Hospitalier Universitaire de Clermont-Ferrand, France (J.S.)
| | | | - Stuart J Connolly
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
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9
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McPeake J, Blayney M, Stewart N, Kaye C, Chan Seem R, Hall R, Martin C, Paton M, Wise A, Puxty K, Lone N. COVID-19 infection and maternal morbidity in critical care units in Scotland: a national cohort study. Int J Obstet Anesth 2023; 53:103613. [PMID: 36564271 PMCID: PMC9715259 DOI: 10.1016/j.ijoa.2022.103613] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Previous research has shown that, in comparison with non-pregnant women of reproductive age, pregnant women with COVID-19 are more likely to be admitted to critical care, receive invasive ventilation, and die. At present there are limited data in relation to outcomes and healthcare utilisation following hospital discharge of pregnant and recently pregnant women admitted to critical care. METHODS A national cohort study of pregnant and recently pregnant women who were admitted to critical care in Scotland with confirmed or suspected COVID-19. We examined hospital outcomes as well as hospital re-admission rates. RESULTS Between March 2020 and March 2022, 75 pregnant or recently pregnant women with laboratory-confirmed COVID-19 were admitted to 24 Intensive Care Units across Scotland. Almost two thirds (n=49, 65%) were from the most deprived socio-economic areas. Complete 90-day acute hospital re-admission data were available for 74 (99%) patients. Nine (12%) women required an emergency non-obstetric hospital re-admission within 90 days. Less than 5% of the cohort had received any form of vaccination. CONCLUSIONS This national cohort study has demonstrated that pregnant or recently pregnant women admitted to critical care with COVID-19 were more likely to reside in areas of socio-economic deprivation, and fewer than 5% of the cohort had received any form of vaccination. More targeted public health campaigning across the socio-economic gradient is urgently required.
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Affiliation(s)
- J. McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, UK,Corresponding author at: Glasgow Royal Infirmary, 84 Castle St., Glasgow, G4 OSF, UK
| | - M.C. Blayney
- Usher Institute, University of Edinburgh, UK,Public Health Scotland, UK
| | | | | | | | | | | | | | | | - K. Puxty
- NHS Greater Glasgow and Clyde, UK,University of Glasgow, School of Medicine, Dentistry and Nursing, Scotland, UK
| | - N.I. Lone
- Usher Institute, University of Edinburgh, UK,NHS Lothian, Scotland, UK
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10
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Lock AE, Hand EO, Hall R, Robinson EE. Breaking Outside the Box: Use of Escape Rooms in Pharmacy Residency Interviews. J Am Coll Clin Pharm 2023. [DOI: 10.1002/jac5.1761] [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: 01/22/2023]
Affiliation(s)
- Ashley E. Lock
- Department of Pharmacotherapy and Pharmacy Services University Health San Antonio Texas USA
- The University of Texas at Austin, College of Pharmacy, Division of Pharmacotherapy Austin Texas USA
- UT Health San Antonio, Pharmacotherapy Education & Research Center San Antonio Texas USA
- UT Health San Antonio, Department of Emergency Medicine San Antonio Texas USA
| | - Elizabeth O. Hand
- Department of Pharmacotherapy and Pharmacy Services University Health San Antonio Texas USA
- The University of Texas at Austin, College of Pharmacy, Division of Pharmacotherapy Austin Texas USA
- UT Health San Antonio, Pharmacotherapy Education & Research Center San Antonio Texas USA
| | - Reed Hall
- Department of Pharmacotherapy and Pharmacy Services University Health San Antonio Texas USA
- The University of Texas at Austin, College of Pharmacy, Division of Pharmacotherapy Austin Texas USA
- UT Health San Antonio, Pharmacotherapy Education & Research Center San Antonio Texas USA
| | - Ellen E. Robinson
- Department of Pharmacotherapy and Pharmacy Services University Health San Antonio Texas USA
- The University of Texas at Austin, College of Pharmacy, Division of Pharmacotherapy Austin Texas USA
- UT Health San Antonio, Pharmacotherapy Education & Research Center San Antonio Texas USA
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11
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Sweiss H, Hall R, Zeilmann D, Escamilla J, Bhayana S, Patel R, Long C. Single-center Evaluation of Safety & Efficacy of Glucagon-Like Peptide-1 Receptor Agonists in Solid Organ Transplantation. Prog Transplant 2022; 32:357-362. [PMID: 36039519 DOI: 10.1177/15269248221122867] [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: 12/29/2022]
Abstract
Introduction: Given the negative outcomes associated with uncontrolled diabetes mellitus, non-insulin therapies with glycemic, cardiovascular, and weight-loss benefits in the general population, such as the glucagonlike peptide-1 receptor agonists (GLP1-RA) have become a more alluring therapeutic option in transplant populations. However, limited evidence exists to demonstrate its safety and efficacy in solid organ transplant. Methods: This program evaluation included adult kidney, liver, lung transplant recipients initiated on a GLP1-RA for diabetes mellitus management for a minimum of 3 months, had at least one follow-up visit after starting therapy, and had at least one hemoglobin A1c (HbA1c) level drawn between 3-12 months after GLP1-RA initiation. Outcomes were assessed at time of initiation of GLP1-RA (baseline) and 3-12 months post-initiation. Nadir values between 3-12 months were utilized to assess outcomes. Results: One-hundred eighteen patients met study inclusion criteria. Seventy-percent of patients received a kidney transplant, 19.5% received a liver transplant, and 6.8% received a lung transplant. A statistically significant difference was observed in median fasting blood glucose and HbA1c at baseline to 3-12-month nadir (P < 0.0001). A significant weight loss benefit was also observed. The rate of adverse drug reactions was low. Seven-percent of patients experienced nausea, 4.2% developed pancreatitis, and 7.1% reported having had at least one hypoglycemic event. Discussion: This is the largest study evaluating GLP1-RA in organ transplantation and demonstrates GLP1-RA is both safe and effective. Further assessment on long-term use of these agents on cardiovascular and renal outcomes is still needed.
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Affiliation(s)
- Helen Sweiss
- Department of Pharmacotherapy & Pharmacy Services, 43159University Health System, 4502 Medical Drive, San Antonio, 78229 TX, USA.,University Health Transplant Institute, 43159University Health System, 4502 Medical Drive, San Antonio, 78229 TX, USA.,Pharmacotherapy Education and Research Center, 14742The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, 78229 TX, USA.,Pharmacotherapy Division, 15528The University of Texas at Austin, College of Pharmacy, 2409 University Avenue, Austin, 78712 TX, USA
| | - Reed Hall
- Department of Pharmacotherapy & Pharmacy Services, 43159University Health System, 4502 Medical Drive, San Antonio, 78229 TX, USA.,University Health Transplant Institute, 43159University Health System, 4502 Medical Drive, San Antonio, 78229 TX, USA.,Pharmacotherapy Education and Research Center, 14742The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, 78229 TX, USA.,Pharmacotherapy Division, 15528The University of Texas at Austin, College of Pharmacy, 2409 University Avenue, Austin, 78712 TX, USA
| | - Dominik Zeilmann
- 130378The University of Incarnate Word, Feik School of Pharmacy, 703 E Hildebrand Avenue, San Antonio, 78212 TX, USA
| | - Jesus Escamilla
- 130378The University of Incarnate Word, Feik School of Pharmacy, 703 E Hildebrand Avenue, San Antonio, 78212 TX, USA
| | - Suverta Bhayana
- University Health Transplant Institute, 43159University Health System, 4502 Medical Drive, San Antonio, 78229 TX, USA.,Department of Nephrology, 14742The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, 78229 TX, USA
| | - Rupal Patel
- University Health Transplant Institute, 43159University Health System, 4502 Medical Drive, San Antonio, 78229 TX, USA.,Department of Nephrology, 14742The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, 78229 TX, USA
| | - Christina Long
- Department of Pharmacotherapy & Pharmacy Services, 43159University Health System, 4502 Medical Drive, San Antonio, 78229 TX, USA.,University Health Transplant Institute, 43159University Health System, 4502 Medical Drive, San Antonio, 78229 TX, USA.,Pharmacotherapy Education and Research Center, 14742The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, 78229 TX, USA.,130378The University of Incarnate Word, Feik School of Pharmacy, 703 E Hildebrand Avenue, San Antonio, 78212 TX, USA
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12
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Van Der Zande JA, Tutarel O, Ramlakhan KP, Johson MR, Hall R, Roos-Hesselink JW. Pregnancy outcomes in women with Ebstein's anomaly: data from the EORP Registry of Pregnancy and Cardiac Disease (ROPAC). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2596] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ebstein's anomaly is a rare congenital cardiac condition characterized by displacement of the posterior and septal leaflets of the tricuspid valve towards the apex of the right ventricle. The ESC Guidelines for the management of cardiovascular diseases during pregnancy categorize women with uncomplicated Ebstein's anomaly as modified World Health Organization (mWHO) risk class II. However, data regarding pregnancy outcomes in women with Ebstein's anomaly are scarce.
Purpose
To evaluate the maternal and perinatal risks of pregnancy in women with Ebstein's anomaly.
Methods
All patients with Ebstein's anomaly who had been included in the Registry of Pregnancy and Cardiac Disease (ROPAC), which is an international, prospective, observational registry of pregnant women with underlying cardiac disease (n=5739), were evaluated. The primary outcome was the occurrence of a major adverse cardiac event, defined as maternal mortality, heart failure, arrhythmia, thromboembolic events or endocarditis. The secondary outcomes were obstetric and perinatal outcomes and the influence of pregnancy on tricuspid valve regurgitation.
Results
Thirty-six hospitals in 22 countries enrolled 81 women with Ebstein's anomaly (mean age 29.7 years, 46.9% nulliparous). Seven (8.6%) women had a history of tricuspid valve repair and a further eight (9.9%) of tricuspid replacement. Most women (67.9%) were in NYHA class I. At least one major adverse cardiac event occurred in 8 (9.9%) pregnancies, including heart failure (n=6), supraventricular arrhythmia (n=3) and thromboembolic events (n=2). There was no maternal death. Almost half of the women underwent a Caesarean section (49%) and preterm delivery occurred in 24.7%. Neonatal mortality was 2.5% and four (4.9%) infants had neonatal congenital heart disease. Serial echocardiographic data pre- and postpregnancy were available in 14 women. There was no clear deterioration in tricuspid regurgitation (see Picture 1).
Conclusion
Although mortality was zero, in 10% of the pregnant women with Ebstein's anomaly a major adverse cardiac event occurred, most frequently heart failure or arrhythmia. Therefore, women with Ebstein's anomaly should be categorized as mWHO risk class II at least, but perhaps more correctly as II–III. Preconception counseling is crucial, so that women are aware of the potential risks of maternal morbidity, preterm delivery and congenital heart disease and the need for careful monitoring during pregnancy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J A Van Der Zande
- Erasmus University Medical Centre, Department of Cardiology / Department of Obstetric and Gynecology , Rotterdam , The Netherlands
| | - O Tutarel
- German Heart Center Muenchen Technical University of Munich, Department of Congenital Heart Disease and Pediatric Cardiology , Munich , Germany
| | - K P Ramlakhan
- Erasmus University Medical Centre, Department of Cardiology / Department of Obstetric and Gynecology , Rotterdam , The Netherlands
| | - M R Johson
- Imperial College London, Department of Obstetric Medicine , London , United Kingdom
| | - R Hall
- University of East Anglia, Department of Cardiology , Norwich , United Kingdom
| | - J W Roos-Hesselink
- Erasmus University Medical Centre, Department of Cardiology , Rotterdam , The Netherlands
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13
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Sweiss H, Lyons JM, Hitchman KMK, Kincaide EL, Hall R, Ranch D, Crowther B. Impact of catch-up vaccinations on anti-HLA antibody response in pediatric kidney transplant candidates. Pediatr Transplant 2022; 26:e14304. [PMID: 35531710 DOI: 10.1111/petr.14304] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Efforts have been concentrated on improving vaccination administration during the pretransplant evaluation period. However, concern for human leukocyte antigen (HLA) sensitization subsequent to vaccination exists. METHODS A retrospective review of pediatric kidney transplant candidates (PKTCs) ≤18 years old who had received vaccinations between February 1, 2017 and November 30, 2019 was conducted. Emergence of de novo anti-HLA antibody (HLA-Ab) 3-4 weeks postvaccinations detected by the Luminex single antigen bead assay (SAB) was evaluated. Outcomes assessed included change in the HLA-Ab mean fluorescence intensity (MFI) ≥25% from baseline, and change in preexisting HLA-Ab MFI strength, categorized as weak: 1000-2999; moderate: 3000-9999; and strong: ≥10 000. RESULTS Sixty vaccinations were administered to 14 patients. Forty-one potential de novo HLA-Ab were detected in five patients. After additional antibody panel testing, 5/41 potential de novo HLA-Ab were determined to be HLA specific; the remaining 36 were deemed nonspecific. The 5 de novo HLA-Ab were observed in three patients and were deemed weak antibody (Ab). Median MFI showed a significant increase for nonspecific Ab, but not de novo HLA-Ab. Median MFI values were deemed transient at 7-10 week follow-up. No HLA-donor-specific Ab developed posttransplant in the patients who developed de novo HLA-Ab. CONCLUSION Vaccination resulted in a transient increase in non-HLA-specific Ab. The majority of responses were non-HLA specific, hypothesized to be related to denatured antigens on single antigen beads. These data suggest limited clinical impact of vaccinations on the emergence of de novo HLA-Ab.
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Affiliation(s)
- Helen Sweiss
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, Texas, USA.,University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA
| | - John Michael Lyons
- Department of Pharmacy, Loyola University Medical Center, Chicago, IL, USA
| | - Kelley M K Hitchman
- University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Histocompatibility and Immunogenetics Laboratory, University Health System, San Antonio, Texas, USA.,Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Elisabeth Lapp Kincaide
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, Texas, USA.,University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA
| | - Reed Hall
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, Texas, USA.,University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA
| | - Daniel Ranch
- University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Barrett Crowther
- Ambulatory Care Pharmacy Services, University of Colorado Health, Aurora, Colorado, USA.,University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
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14
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Diamond C, Oeffinger K, Hall R, Driscoll T, Cardones A. LB907 Sequelae of pediatric allogeneic hematopoietic stem cell transplantation. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.925] [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: 10/17/2022]
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15
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Culton D, Ujiie H, Schmidt E, Murrell D, Stoykov I, Verheesen P, Borradori L, Hall R, Joly P. 311 Treatment of bullous pemphigoid by inhibiting fcrn: Pre-registration report of a phase 2/3 trial with efgartigimod. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.319] [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: 11/28/2022]
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16
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Abutaleb M, Croxford W, Fatimilehin A, Bowen-Jones S, Bewley M, Colaco R, Hall R, Whitehurst P, Wooder R, Radhakrishna G, Woolf D. PD-0078 Three-year update of outcomes for SABR-treated extracranial oligometastases: A real world experience. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02748-7] [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: 11/29/2022]
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17
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Misra U, Gilvarry E, Marshall J, Hall R, McLure H, Mayall R, El-Ghazali S, Redfern N, McGrady E, Gerada C. Substance use disorder in the anaesthetist: Guidelines from the Association of Anaesthetists: Guidelines from the Association of Anaesthetists. Anaesthesia 2022; 77:691-699. [PMID: 35445390 DOI: 10.1111/anae.15732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 12/25/2022]
Abstract
Anaesthetists have a higher incidence of substance use disorder when compared with other doctors. This might be due to the ease of access to intravenous opioids, propofol, midazolam, inhalational agents and other anaesthetic drugs. Alcohol use disorder continues to be the most common problem. Unfortunately, the first sign that something is amiss might be the anaesthetist's death from an accidental or deliberate overdose. While there are few accurate data, suicide is presumed to be the cause of death in approximately 6-10% of all anaesthetists. If we are to prevent this, substance use disorder must be recognised early, we should ensure the anaesthetist is supported by their department and hospital management and that the anaesthetist engages fully with treatment. Over 75% of anaesthetists return to full practice if they co-operate fully with the required treatment and supervision.
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Affiliation(s)
- U Misra
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - E Gilvarry
- Addictions Services at Cumbria, Northumberland Tyne and Wear NHS FT, Newcastle upon Tyne, UK
| | - J Marshall
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Hall
- Royal Papworth Hospital NHS Trust, Cambridge, UK
| | - H McLure
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - S El-Ghazali
- Department of Anaesthesia, London North West Hospital Trust, London, UK
| | - N Redfern
- Department of Anaesthesia, Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | | | - C Gerada
- NHS Practitioner Health, London, UK
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18
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Bowen Jones S, Fatimilehin A, Hirst L, Hall R, Harris C, Whitehurst P, Croxford W, Bayman N, Colaco R, Woolf D, Radhakrishna G. The First Use of Stereotactic Ablative Body Radiotherapy (SABR) in Extra-cranial Non-lung Oligometastatic Disease: A Single Centre. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2022.01.017] [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: 11/03/2022]
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19
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Turner B, Jasionowska S, Bakko F, Huttman M, Hall R, Doshi A, Agarwal T. 349 Improving Surgical Teaching for Junior Trainees Internationally in Light of Covid-19. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
During the Covid-19 pandemic there has been a gross effect on surgical training at all grades. A cohort that has been affected but reported less frequently are medical students and foundation doctors (junior trainees), whose interest in the field and clinical skills may have been affected by reduced service provision.
Method
A survey of junior trainees was conducted to analyse their perceived adequacy of surgical teaching in light of the effect of Covid-19. An online teaching course was then designed to target areas of weakness identified in the survey. The content was designed with the Imperial College London surgery curriculum and was vetted by a consultant surgeon.
Results
Of the 713 people surveyed, 393 (55%) had received little or no surgical teaching and 496 (70%) respondents said they were “not” or “slightly” confident in managing common and emergency surgical presentations. A free text box highlighted that deteriorating patients, clinical decision-making, and initiating management were the greatest concerns. This was used to design an international online teaching course for junior trainees, that focused explicitly on clinical care. The sessions were run live on MindTheBleep via Facebook live, to answer questions in real time and examine cases with live audience participation, receiving feedback after every session. This model has reached trainees in >30 countries with >200 feedback responses and an average rating of 4.5/5.
Conclusions
Junior trainees are a key cohort whose interest and education in surgery has suffered due to the pandemic. An innovative, online, clinically orientated course is assisting to re-engage trainees internationally.
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Affiliation(s)
- B. Turner
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S. Jasionowska
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - F. Bakko
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M. Huttman
- University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - R. Hall
- Warwick University, Warwick, United Kingdom
| | - A. Doshi
- Barts Health NHS Trust, London, United Kingdom
| | - T. Agarwal
- London Northwest Healthcare Trust, London, United Kingdom
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20
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Webb MM, Bridges P, Aruparayil N, Chugh C, Beacon T, Singh T, Sawhney SS, Bains L, Hall R, Jayne D, Gnanaraj J, Mishra A, Culmer PR. The RAIS Device for Global Surgery: Using a Participatory Design Approach to Navigate the Translational Pathway to Clinical Use. IEEE J Transl Eng Health Med 2022; 10:3700212. [PMID: 35865752 PMCID: PMC9292337 DOI: 10.1109/jtehm.2022.3177313] [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] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
Background: Over 5 billion people worldwide have no access to surgery worldwide, typically in low-resource settings, despite it being a primary life-saving treatment. Gas Insufflation-Less Laparoscopic Surgery (GILLS) can address this inequity, by improving current GILLS instrumentation to modern surgical standards. Objective: to develop and translate a new Retractor for Abdominal Insufflation-less Surgery (RAIS) into clinical use and thus provide a context-appropriate system to advance GILLS surgery. Methods: A collaborative multidisciplinary team from the UK and India was formed, embedding local clinical stakeholders and an industry partner in defining user and contextual needs. System development was based on a phased roadmap for ‘surgical device design in low resource settings’ and embedded participatory and frugal design principles in an iterative process supported by traditional medical device design methodologies. Each phase of development was evaluated by the stakeholder team through interactive workshops using cadaveric surgical simulations. A Commercialisation phase undertook Design to Manufacture and regulatory approval activities. Clinical validation was then conducted with rural surgeons performing GILLS procedures using the RAIS system. Semi-structured questionnaires and interviews were used to evaluate device performance. Results: A set of user needs and contextual requirements were defined and formalised. System development occurred across five iterations. Stakeholder participation was instrumental in converging on a design which met user requirements. A commercial RAIS system was then produced by an industry partner under Indian regulatory approval. This was successfully used in clinical validation to conduct 12 surgical procedures at two locations in rural India. Surgical feedback showed that the RAIS system provided a valuable and usable surgical instrument which was appropriate for use in low-resource contexts. Conclusions: Using a context-specific development approach with close engagement of stakeholders was crucial to develop the RAIS system for low-resource regions. The outcome is translation from global health need into a fully realized commercial instrument which can be used by surgeons in low-resource regions across India.
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Affiliation(s)
- M. Marriott Webb
- School of Mechanical Engineering, University of Leeds, Leeds, U.K
| | | | - N. Aruparayil
- Leeds Institute of Medical Research, University of Leeds, Leeds, U.K
| | - C. Chugh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - T. Beacon
- Medical Aid International, Bedford, U.K
| | - T. Singh
- XLO Ortho Life Systems, New Delhi, India
| | | | - L. Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - R. Hall
- Pd-m International, Thirsk, U.K
| | - D. Jayne
- Department of Academic Surgery, University of Leeds, Leeds, U.K
| | - J. Gnanaraj
- Department of Electronics and Instrumentation Engineering, Karunya University, Coimbatore, India
| | - A. Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - P. R. Culmer
- School of Mechanical Engineering, University of Leeds, Leeds, U.K
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21
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Klein K, Nelson J, Long C, Speeg K, Alkhouri N, Hall R. Effect of Hepatitis C Viremia on Posttransplant Diabetes Mellitus in Liver Transplant Recipients. Prog Transplant 2021; 32:73-77. [PMID: 34874192 DOI: 10.1177/15269248211064879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Posttransplant diabetes mellitus (PTDM) can increase morbidity and mortality in liver transplant recipients. Although hepatitis C seropositivity is a known risk factor for PTDM, the impact of viremia versus no viremia at time of transplant is unknown. PROJECT AIMS This program evaluation sought to compare PTDM in hepatitis C seropositive patients with and without viremia at the time of liver transplant. DESIGN This single-center retrospective review included adult hepatitis C seropositive liver transplant recipients transplanted between January 1, 2010 to September 5, 2017 without pretransplant diabetes. Primary outcome was PTDM within 1 year. Secondary outcomes included evaluating 1-year posttransplant death-censored graft loss, mortality, and metabolic outcomes. RESULTS Fifty-seven liver transplant recipients with hepatitis C were included, of which 53% (n = 30) were viremic at transplant. Baseline characteristics were similar between groups. Significantly more patients with pretransplant viremia developed PTDM by 1-year posttransplant compared to the patients without viremia (43% vs 11%, P = 0.01). There were no differences between groups outside of more patients with viremia requiring antihypertensives by 1-year posttransplant compared to patients without viremia (57% vs 22%, P = 0.01). CONCLUSION Liver transplant patients with hepatitis C viremia at transplant were more likely to develop PTDM at 1 year compared to those without pretransplant viremia. This is an added consideration when deciding the timing of direct-acting antiviral (DAA) utilization in the context of liver transplant for hepatitis C seropositive patients.
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Affiliation(s)
- Kelsey Klein
- 43159University Health System, San Antonio, TX, USA.,43159University Health System, San Antonio, TX, USA.,University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Joelle Nelson
- 43159University Health System, San Antonio, TX, USA.,43159University Health System, San Antonio, TX, USA.,University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Christina Long
- 43159University Health System, San Antonio, TX, USA.,University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,130378University of the Incarnate Word Feik School of Pharmacy, San Antonio, TX, USA
| | - Kermit Speeg
- 43159University Health System, San Antonio, TX, USA.,14742University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Reed Hall
- 43159University Health System, San Antonio, TX, USA.,43159University Health System, San Antonio, TX, USA.,University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,University of Texas at Austin College of Pharmacy, Austin, TX, USA
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22
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Sweiss H, Bhayana S, Hall R, Nelson J, Kincaide E. Methenamine for Recurrent Urinary Tract Infections in Solid Organ Transplantation. Prog Transplant 2021; 32:67-72. [PMID: 34859711 DOI: 10.1177/15269248211064880] [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: 11/16/2022]
Abstract
INTRODUCTION Recurrent urinary tract infections remain a challenge in solid organ transplant and have a negative impact on morbidity/mortality. PROJECT AIM The purpose of this program evaluation was to determine the impact of methenamine on recurrent urinary tract infection in kidney and liver-kidney transplant recipients. DESIGN This retrospective review included patients > 18 years of age who received a kidney or liver-kidney transplant. Patients were divided into the following groups: (1) Methenamine therapy initiation received methenamine for ≥ 180 days or (2) Non-methenamine therapy: did not receive recurrent urinary tract infection prophylaxis. A total of 60 patients were included. RESULTS When comparing outcomes between methenamine therapy initiation and non-methenamine therapy group, a significant reduction in the rate of recurrent urinary tract infection was reported in the methenamine therapy initiation group (0.6 vs 1.3 per 180 patient days follow-up, P = 0.0005). A significant reduction was also noted with rate of asymptomatic bacteriuria, treatment failures, bacteremia, hospitalizations due to recurrent urinary tract infection, multi-drug resistant organism isolated, and the average duration of antibiotic use. A significant difference in the time to failure of methenamine therapy initiation versus non-methenamine therapy is noted up to 180 patient-days follow-up (RR 1.56, P = 0.0019). CONCLUSION This evaluation supported methenamine therapy for recurrent urinary tract infection in kidney and liver-kidney transplant. The most significant impact of methenamine recurrent urinary tract infection was seen in the first 30 days after initiation.
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Affiliation(s)
- Helen Sweiss
- 43159University Health System, San Antonio, TX, USA.,43159University Health System, San Antonio, TX, USA.,14742The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | - Suverta Bhayana
- 43159University Health System, San Antonio, TX, USA.,14742The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Reed Hall
- 43159University Health System, San Antonio, TX, USA.,43159University Health System, San Antonio, TX, USA.,14742The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | - Joelle Nelson
- 43159University Health System, San Antonio, TX, USA.,43159University Health System, San Antonio, TX, USA.,14742The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | - Elisabeth Kincaide
- 43159University Health System, San Antonio, TX, USA.,43159University Health System, San Antonio, TX, USA.,14742The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
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23
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Hargreaves S, Carter J, Knights F, Deal A, Goldsmith L, Crawshaw AF, Hayward S, Zenner D, Wurie F, Hall R. Digital screening tool (Health Catch-UP!) to promote multi-disease screening in migrants. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.358] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The ECDC has called for innovative strategies to deliver multi-disease screening (TB, LTBI, HIV, hepatitis B/C, Chagas, Strongyloidiasis and schistosomiasis) and catch-up vaccination (MMR, DTP) to adult migrants within the primary care context. We did a UK i qualitative study to explore current practice and seek views on a novel integrated digital tool to support delivery of screening recommendations for migrants https://emishealth.vids.io/videos/a49ad1bb1a18e4c72c/health-catch-up-with-requested-edits-mp4).
Methods
Phase 1 was conducted via telephone with clinical primary care practitioners (PCPs) (phase 1) and informed data collection and analysis for phase 2 with administrative staff. Data were analysed iteratively, informed by thematic analysis (Ethics no.20/HRA/1674).
Results
64 participants were recruited in Phase 1 (25 general practitioners [GPs], 15 nurses, 7 healthcare assistants, 1 pharmacist); Phase 2 comprised administrative staff (11 Practice-Managers, 5 receptionists). There was lack of consistency in delivery of screening and vaccination. Most GP practices adopted a practice-specific approach, or had no system in place; screening only for HIV and hepatitis B/C. Barriers to screening were perceived lack of knowledge/training and limited financial resources. Facilitators included having an infectious disease/migrant-health champion, incentivisation, and clear protocols. Participants responded positively to the integrated Health Catch-UP! tool, confirming that it would increase screening and vaccination, reduce missed opportunities for preventative healthcare, and raise awareness of migrant health.
Conclusions
Infectious disease screening and catch-up vaccination is not currently delivered well in primary care in high-migrant receiving European countries. Innovative digital tools like Health Catch-UP! could aid clinical decision-making and facilitating improved health outcomes for migrants. Further work is needed to evaluate this intervention.
Key messages
Infectious disease screening and catch-up vaccination is not currently delivered well in primary care in high-migrant receiving European countries. Innovative digital tools could aid clinical decision-making and facilitating improved health outcomes for migrants.
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Affiliation(s)
- S Hargreaves
- Migrant Health Research Group, St George's University of London, London, UK
| | - J Carter
- Migrant Health Research Group, St George's University of London, London, UK
| | - F Knights
- Migrant Health Research Group, St George's University of London, London, UK
| | - A Deal
- Migrant Health Research Group, St George's University of London, London, UK
| | - L Goldsmith
- Migrant Health Research Group, St George's University of London, London, UK
| | - AF Crawshaw
- Migrant Health Research Group, St George's University of London, London, UK
| | - S Hayward
- Migrant Health Research Group, St George's University of London, London, UK
| | - D Zenner
- Queen Mary's, University of London, London, UK
| | - F Wurie
- Health Improvement Directorate, Public Health England, London, UK
| | - R Hall
- Migrant Health Research Group, St George's University of London, London, UK
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24
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Raber J, Holden S, Sudhakar R, Hall R, Glaeser B, Lenarczyk M, Rockwell K, Nawarawong N, Sterrett J, Perez R, Leonard SW, Morré J, Choi J, Kronenberg A, Borg A, Kwok A, Stevens JF, Olsen CM, Willey JS, Bobe G, Baker J. Effects of 5-Ion Beam Irradiation and Hindlimb Unloading on Metabolic Pathways in Plasma and Brain of Behaviorally Tested WAG/Rij Rats. Front Physiol 2021; 12:746509. [PMID: 34646164 PMCID: PMC8503608 DOI: 10.3389/fphys.2021.746509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 07/23/2021] [Accepted: 08/24/2021] [Indexed: 01/13/2023] Open
Abstract
A limitation of simulated space radiation studies is that radiation exposure is not the only environmental challenge astronauts face during missions. Therefore, we characterized behavioral and cognitive performance of male WAG/Rij rats 3 months after sham-irradiation or total body irradiation with a simplified 5-ion mixed beam exposure in the absence or presence of simulated weightlessness using hindlimb unloading (HU) alone. Six months following behavioral and cognitive testing or 9 months following sham-irradiation or total body irradiation, plasma and brain tissues (hippocampus and cortex) were processed to determine whether the behavioral and cognitive effects were associated with long-term alterations in metabolic pathways in plasma and brain. Sham HU, but not irradiated HU, rats were impaired in spatial habituation learning. Rats irradiated with 1.5 Gy showed increased depressive-like behaviors. This was seen in the absence but not presence of HU. Thus, HU has differential effects in sham-irradiated and irradiated animals and specific behavioral measures are associated with plasma levels of distinct metabolites 6 months later. The combined effects of HU and radiation on metabolic pathways in plasma and brain illustrate the complex interaction of environmental stressors and highlights the importance of assessing these interactions.
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Affiliation(s)
- Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States.,Department of Neurology, Psychiatry, and Radiation Medicine, Division of Neuroscience, ONPRC, Oregon Health and Science University, Portland, OR, United States.,College of Pharmacy, Oregon State University, Corvallis, OR, United States
| | - Sarah Holden
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Reetesh Sudhakar
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Reed Hall
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Breanna Glaeser
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Marek Lenarczyk
- Radiation Biosciences Laboratory, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kristen Rockwell
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Natalie Nawarawong
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jennifer Sterrett
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ruby Perez
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Scott William Leonard
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jeffrey Morré
- Mass Spectrometry Core, Oregon State University, Corvallis, OR, United States
| | - Jaewoo Choi
- Linus Pauling Institute, Oregon State University, Corvallis, OR, United States
| | - Amy Kronenberg
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, United States
| | - Alexander Borg
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Andy Kwok
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jan Frederik Stevens
- College of Pharmacy, Oregon State University, Corvallis, OR, United States.,Linus Pauling Institute, Oregon State University, Corvallis, OR, United States
| | - Christopher M Olsen
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jeffrey S Willey
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Gerd Bobe
- Linus Pauling Institute, Oregon State University, Corvallis, OR, United States.,Department of Animal Sciences, Oregon State University, Corvallis, OR, United States
| | - John Baker
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States.,Radiation Biosciences Laboratory, Medical College of Wisconsin, Milwaukee, WI, United States
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25
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Hall R, Chattopadhyay R, Pugh P. Impact of the Covid-19 pandemic on the device therapy for patients with the heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0931] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Hospital admissions of patients with cardiovascular disease were markedly reduced in the UK in 2020 during the Covid-19 pandemic. In many institutions, including ours, patient care was redistributed from a specialty-based approach to a ward-based system, meaning some patients being admitted and managed under the care of non-specialist teams.
Purpose
We wished to examine the impact of these changes on heart failure (HF) patients presenting during the pandemic and on appropriate delivery of complex device therapies.
Methods
The study was undertaken in a large UK teaching hospital. The institution audit programme includes cardiac device therapy provision, aiming to ensure that implantable cardioverter defibrillators and cardiac resynchronisation therapy are offered to the target population in accordance with NICE guidance [Technology Appraisal 314]. In accordance with the guidance, patients admitted to hospital with serious ventricular arrhythmia, familial cardiac condition with high risk of sudden cardiac death (SCD), surgical repair of congenital heart disease (CHD) and patients with HF and LVEF<36% were identified from hospital coding. Findings during the pandemic (March to August 2020) were compared with the same period in 2019. Fisher's exact test was used to compare proportions.
Results
Among non-HF patients, device therapy prescription was consistent in the two periods observed. Table 1 shows how many patients were eligible for device therapy and how many were offered it. Table 2 contains details of HF admissions, showing an 8% reduction in admissions during the pandemic. The proportion of patients eligible for device therapy did not change significantly. However, there was a significant reduction in the proportion of eligible patients who were offered device therapy (79% vs 94% p=0.03). In addition, during the pandemic there was a trend towards a greater chance of patients being considered too frail for device therapy (p=0.08). Among 12 patients overlooked for device therapy, 10 were not under the care of Cardiology. Among 31 patients considered too frail for device therapy, 26 were not under the care of Cardiology.
Conclusion
During the Covid-19 pandemic, a modest reduction in HF hospital admission was observed with a marked fall in identification of patients eligible for device therapy. Possible explanations include intense pressure to discharge patients quickly, an increased perception of patient frailty during a crisis and the lack of recognition of indications for device therapy when patients are under the care of non-specialists. These findings suggest that cardiac services should actively look for HF patients who may have missed out on life-saving device therapies during the pandemic.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Hall
- Addenbrooke's Hospital, Cardiology, Cambridge, United Kingdom
| | - R Chattopadhyay
- Addenbrooke's Hospital, Cardiology, Cambridge, United Kingdom
| | - P.J Pugh
- Addenbrooke's Hospital, Cardiology, Cambridge, United Kingdom
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26
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Ramlakhan KP, Malhame I, Marelli A, Rutz T, Goland S, Johnson MR, Hall R, Cornette JMJ, Roos-Hesselink JW. Hypertensive disorders of pregnancy in women with structural heart disease: data from the ESC EORP Registry of Pregnancy and Cardiac disease (ROPAC). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2892] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Hypertensive disorders of pregnancy (HDP) are estimated to occur in 10% of pregnancies in the general population and preeclampsia specifically in 3–5%. HDP are suggested to be more common in and less well tolerated by women with heart disease. However, the current data are conflicting and this knowledge gap impacts clinical practice guidelines.
Purpose
To harness the well characterized data of the Registry of Pregnancy and Cardiac disease (ROPAC) to examine the frequency of HDP in women with structural heart disease and its impact on maternal and perinatal outcomes.
Methods
The ROPAC registry (n=5739) is a worldwide prospective registry on pregnancies in women with heart disease, including congenital heart disease (CHD, n=3295), valvular heart disease (VHD, n=1648), cardiomyopathy (CMP, n=438), aortopathy (AOP, n=217), ischemic heart disease (IHD, n=95), and pulmonary arterial hypertension (PAH, n=45). We defined HDP as either chronic hypertension, gestational hypertension, and/or preeclampsia (including HELLP syndrome and eclampsia) and assessed the frequency of HDP in each heart disease category. Predictors of preeclampsia were identified using multivariable logistic regression. The proportion of women with adverse maternal, pregnancy, and fetal/neonatal outcomes were described among women with preeclampsia or HDP, and compared between women with and women without HDP using chi-square tests.
Results
In total, the frequency of HDP and preeclampsia was 9.3% and 2.6% in CHD, 7.5% and 2.2% in VHD, 18.7% and 7.1% in CMP, 15.7% and 2.8% AOP, 35.8% and 6.3% in IHD, and 22.2% and 11.1% in PAH. Independent predictors of preeclampsia were chronic hypertension (OR 3.06, 95% CI 2–4.69), nulliparity (2.39, 1.68–3.38), HDP in a previous pregnancy (2.29, 1.11–4.7), gestational diabetes in the current pregnancy (2.13, 1.13–4.03), pulmonary hypertension (1.71, 1.08–2.7) and age (1.04, 1.01–1.07). In women with preeclampsia and heart disease, maternal mortality was 3.5% and heart failure was 29.1%. Maternal mortality (1.4% vs 0.6%, p=0.042), heart failure (18.5% vs 10.6%), Caesarean section (61.2% vs 48.4%), preterm births (27.4% vs 16.9%), low Apgar score (9.8% vs 6.6%), small for gestational age (14.6% vs 9.7%) and neonatal mortality (1.7% vs 0.4%) were higher in women with than women without HDP (all p<0.001 except maternal mortality).
Conclusions
The frequency of HDP is increased (>10%) in CMP, AOP, IHD and PAH, but not in CHD and VHD. The high frequency of HDP is partly due to chronic hypertension, but the incidence of preeclampsia is also increased (>5%) in CMP, IHD and PAH. Among women with cardiac disease, HDP were associated with adverse maternal and perinatal outcomes. The high maternal mortality rate of 3.5% in women with heart disease and preeclampsia warrants close clinical monitoring and a better understanding of the optimal management strategies in the complex population group.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Funding from “Zabawas Foundation” and “De Hoop Foundation” in addition to the support from EORP is greatly acknowledged. Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2021), Vifor (2019–2022). HDP in women with heart diseaseIncidence of HDP per diagnosis group
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Affiliation(s)
- K P Ramlakhan
- Erasmus University Medical Centre, Department of Cardiology, Rotterdam, Netherlands (The)
| | - I Malhame
- McGill University Health Centre, Department of Medicine, Montreal, Canada
| | - A Marelli
- McGill University Health Centre, McGill Adult Unit for Congenital Heart Disease (MAUDE Unit), Department of Cardiology, Montreal, Canada
| | - T Rutz
- Lausanne university hospital, University of Lausanne, Service of Cardiology, Lausanne, Switzerland
| | - S Goland
- Kaplan Medical Center, Heart Institute, Hebrew University and Hadassah Medical School, Jerusalem, Rehovot, Israel
| | - M R Johnson
- Imperial College London, Chelsea and Westminster Hospital, Department of Obstetric Medicine, London, United Kingdom
| | - R Hall
- University of East Anglia, Department of Cardiology, Norwich, United Kingdom
| | - J M J Cornette
- Erasmus University Medical Centre, Department of Obstetrics & Gynaecology, Rotterdam, Netherlands (The)
| | - J W Roos-Hesselink
- Erasmus University Medical Centre, Department of Cardiology, Rotterdam, Netherlands (The)
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27
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Riley D, Abraham R, Alaklabi S, Devitt M, Hall R, Horton B, Gentzler R. P40.04 CNS Adverse Events and Survival in Patients with NSCLC Brain Metastases Treated With Concurrent Radiation and Immunotherapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.441] [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: 11/30/2022]
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28
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Hall R, Mitchell L, Sachdeva J. Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review. BJPsych Open 2021; 7:e184. [PMID: 34593070 PMCID: PMC8503911 DOI: 10.1192/bjo.2021.1022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently 'detransition'. AIMS To describe service users' access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify 'detransitioning'. METHOD A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and 'accessing care' or 'other outcome'. RESULTS The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7-19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1-1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1-17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1-4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning. CONCLUSIONS Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.
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Affiliation(s)
- R Hall
- Devon Partnership Trust, UK
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29
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Riley D, Kaur N, Baglione A, Hall R, Barnes L, Gentzler R. P45.16 Adverse Event Burden of Oral Tyrosine Kinase Inhibitors in EGFR and ALK Metastatic Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.484] [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: 12/01/2022]
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30
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Fatimilehin A, Bowen Jones S, Bewley M, Hall R, Harris C, Whitehurst P, Bayman N, Colaco R, Woolf D, Radhakrishna G. PO-1523 Real world outcomes in patients with oligometastases treated with SABR - a single centre experience. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07974-3] [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: 10/20/2022]
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31
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Tattar R, Hall R. MANAGEMENT OF A RECURRENT MANDIBULAR UNICYSTIC AMELOBLASTOMA. Oral Surg Oral Med Oral Pathol Oral Radiol 2021. [DOI: 10.1016/j.oooo.2021.03.170] [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: 11/29/2022]
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32
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Abstract
The solid organ transplant community is slow to adopt the routine practice of using direct oral anticoagulants. Rivaroxaban and apixaban share common metabolic pathways with tacrolimus. This study aimed to clarify the impact of rivaroxaban/apixaban on tacrolimus troughs. Fifty solid organ transplant recipients with concomitant use of tacrolimus and rivaroxaban/apixaban were retrospectively assessed for changes in tacrolimus troughs and dose. Average dose-adjusted tacrolimus troughs and average tacrolimus total daily doses prior to and after rivaroxaban/apixaban initiation were compared. Subgroup analyses evaluating rivaroxaban and apixaban individually were performed. Rivaroxaban was prescribed to 18 recipients, and apixaban was prescribed to 32 recipients. Transplanted organs included kidney (n = 22), lung (n = 18), liver (n = 7), simultaneous pancreas and kidney (n = 1), and simultaneous kidney and liver (n = 2). The median doseadjusted tacrolimus trough and tacrolimus total daily dose prior to rivaroxaban/apixaban initiation was 2.15 ng/mL/mg (IQR 1.17, 3.37) and 4 mg (IQR 1.88, 6.25), respectively. The median dose-adjusted tacrolimus trough and tacrolimus total daily dose after rivaroxaban/apixaban initiation was 2.16 ng/mL/mg (IQR 1.24, 4.10) and 3.55 mg (IQR 1.5, 6.35), respectively. No significant difference was found between average dose-adjusted tacrolimus troughs or tacrolimus total daily doses before and after rivaroxaban/apixaban initiation or in the individual subgroup analyses for rivaroxaban/apixaban. It is unlikely that initiating rivaroxaban/apixaban affects tacrolimus troughs or requires tacrolimus dose adjustment. This study does not elucidate if tacrolimus affects rivaroxaban/apixaban pharmacokinetics or pharmacodynamics.
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Affiliation(s)
- Aileen C Scheibner
- Department of Pharmacotherapy Services, 43159University Health System, San Antonio, TX, USA.,Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, TX, USA.,University of Texas Health San Antonio, San Antonio, TX, USA
| | - Crystal Franco-Martinez
- Department of Pharmacotherapy Services, 43159University Health System, San Antonio, TX, USA.,Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, TX, USA.,University of Texas Health San Antonio, San Antonio, TX, USA
| | - Elisabeth Kincaide
- Department of Pharmacotherapy Services, 43159University Health System, San Antonio, TX, USA.,Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, TX, USA.,University of Texas Health San Antonio, San Antonio, TX, USA
| | - Reed Hall
- Department of Pharmacotherapy Services, 43159University Health System, San Antonio, TX, USA.,Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, TX, USA.,University of Texas Health San Antonio, San Antonio, TX, USA.,Pharmacotherapy Education & Research Center, School of Medicine, University of Texas Health San Antonio, TX, USA
| | - Christina Long
- Department of Pharmacotherapy Services, 43159University Health System, San Antonio, TX, USA.,University of Texas Health San Antonio, San Antonio, TX, USA.,Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX, USA
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Raber J, Perez R, Torres ERS, Krenik D, Boutros S, Patel E, Chlebowski AC, Torres ER, Perveen Z, Penn A, Paulsen DB, Bartlett MG, Jia E, Holden S, Hall R, Morré J, Wong C, Ho E, Choi J, Stevens JF, Noël A, Bobe G, Kisby G. Effects of Chronic Secondhand Smoke (SHS) Exposure on Cognitive Performance and Metabolic Pathways in the Hippocampus of Wild-Type and Human Tau Mice. Environ Health Perspect 2021; 129:57009. [PMID: 34009016 PMCID: PMC8132614 DOI: 10.1289/ehp8428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Exposure to secondhand smoke (SHS) is a risk factor for developing sporadic forms of sporadic dementia. A human tau (htau) mouse model is available that exhibits age-dependent tau dysregulation, neurofibrillary tangles, neuronal loss, neuroinflammation, and oxidative stress starting at an early age (3-4 months) and in which tau dysregulation and neuronal loss correlate with synaptic dysfunction and cognitive decline. OBJECTIVE The goal of this study was to assess the effects of chronic SHS exposure (10 months' exposure to ∼30 mg/m3) on behavioral and cognitive function, metabolism, and neuropathology in mice. METHODS Wild-type (WT) and htau female and male mice were exposed to SHS (90% side stream, 10% main stream) using the SCIREQ® inExpose™ system or air control for 168 min per day, for 312 d, 7 d per week. The exposures continued during the days of behavioral and cognitive testing. In addition to behavioral and cognitive performance and neuropathology, the lungs of mice were examined for pathology and alterations in gene expression. RESULTS Mice exposed to chronic SHS exposure showed the following genotype-dependent responses: a) lower body weights in WT, but not htau, mice; b) less spontaneous alternation in WT, but not htau, mice in the Y maze; c) faster swim speeds of WT, but not htau, mice in the water maze; d) lower activity levels of WT and htau mice in the open field; e) lower expression of brain PHF1, TTCM1, IGF1β, and HSP90 protein levels in WT male, but not female, mice; and f) more profound effects on hippocampal metabolic pathways in WT male than female mice and more profound effects in WT than htau mice. DISCUSSION The brain of WT mice, in particular WT male mice, might be especially susceptible to the effects of chronic SHS exposure. In WT males, independent pathways involving ascorbate, flavin adenine dinucleotide, or palmitoleic acid might contribute to the hippocampal injury following chronic SHS exposure. https://doi.org/10.1289/EHP8428.
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Affiliation(s)
- Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
- Departments of Neurology, Psychiatry, and Radiation Medicine, Division of Neuroscience ONPRC, Oregon Health & Science University, Portland, Oregon, USA
- College of Pharmacy, Oregon State University, Corvallis, Oregon, USA
| | - Ruby Perez
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Eileen Ruth S. Torres
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Destine Krenik
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Sydney Boutros
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Esha Patel
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Anna C. Chlebowski
- Department of Basic Medical Sciences, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific Northwest, Lebanon, Oregon, USA
| | - Estefania Ramos Torres
- Department of Basic Medical Sciences, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific Northwest, Lebanon, Oregon, USA
| | - Zakia Perveen
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana, USA
| | - Arthur Penn
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana, USA
| | - Daniel B. Paulsen
- Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana, USA
| | | | - Enze Jia
- University of Georgia, College of Pharmacy, Athens, Georgia, USA
| | - Sarah Holden
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Reed Hall
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey Morré
- Mass Spectrometry Core, Oregon State University, Corvallis, Oregon, USA
| | - Carmen Wong
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
- Department of Animal Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Emily Ho
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jaewoo Choi
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
| | - Jan Frederik Stevens
- College of Pharmacy, Oregon State University, Corvallis, Oregon, USA
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
| | - Alexandra Noël
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana, USA
| | - Gerd Bobe
- Mass Spectrometry Core, Oregon State University, Corvallis, Oregon, USA
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
| | - Glen Kisby
- Department of Basic Medical Sciences, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific Northwest, Lebanon, Oregon, USA
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Holden S, Perez R, Hall R, Fallgren CM, Ponnaiya B, Garty G, Brenner DJ, Weil MM, Raber J. Effects of Acute and Chronic Exposure to a Mixed Field of Neutrons and Photons and Single or Fractionated Simulated Galactic Cosmic Ray Exposure on Behavioral and Cognitive Performance in Mice. Radiat Res 2021; 196:31-39. [PMID: 33857301 DOI: 10.1667/rade-20-00228.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/19/2021] [Indexed: 12/22/2022]
Abstract
During space missions, astronauts experience acute and chronic low-dose-rate radiation exposures. Given the clear gap of knowledge regarding such exposures, we assessed the effects acute and chronic exposure to a mixed field of neutrons and photons and single or fractionated simulated galactic cosmic ray exposure (GCRsim) on behavioral and cognitive performance in mice. In addition, we assessed the effects of an aspirin-containing diet in the presence and absence of chronic exposure to a mixed field of neutrons and photons. In C3H male mice, there were effects of acute radiation exposure on activity levels in the open field containing objects. In addition, there were radiation-aspirin interactions for effects of chronic radiation exposure on activity levels and measures of anxiety in the open field, and on activity levels in the open field containing objects. There were also detrimental effects of aspirin and chronic radiation exposure on the ability of mice to distinguish the familiar and novel object. Finally, there were effects of acute GCRsim on activity levels in the open field containing objects. Activity levels were lower in GCRsim than sham-irradiated mice. Thus, acute and chronic irradiation to a mixture of neutrons and photons and acute and fractionated GCRsim have differential effects on behavioral and cognitive performance of C3H mice. Within the limitations of our study design, aspirin does not appear to be a suitable countermeasure for effects of chronic exposure to space radiation on cognitive performance.
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Affiliation(s)
- Sarah Holden
- Department of Behavioral Neuroscience, Division of Neuroscience ONPRC, Oregon Health & Science University, Portland, Oregon 97239
| | - Ruby Perez
- Department of Behavioral Neuroscience, Division of Neuroscience ONPRC, Oregon Health & Science University, Portland, Oregon 97239
| | - Reed Hall
- Department of Behavioral Neuroscience, Division of Neuroscience ONPRC, Oregon Health & Science University, Portland, Oregon 97239
| | - Christina M Fallgren
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado 80523
| | - Brian Ponnaiya
- Columbia University Center for Radiological Research, New York, New York 10032
| | - Guy Garty
- Columbia University Center for Radiological Research, New York, New York 10032
| | - David J Brenner
- Columbia University Center for Radiological Research, New York, New York 10032
| | - Michael M Weil
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado 80523
| | - Jacob Raber
- Department of Behavioral Neuroscience, Division of Neuroscience ONPRC, Oregon Health & Science University, Portland, Oregon 97239.,Department of Neurology and Radiation Medicine, Division of Neuroscience ONPRC, Oregon Health & Science University, Portland, Oregon 97239
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Wrigley P, Wood P, O'Neill S, Hall R, Robertson D. Off-site modular construction and design in nuclear power: A systematic literature review. Progress in Nuclear Energy 2021. [DOI: 10.1016/j.pnucene.2021.103664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Ramlakhan K, Tobler D, Greutmann M, Schwerzmann M, Baris L, Yetman A, Nihoyannopoulos P, Manga P, Boersma H, Johnson M, Hall R, Roos-Hesselink J. Aortic coarctation in pregnancy: outcomes and predictors for cardiovascular and hypertensive complications. Data from the ESC Registry of Pregnancy and Cardiac disease (ROPAC). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3305] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pregnancy in women with repaired aortic coarctation (CoA) has a moderately increased risk (mWHO II-III) of an adverse cardiovascular, obstetric or fetal event, but prospective data to validate this estimated risk is scarce.
Purpose
We examined maternal and fetal outcomes in pregnant women with unrepaired and repaired CoA to identify predictors of adverse outcomes.
Methods
Pregnancies in women with CoA were selected from the worldwide prospective Registry of Pregnancy and Cardiac Disease (ROPAC, n=5739). The frequency and predictors of major adverse cardiac events (MACE, defined as maternal cardiac death, heart failure, atrial fibrillation/flutter, ventricular tachyarrhythmia, endocarditis, thromboembolic events, aortic dissection and acute coronary syndrome), and hypertensive complications (defined as pregnancy-induced hypertension, (pre)eclampsia or HELLP syndrome) were analyzed.
Results
Of 303 pregnancies in women with CoA (median age 30 years, median pregnancy duration 39 weeks), 10% were in women with unrepaired CoA and 27% in women with pre-existing hypertension. There were no maternal deaths. There were 4 neonatal deaths of which 3 occurred after a spontaneous extreme preterm birth. MACE occurred in 4.3% of pregnancies, predominantly involving heart failure (3.3%). MACE rate was similar in unrepaired vs repaired CoA (3.4% vs 4.4%, p=0.814). Predictors of MACE included pre-pregnancy clinical signs of heart failure (OR 31.8, 95% CI 6.8–147.7), LVEF <40% (OR 10.4, 95% CI 1.8–59.5), NYHA class >1 (OR 11.4, 95% CI 3.6–36.3), cardiac medication use (OR 4.9, 95% CI 1.3–18.3) and living in an emerging country (OR 4.88, 95% CI 1.58–15.07). Hypertensive complications occurred in 6.3%, more often in the subgroup with pre-existing hypertension (11% vs 5%, p=0.040). Pre-existing hypertension was the only predictor (OR 2.6, 95% CI 1.01–6.6). Caesarean section was performed in 50% of the total cohort.
Conclusions
Pregnancies in women with CoA are safe, well tolerated and MACE and hypertensive complication rates are low. These findings support mWHO risk score reevaluation to mWHO II for women with CoA without cardiac impairment.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): ESC EURObservational Research Programme (EORP)
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Affiliation(s)
- K.P Ramlakhan
- Erasmus University Medical Centre, Department of Cardiology, Rotterdam, Netherlands (The)
| | - D Tobler
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - M Greutmann
- University Heart Center, Department of Cardiology, Zurich, Switzerland
| | - M Schwerzmann
- Kantonsspital, Department of Cardiology, St Gallen, Switzerland
| | - L Baris
- Erasmus University Medical Centre, Department of Cardiology, Rotterdam, Netherlands (The)
| | - A.J Yetman
- Children's Hospital and Medical Center, Division of Pediatric Cardiology, Omaha, United States of America
| | - P Nihoyannopoulos
- National Heart and Lung Institute, Department of Cardiology, London, United Kingdom
| | - P Manga
- University of the Witwatersrand, Division of Cardiology, Department of Internal Medicine, Johannesburg, South Africa
| | - H Boersma
- Erasmus University Medical Centre, Department of Clinical Epidemiology, Rotterdam, Netherlands (The)
| | - M.R Johnson
- Imperial College London, Department of Obstetric Medicine, London, United Kingdom
| | - R Hall
- University of East Anglia, Department of Cardiology, Norwich, United Kingdom
| | - J.W Roos-Hesselink
- Erasmus University Medical Centre, Department of Cardiology, Rotterdam, Netherlands (The)
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Tutarel O, Baris L, Johnson M, Hall R, Roos-Hesselink J. Pregnancy outcomes in women with a systemic right ventricle and transposition of the great arteries. Results from the ESC-EORP Registry of Pregnancy and Cardiac disease (ROPAC). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2218] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac disease is one of the major causes of maternal mortality. We studied pregnancy outcomes in women with a systemic right ventricle (sRV) after the atrial switch procedure for transposition of the great arteries (TGA) or congenitally corrected TGA (CCTGA).
Methods
The ESC-EORP Registry of Pregnancy and Cardiac Disease is an international prospective registry of pregnant women with cardiac disease. Pregnancy outcomes (maternal and fetal) in women with a sRV are described. The primary endpoint was a major cardiovascular event (MACE) defined as maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary event and other thromboembolic events.
Results
Altogether, 163 women with a sRV (TGA n=121, CCTGA n=42, mean age 28.8±4.6 years) were included. Maternal mortality did not occur. At least one MACE occurred in 26 women (heart failure in 16 (9.8%), arrhythmias (atrial 5, ventricular 6) in 11 (6.7%), and others in 4 (2.5%)). Predictors of MACE were pre-pregnancy signs of heart failure [Odds ratio (OR) 6.05, 95% CI: 1.41–25.97, p=0.02] as well as a sRV ejection fraction below 40% [OR 2.81, 95% CI: 1.18–6.69, p=0.02]. One woman experienced fetal loss, while no neonatal mortality was observed. No significant differences were found between women with CCTGA and TGA. In the subset of women who had an echocardiogram before and after pregnancy, no clear deterioration in sRV was observed.
Conclusion
The majority of women with a sRV tolerated pregnancy well with a favorable maternal and fetal outcome. Heart failure and arrhythmias were the most common MACE.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Tutarel
- German Heart Centre Munich - Technical University of Munich, Munich, Germany
| | - L Baris
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - M Johnson
- Imperial College London, London, United Kingdom
| | - R Hall
- University of East Anglia, Norwich, United Kingdom
| | - J.W Roos-Hesselink
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
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Berry P, Burrows K, Hall R, Gater A, Bradley H, Ward A, Tolley C, Delong P, Hsia EC. AB1332-HPR ASSESSING THE PATIENT EXPERIENCE OF LUPUS NEPHRITIS: DEVELOPMENT OF A CONCEPTUAL MODEL AND REVIEW OF EXISTING PATIENT-REPORTED OUTCOME (PRO) MEASURES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Lupus nephritis (LN) is an autoimmune disease characterized by inflammation of the kidneys as a result of systemic lupus erythematosus (SLE). Approximately 50% of SLE patients will develop LN, which is considered to be one of the most severe manifestations of SLE and the leading cause of morbidity and mortality in SLE. While there is ample existing evidence on disease experience and PROs used in extra-renal SLE, little research has been done in LN. Qualitative interviews with patients can help identify concepts that are both important and relevant to the patient. In order to effectively evaluate treatment benefit, it is critical that PRO measures used to assess such concepts and define clinical trial endpoints are fit for purpose and have strong evidence of content validity in the specific context of use.Objectives:The objective of this study was to understand the patient experience of LN and to identify and characterize the signs and symptoms of LN and their impact on health-related quality of life (HRQoL) through the development of a disease-specific conceptual model. This model was then used to evaluate the content validity of existing PRO measures available for use in LN.Methods:A structured literature search was conducted in Medline, Embase and PsycINFO to identify qualitative research articles documenting the patient experience of LN. PRO measures developed or commonly used to assess patient experiences of LN were also identified. Semi-structured concept elicitation interviews were conducted with 15 adult patients in the US with a clinician-confirmed diagnosis of LN (defined in accordance with established clinical guidelines). Supplementary qualitative data were also collected from a review of publicly available online blogs/forums. Findings were used to inform the development of a conceptual model detailing the impact of LN signs, symptoms and HRQoL and evaluate the validity of existing measures used within LN.Results:Searches revealed a paucity of qualitative research conducted with LN patients, supporting the need for prospective research in LN. Consistent with existing literature in SLE, the core signs and symptoms identified from the qualitative literature review, interviews and blog/forum review included joint pain, fatigue, joint stiffness, swelling (particularly in the extremities) and skin rashes. LN patients also reported urinary frequency, urgency, foamy urine and blood in their urine. Disease impact on physical functioning, activities of daily living, emotions, social life, work/finances and sleep were reported. PRO measures commonly used to evaluate patient experiences in LN included the SF-36, LupusQOL, LupusPRO, SLE Symptom Checklist, KDQoL and KSQ. Conceptual mapping of instruments against the newly developed conceptual model (Figure 1) highlighted that no single measure provides a comprehensive assessment of all symptoms/impact important to LN patients. Furthermore, items are largely focused on impact of symptoms with few items on symptom severity.Figure 1.Conceptual model of lupus nephritis symptoms and associated impactsConclusion:The presentation of signs and symptoms in LN patients appears similar to those reported in extra-renal SLE populations, with the addition of swelling and urinary symptoms. Qualitative research with LN patients guided the development of a comprehensive LN conceptual model outlining the disease experience from the patients’ perspective. These insights can be useful to inform PRO measurement strategies for clinical trials in LN.Acknowledgments:With thanks to Dr. Betty Diamond and Dr. David Wofsy for their collaboration and helpful insightsDisclosure of Interests:Pamela Berry Employee of: Janssen, Kate Burrows Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Rebecca Hall Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract., Adam Gater Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Helena Bradley Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Amy Ward Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Chloe Tolley Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Patricia Delong Employee of: Janssen, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC
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Smyk W, Weber SN, Hall R, Gruenhage F, Lammert F, Krawczyk M. Genetic variant c.711A>T in the hepatobiliary phospholipid transporter ABCB4 is associated with significant liver fibrosis. J Physiol Pharmacol 2020; 71. [PMID: 32991311 DOI: 10.26402/jpp.2020.3.02] [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] [Received: 05/21/2020] [Accepted: 06/30/2020] [Indexed: 11/03/2022]
Abstract
Liver fibrosis is the common consequence of chronic liver diseases (CLD). Recently liver stiffness measurements (LSM) ≥ 9.1 kPa, as determined by transient elastography (TE), were demonstrated to predict significant fibrosis (stages ≥ F2) in a population-based setting. The PNPLA3 (adiponutrin) p.I148M polymorphism enhances the risk of liver injury. The aim of our study was to investigate the association between the procholestatic ABCB4 polymorphism c.711A>T and LSM ≥ 9.1 kPa in humans as well as the interaction between ABCB4 and PNPLA3 in a mouse model of chronic cholestasis. Prospectively, we recruited 712 patients with CLD (278 women, age 50 ± 13 years) with available TE results; liver biopsy results were available in 165 individuals. The ABCB4 c.711 genotype was determined by PCR-based assays. PNPLA3 expression and liver injury were studied in Abcb4-/- mice and wild-type controls. Overall, median LSM in our cohort was 6.7 kPa, and 226 individuals had LSM ≥ 9.1 kPa. Carriers of the ABCB4 variant c.711A presented more frequently with LSM ≥ 9.1 kPa (OR = 1.33, P = 0.020) and FIB-4 score ≥ 2.67 (OR = 1.38, P = 0.040). The presence of the risk allele was associated (P = 0.002) with FIB-4. In a multivariate model, the ABCB4 variant (OR = 1.43, P = 0.047) as well as BMI (P = 0.043, OR = 1.04) and age (OR = 1.02, P < 0.010) were independent risk factors for fibrosis stage ≥ F2. Abcb4 deficiency in mice led to enhanced liver injury, coupled with a decrease (P = 0.020) of hepatic PNPLA3 expression. To conclude, the procholestatic variant ABCB4 c.711A>T might represent a new genetic risk factor for clinically significant liver fibrosis. Lower expression of PNPLA3 in fibrotic Abcb4-/- livers points to the interaction between phospholipid metabolism and PNPLA3 in progressive liver injury.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/genetics
- ATP Binding Cassette Transporter, Subfamily B/metabolism
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Animals
- Case-Control Studies
- Female
- Genetic Association Studies
- Genetic Predisposition to Disease
- Humans
- Liver/metabolism
- Liver/pathology
- Liver Cirrhosis/diagnosis
- Liver Cirrhosis/genetics
- Liver Cirrhosis/metabolism
- Liver Cirrhosis, Experimental/genetics
- Liver Cirrhosis, Experimental/metabolism
- Liver Cirrhosis, Experimental/pathology
- Male
- Mice, Knockout
- Middle Aged
- Phenotype
- Phospholipases A2, Calcium-Independent/genetics
- Phospholipases A2, Calcium-Independent/metabolism
- Phospholipids/metabolism
- Polymorphism, Single Nucleotide
- Risk Assessment
- Risk Factors
- Young Adult
- ATP-Binding Cassette Sub-Family B Member 4
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Affiliation(s)
- W Smyk
- Department of Medicine II Saarland university Medical Center, Saarland university, Homburg, Germany
- Liver and Internal Medicine unit, Department of General, Transplant and Liver Surgery, Medical university of Warsaw, Warsaw, Poland
| | - S N Weber
- Department of Medicine II Saarland university Medical Center, Saarland university, Homburg, Germany
| | - R Hall
- Department of Medicine II Saarland university Medical Center, Saarland university, Homburg, Germany
| | - F Gruenhage
- Department of Medicine II Saarland university Medical Center, Saarland university, Homburg, Germany
| | - F Lammert
- Department of Medicine II Saarland university Medical Center, Saarland university, Homburg, Germany
| | - M Krawczyk
- Department of Medicine II Saarland university Medical Center, Saarland university, Homburg, Germany.
- Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Laboratory of Metabolic Liver Diseases, Centre for Preclinical Research, Medical university of Warsaw, Warsaw, Poland
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Kincaide E, Hitchman K, Hall R, Yamaguchi I, Ding Y, Crowther B. Impact of active antibody-mediated rejection treatment on donor-specific antibodies in pediatric kidney transplant recipients. Pediatr Transplant 2019; 23:e13590. [PMID: 31617318 DOI: 10.1111/petr.13590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/17/2019] [Accepted: 09/01/2019] [Indexed: 01/06/2023]
Abstract
AMR is a major cause of graft loss after kidney transplantation. We evaluated a retrospective cohort of 13 pediatric kidney transplant patients diagnosed with active AMR. All 13 patients were treated with plasmapheresis (PP), IVIg, and rituximab. Anti-HLA DSAs were measured at the time of transplantation, AMR diagnosis, 30 days post-rejection treatment, 90 days post-rejection treatment, and 24 ± 12 months post-AMR. A total of 68 DSAs were identified from 13 patients at the time of active AMR diagnosis. The primary objective of this study was to differentiate treatment response rates between class I and class II anti-HLA DSA post-AMR treatment. Overall, DSAs were significantly reduced at 30 days, and the reduction was sustained at 90 days post-treatment, even for class II anti-HLA and strongly positive DSAs. A significant difference between class I and class II anti-HLA DSA was observed at 30 days; however, between class significance was lost at 90-day follow-up due to continued class II anti-HLA DSA treatment response. Low DSA strength was predictive of treatment response. eGFR demonstrated significant improvement 90 days after AMR diagnosis compared to the initial value at the time of AMR, and the effect was sustained for 12 months. These results suggest that the AMR treatment is effective in pediatric kidney transplant recipients with an early diagnosis of active AMR across both class I and class II anti-HLA DSAs.
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Affiliation(s)
- Elisabeth Kincaide
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA.,University Transplant Center, University Health System, San Antonio, TX, USA.,Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kelley Hitchman
- University Transplant Center, University Health System, San Antonio, TX, USA.,Histocompatibility and Immunogenetics Laboratory, University Health System, San Antonio, TX, USA.,Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Reed Hall
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA.,University Transplant Center, University Health System, San Antonio, TX, USA.,Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Ikuyo Yamaguchi
- University Transplant Center, University Health System, San Antonio, TX, USA.,Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Yanli Ding
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Barrett Crowther
- Ambulatory Care Pharmacy Services, University of Colorado Health, Aurora, CO, USA.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
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Irvine K, Hall R, Taylor L. A profile of the Centre for Health Record Linkage. Int J Popul Data Sci 2019; 4:1142. [PMID: 37655068 PMCID: PMC8142947 DOI: 10.23889/ijpds.v4i2.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Context The Centre for Health Record Linkage (CHeReL) was established in 2006 as a dedicated health and human services data linkage facility for two Australian jurisdictions, New South Wales and the geographically-nested Australian Capital Territory. The two jurisdictions have their own Governments and separate Health and Human Service systems. Purpose and Operations The primary purpose of the CHeReL is to make linked administrative and routinely collected health data available to researchers and government within relevant regulatory and governance frameworks. The CHeReL's data governance and technical operations draw on international best practice and have been refined by learnings from other data linkage centres. Outcomes Over twelve years of operation, more than 2,320 unique investigators from 140 institutions have used the CHeReL, producing 615 publications in peer-reviewed literature. A robust pipeline of new development is expected to further amplify the use of linked data for cutting edge medical research and support a vision of data-informed policy and data-driven government services.
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Affiliation(s)
- K Irvine
- NSW Health, St Leonards NSW 2065 Australia
| | - R Hall
- Choicemaker LLC, Princeton New Jersey 08540 USA
| | - L Taylor
- NSW Health, St Leonards NSW 2065 Australia
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Abstract
CONTEXT The Centre for Health Record Linkage (CHeReL) was established in 2006 as a dedicated health and human services data linkage facility for two Australian jurisdictions, New South Wales and the geographically-nested Australian Capital Territory. The two jurisdictions have their own Governments and separate Health and Human Service systems. PURPOSE AND OPERATIONS The primary purpose of the CHeReL is to make linked administrative and routinely collected health data available to researchers and government within relevant regulatory and governance frameworks. The CHeReL's data governance and technical operations draw on international best practice and have been refined by learnings from other data linkage centres. OUTCOMES Over twelve years of operation, more than 2,320 unique investigators from 140 institutions have used the CHeReL, producing 615 publications in peer-reviewed literature. A robust pipeline of new development is expected to further amplify the use of linked data for cutting edge medical research and support a vision of data-informed policy and data-driven government services.
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Affiliation(s)
- K Irvine
- NSW Health, St Leonards NSW 2065 Australia
| | - R Hall
- Choicemaker LLC, Princeton New Jersey 08540 USA
| | - L Taylor
- NSW Health, St Leonards NSW 2065 Australia
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Gentzler R, Mohindra N, Jalal S, Reckamp K, Hall R, Hanna N, Chae Y, Villaflor V, Koczywas M, Helenowski I, Rademaker A, Patel J. P1.01-67 Ph I/II Carboplatin, Nab-Paclitaxel and Pembrolizumab for Advanced NSCLC (HCRN LUN13-175): Outcomes by Nab-Paclitaxel Dose. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.782] [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: 10/25/2022]
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Mcloughlin E, Hanson L, Moore M, Horton B, Gentzler R, Hall R. P2.01-52 Clinical Characteristics and Outcomes in NSCLC Patients Associated with Very High PD-L1 Expression. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1395] [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: 10/25/2022]
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Kazakov A, Hall R, Weber SN, Trouvain A, Lammert F, Maack C, Boehm M, Laufs U, Werner C. P4997Raf kinase inhibitor protein of the bone marrow contributes to cardiac fibrogenesis in pressure-overloaded myocardium. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0175] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Raf Kinase Inhibitor Protein (RKIP) regulates myocardial remodeling under conditions of enhanced myocardial oxidative stress in pressure-overloaded left ventricle (LV) modulating myocardial production of reactive oxygen species (ROS). A second mode of action may be the mobilization of circulating fibroblasts (fibrocytes) from the bone-marrow (BM). However the underlying mechanisms are incompletely understood.
Methods and results
To further characterize the role of RKIP in BM cells for myocardial remodeling 10-week-old wild-type (WT) C57BL/6N mice were subjected to transplantation of bone marrow (BMT) from 10-week-old C57BL/6-RKIP-deficient (RKIP−/−) N or WT C57BL/6N mice expressing green fluorescent protein (GFP)+ ubiquitously. 28 days later, transverse aortic constriction (TAC, 360 μm) or SHAM-operation was performed. 5 weeks post TAC, LV systolic pressure (LVSP) and heart weight to tibia length ratio were significantly increased in both types of BMT, compared with corresponding SHAM. Increased afterload elicited myocardial fibrosis as assessed by picrosirius red staining (WT/WT SHAM 15±2.5%, WT/WT TAC 21.3±1.4%, p<0.05; RKIP−/−/WT SHAM 17±2%, RKIP−/−/WT TAC 18±3%, p=ns) and significantly increased the number of LV fibroblasts per mm2 estimated by immunostaining for intracellular fibronectin, which were further reduced by transplantation of RKIP−/−N BM (WT/WT SHAM 5499±313, WT/WT TAC 7493±741 per mm2, p<0.05; RKIP−/−/WT SHAM 5737±259, RKIP−/−/WT TAC 5282±551, per mm2, p=ns). Moreover, transplantation of RKIP−/−N BM significantly diminished the number of circulating BM-derived GFP+ fibroblasts in the peripheral blood and LV myocardium during pressure overload (WT/WT SHAM 961±129, WT/WT TAC 2326±273 per mm2, p<0.05; RKIP−/−/WT SHAM 1041±209, RKIP−/−/WT TAC 1518±107, per mm2, p=ns). The myocardial redox status was assessed by the co-immunostaining for ROS production marker 8-hydroxyguanosin (8-dOHG), cardiomyocyte marker α-sarcomeric actin and fibroblast marker intracellular fibronectin. Pressure overload during 5 weeks significantly increased the percentages of 8-dOHG+cardiomyocytes (WT/WT SHAM 34±9%, WT/WT TAC 63±6%, p<0.05; RKIP−/−/WT SHAM 29±6%, RKIP−/−/WT TAC 31±8%, p=ns) and 8-dOHG+fibroblasts (WT/WT SHAM 57±6%, WT/WT TAC 73±4%, p<0.05; RKIP−/−/WT SHAM 58±2%, RKIP−/−/WT TAC 58±7%, p=ns) in mice transplanted with WT BM but not with RKIP−/−N BM.
Conclusions
In pressure-overload induced enhanced myocardial ROS production, deficiency of RKIP-expression in the bone marrow abrogates left ventricular fibrosis by reduction of myocardial ROS production and mobilization of BM-derived fibroblasts. These findings suggest that the function of RKIP in the bone marrow may be important for maladaptive myocardial remodelling.
Acknowledgement/Funding
Deutsche Forschungsgemeinschaft: KA4024/3-1, SFB TRR219; Saarland University HOMFOR, Dr. Marija Orlovich foundation, Corona foundation s199/10060/2014
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Affiliation(s)
- A Kazakov
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - R Hall
- Saarland University Hospital, Department of Internal Medicine II, Gastroenterology, Hepatology Endocrinology, Diabetology and Nutr, Homburg, Germany
| | - S N Weber
- Saarland University Hospital, Department of Internal Medicine II, Gastroenterology, Hepatology Endocrinology, Diabetology and Nutr, Homburg, Germany
| | - A Trouvain
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - F Lammert
- Saarland University Hospital, Department of Internal Medicine II, Gastroenterology, Hepatology Endocrinology, Diabetology and Nutr, Homburg, Germany
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Department of translational research, Wurzburg, Germany
| | - M Boehm
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - U Laufs
- Leipzig University Hospital, Leipzig, Germany
| | - C Werner
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
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Torres ERS, Hall R, Bobe G, Choi J, Impey S, Pelz C, Lindner JR, Stevens JF, Raber J. Integrated Metabolomics-DNA Methylation Analysis Reveals Significant Long-Term Tissue-Dependent Directional Alterations in Aminoacyl-tRNA Biosynthesis in the Left Ventricle of the Heart and Hippocampus Following Proton Irradiation. Front Mol Biosci 2019; 6:77. [PMID: 31552266 PMCID: PMC6746933 DOI: 10.3389/fmolb.2019.00077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022] Open
Abstract
In this study, an untargeted metabolomics approach was used to assess the effects of proton irradiation (1 Gy of 150 MeV) on the metabolome and DNA methylation pattern in the murine hippocampus and left ventricle of the heart 22 weeks following exposure using an integrated metabolomics-DNA methylation analysis. The integrated metabolomics-DNA methylation analysis in both tissues revealed significant alterations in aminoacyl-tRNA biosynthesis, but the direction of change was tissue-dependent. Individual and total amino acid synthesis were downregulated in the left ventricle of proton-irradiated mice but were upregulated in the hippocampus of proton-irradiated mice. Amino acid tRNA synthetase methylation was mostly downregulated in the hippocampus of proton-irradiated mice, whereas no consistent methylation pattern was observed for amino acid tRNA synthetases in the left ventricle of proton-irradiated mice. Thus, proton irradiation causes long-term changes in the left ventricle and hippocampus in part through methylation-based epigenetic modifications. Integrated analysis of metabolomics and DNA methylation is a powerful approach to obtain converging evidence of pathways significantly affected. This in turn might identify biomarkers of the radiation response, help identify therapeutic targets, and assess the efficacy of mitigators directed at those targets to minimize, or even prevent detrimental long-term effects of proton irradiation on the heart and the brain.
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Affiliation(s)
- Eileen Ruth S Torres
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States
| | - Reed Hall
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States
| | - Gerd Bobe
- Linus Pauling Institute, Oregon State University, Corvallis, OR, United States.,Department of Animal & Rangeland Sciences, Oregon State University, Corvallis, OR, United States
| | - Jaewoo Choi
- Linus Pauling Institute, Oregon State University, Corvallis, OR, United States.,Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States
| | - Soren Impey
- Oregon Stem Cell Center and Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
| | - Carl Pelz
- Oregon Stem Cell Center and Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
| | - Jonathan R Lindner
- Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, United States.,Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
| | - Jan F Stevens
- Linus Pauling Institute, Oregon State University, Corvallis, OR, United States.,Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States
| | - Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States.,Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States.,Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States.,Division of Neuroscience ONPRC, Departments of Neurology and Radiation Medicine, Oregon Health & Science University, Portland, OR, United States
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Wrigley P, Wood P, Stewart P, Hall R, Robertson D. Module layout optimization using a genetic algorithm in light water modular nuclear reactor power plants. Nuclear Engineering and Design 2019. [DOI: 10.1016/j.nucengdes.2018.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hall R, Rutledge J, Hall K, Colon-Emeric C. RACIAL DIFFERENCES IN RESILIENCE AMONG OLDER DIALYSIS PATIENTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2242] [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: 11/13/2022] Open
Affiliation(s)
- R Hall
- Duke University, Durham, North Carolina, United States
| | | | - K Hall
- Duke University, Durham, NC, USA
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Smedley LW, Foster DB, Barthol CA, Hall R, Gutierrez GC. Safety and Efficacy of Intermittent Bolus and Continuous Infusion Neostigmine for Acute Colonic Pseudo-Obstruction. J Intensive Care Med 2018; 35:1039-1043. [PMID: 30373445 DOI: 10.1177/0885066618809010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare clinical response of intermittent bolus versus continuous infusion neostigmine for acute colonic pseudo-obstruction (ACPO). Acute colonic pseudo-obstruction occurs due to reduced colonic parasympathetic activity. Neostigmine is an acetylcholinesterase inhibitor that increases frequency of smooth muscle contraction by increasing acetylcholine at autonomic nervous system synapses. Although these administration modalities have been studied separately, they have never been compared. METHODS This retrospective study compared bolus versus continuous infusion neostigmine for ACPO. The primary outcome was initial clinical response, defined as bowel movement (BM) within 4 hours of bolus dose or 24 hours of initiation of continuous infusion. Secondary outcomes included time to BM, bowel diameter reduction at 24 hours, incidence of bradycardia, additional neostigmine requirements, and need for colonic decompression or surgical intervention. RESULTS Seventy-five patients were included (bolus n = 37; infusion n = 38). Median total 24-hour neostigmine dose was 2.0 mg (interquartile range [IQR]: 2.0-2.6) with bolus and 9.6 mg (IQR: 6.3-9.6) with continuous infusion. Initial clinical response was similar (infusion 81.6% vs bolus 62.2%, P = .06), but continuous infusion was associated with greater bowel diameter reduction (73.7% vs 40.5%, P = .004). Bolus administration had shorter time to BM (1.4 vs 3.5 hours, P = .0478) and increased need for colonic decompression (67.6% vs 39.5%, P = .0148). Bolus dosing was associated with less bradycardia (13.5% vs 39.5%, P = 0.011), with no difference in atropine usage (10.8% vs 5.3%, P = .43). CONCLUSION Initial clinical response was similar between groups; however, continuous infusion neostigmine was associated with greater bowel diameter reduction at 24 hours. Bolus administration resulted in less bradycardia; however, given the lack of difference in atropine use, clinical significance is unknown. This study is the first to compare bolus versus continuous infusion neostigmine for ACPO. Further studies are needed to confirm findings.
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Affiliation(s)
- Lucas W Smedley
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA.,School of Medicine, Pharmacotherapy Research and Education Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Dana B Foster
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA.,School of Medicine, Pharmacotherapy Research and Education Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Colleen A Barthol
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA.,School of Medicine, Pharmacotherapy Research and Education Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Reed Hall
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA.,School of Medicine, Pharmacotherapy Research and Education Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - G Christina Gutierrez
- Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA.,School of Medicine, Pharmacotherapy Research and Education Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, TX, USA
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Gralla R, Hollen P, Hall R, Gentzler R, Cheng H, Halmos B, Crawford J, Cerise J, Lesser M. P2.01-39 Can Benefit or Futility in Treating Advanced Nsclc Be Determined Early Using the LCSS 3-Item Global Index (3-IGI) PRO? J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1093] [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: 11/28/2022]
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