108 research outputs found
Polymerase chain reaction to search for Herpes viruses in uveitic and healthy eyes: a South African perspective
Objective: To analyse aqueous polymerase chain reaction (PCR) results
in patients diagnosed with undifferentiated uveitis and determine
prevalence of herpesviridae in non-uveitic patients undergoing routine
cataract extraction. Design: Retrospective comparative case series and
prospective cross-sectional study. Subjects: 72 patients with
idiopathic uveitis and 57 surgical patients. Methods: Diagnostic
aqueous paracentesis with PCR testing for 6 herpes viridae in uveitic
patients. Anterior chamber paracentesis immediately pre-operative in
the prospective arm, with PCR testing. Results: In the retrospective
review we had a 47.2% positive PCR yield. Data analysis revealed a
statistically significant correlation between a positive yield and
being HIV+ (p=0.018); between an EBV+ yield and being HIV+ (p= 0.026)
and a CMV+ result and being HIV+ (p=0.032). Posterior uveitis (p=0.014)
and symptoms <30 days (p= 0.0014) had a statistically significant
yield. In the prospective arm of the study: all 57 patients were HIV-
and all aqueous samples were negative for the 6 herpesviridae.
Conclusion: We recommend PCR testing for Herpesviridae as a safe second
line test for patients with undifferentiated uveitis. We were unable to
establish prevalence and suggest that the idea of a commensal herpes
virus is unlikely if the blood-ocular barrier is intact
Factors influencing the development of early- or late-onset Parkinson’s disease in a cohort of South African patients
Background. Neurodegenerative disorders such as Parkinson’s disease (PD) contribute significantly to global disease burden. PD can be categorised into early-onset PD (EOPD) with an age at onset (AAO) of ≤50 years and late-onset PD (LOPD) with an AAO of 50 years.
Aims. To identify factors influencing EOPD and LOPD development in a group of patients in South Africa (SA).
Methods. A total of 397 unrelated PD patients were recruited from the Movement Disorders Clinic at Tygerberg Hospital and via the Parkinson’s Association of SA. Patient demographic and environmental data were recorded and associations with PD onset (EOPD v. LOPD) were analysed with a Pearson’s Chi-squared test. The English- and Afrikaans-speaking (Afrikaner) white patients were analysed separately.
Results. Logistic regression analysis showed that ethnicity (
F.A.R.O.G. FORUM, Vol. 4 No. 1
https://digitalcommons.library.umaine.edu/francoamericain_forum/1054/thumbnail.jp
Relation of maternal prepregnancy body mass index with offspring bone mass in childhood: is there evidence for an intrauterine effect?1234
Background: Evidence indicates that intrauterine skeletal development has implications for bone mass in later life and that maternal fat stores in pregnancy are important for fetal bone mineral accrual
Improving the Quality of Care in Care Homes Using the Quality Improvement Collaborative Approach: Lessons Learnt from Six Projects Conducted in the UK and The Netherlands.
The Breakthrough Series Quality Improvement Collaborative (QIC) initiative is a well-developed and widely used approach, but most of what we know about it has come from healthcare settings. In this article, those leading QICs to improve care in care homes provide detailed accounts of six QICs and share their learning of applying the QIC approach in the care home sector. Overall, five care home-specific lessons were learnt: (i) plan for the resources needed to support collaborative teams with collecting, processing, and interpreting data; (ii) create encouraging and safe working environments to help collaborative team members feel valued; (iii) recruit collaborative teams, QIC leads, and facilitators who have established relationships with care homes; (iv) regularly check project ideas are aligned with team members' job roles, responsibilities, and priorities; and (v) work flexibly and accept that planned activities may need adapting as the project progresses. These insights are targeted at teams delivering QICs in care homes. These insights demonstrate the need to consider the care home context when applying improvement tools and techniques in this setting
Population changes in a whale breeding ground revealed by citizen science noninvasive genetics
Historical exploitation, and a combination of current anthropogenic impacts, such as climate
change and habitat degradation, impact the population dynamics of marine mammalian
megafauna. Right whales (Eubalaena spp.) are large cetaceans recovering from hunting, whose
reproductive and population growth rate appear to be impacted by climate change. We apply
noninvasive genetic methods to monitor southern right whale (E. australis, SRW) and test the
application of noninvasive genetics to minimise the observer effects on the population. Our
aim is to describe population structure, and interdecadal and interannual changes to assess
species status in the Great Acceleration period of Anthropocene. As a basis for population
genetic analyses, we collected samples from sloughed skin during post-migration epidermal
moult. Considering the exploration-exploitation dilemma, we collaborated with whale
watching companies, as part of a citizen science approach and to reduce ad hoc logistic operations
and biopsy equipment. We used mitochondrial and microsatellite data and population
genetic tools. We report for the first time the genetic composition and differentiation of the
Namibian portion of the range. Population genetic parameters suggest that South Africa hosts
the largest population. This corresponds with higher estimates of current gene flow from Africa
compared to older samples. We have observed considerable interannual variation in population
density at the breeding ground and an interdecadal shift in genetic variability, evidenced
by an increase in the point estimate inbreeding. Clustering analyses confirmed differentiation
between the Atlantic and Indo-Pacific, presumably originating during the ice ages. We show
that population monitoring of large whales, essential for their conservation management, is
feasible using noninvasive sampling within non-scientific platforms. Observed patterns are concurrent to changes of movement ecology and decline in reproductive success of the South
African population, probably reflecting a large-scale restructuring of pelagic marine food
webs.Charles University Grant Agency, Czech Republic.https://www.elsevier.com/locate/geccoam2023Mammal Research InstituteZoology and Entomolog
The challenge of equipoise: qualitative interviews exploring the views of health professionals and women with multiple ipsilateral breast cancer on recruitment to a surgical randomised controlled feasibility trial
Background-
A multicentre feasibility trial (MIAMI), comparing outcomes and quality of life of women with multiple ipsilateral breast cancer randomised to therapeutic mammoplasty or mastectomy, was conducted from September 2018 to March 2020. The MIAMI surgical trial aimed to investigate recruitment of sufficient numbers of women. Multidisciplinary teams at 10 breast care centres in the UK identified 190 with MIBC diagnosis; 20 were eligible for trial participation but after being approached only four patients were recruited. A nested qualitative study sought to understand the reasons for this lack of recruitment.
Methods-
Interviews were conducted from November 2019 to September 2020 with 17 staff from eight hospital-based breast care centres that recruited and attempted to recruit to MIAMI; and seven patients from four centres, comprising all patients who were recruited to the trial and some who declined to take part. Interviews were audio-recorded, anonymised and analysed using thematic methods of building codes into themes and sub-themes using the process of constant comparison.
Results-
Overarching themes of (1) influences on equipoise and recruitment and (2) effects of a lack of equipoise were generated. Within these themes, health professional themes described the barriers to recruitment as ‘the treatment landscape has changed’, ‘staff preferences and beliefs’ which influenced equipoise and patient advice; and how different the treatments were for patients. Patient themes of ‘altruism and timing of trial approach’, ‘influences from consultants and others’ and ‘diagnostic journey doubts’ all played a part in whether patients agreed to take part in the trial.
Conclusions-
Barriers to recruiting to breast cancer surgical trials can be significant, especially where there are substantial differences between the treatments being offered and a lack of equipoise communicated by healthcare professionals to patients. Patients can become overwhelmed by numerous requests for participation in research trials and inappropriate timing of trial discussions. Alternative study designs to the gold standard randomised control trial for surgical interventions may be required to provide the high-quality evidence on which to base practice
Forty-eight-week efficacy and safety and early CNS tolerability of doravirine (MK-1439), a novel NNRTI, with TDF/FTC in ART-naive HIV-positive patients
INTRODUCTION: Doravirine (DOR) is an investigational NNRTI (aka MK-1439) that retains activity against common NNRTI-resistant mutants. We have previously reported the Part 1 results from a two-part, randomized, double-blind, Phase IIb study in ART-naïve HIV-1-positive patients (1). At doses of 25, 50, 100 and 200 mg qd, DOR plus open-label tenofovir/emtricitabine (TDF/FTC) demonstrated potent antiretroviral activity comparable to EFV 600 mg qhs plus TDF/FTC and was generally well tolerated at week 24. DOR 100 mg was selected for use in patients continuing in Part 1 and those newly enrolled in Part 2. METHODS: Patients receiving DOR 25, 50 or 200 mg in Part 1 were switched to 100 mg after dose selection. In Part 2, 132 additional patients were randomized 1:1 to DOR 100 mg qd or EFV 600 mg qhs (each with TDF/FTC). We present week 48 efficacy and safety results for all patients in Part 1, and early (week 8) CNS tolerability only for patients randomized to DOR 100 mg or to EFV in Parts 1 and 2 combined. The primary safety endpoint is the % of patients with pre-specified CNS events (all causality) by week 8 for DOR 100 mg qd vs EFV (Parts 1 + 2 combined). RESULTS: Part 1 week 48 efficacy and safety results are shown below. CONCLUSIONS: In ART-naïve, HIV-1-positive patients also receiving TDF/FTC, DOR 100 mg qd demonstrated potent antiretroviral activity and immunological effect at week 48 and was generally safe and well tolerated. Patients who received DOR 100 mg qd had significantly fewer treatment-emergent CNS AEs by week 8 than those who received EFV
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