20 results found
Cordery R, Reeves L, Zhou J, et al., 2022, Transmission of SARS-CoV-2 by children to contacts in schools and households: a prospective cohort and environmental sampling study in London, The Lancet Microbe, ISSN: 2666-5247
Background: Assessing transmission of SARS-CoV-2 by children in schools is of critical importance to inform public health action. We assessed frequency of acquisition of SARS-CoV-2 by contacts of pupils with COVID-19 in schools and households, and quantified SARS-CoV-2 shed into air and onto fomites in both settings.Methods: Incidents involving exposure to at least one index pupil with COVID-19 in 8 schools were identified between October 2020-July 2021 (prevailing variants, original, alpha and delta). Weekly PCR testing for SARS-CoV-2 was undertaken on immediate classroom contacts (the “bubble”), non-bubble school contacts, and household contacts of index pupils, supported by genome sequencing, and on surface and air samples from school and home environments.Findings: Secondary transmission of SARS-CoV-2 was not detected in 28 bubble contacts, representing 10 bubble classes (participation rate 8.8%, IQR 4.6-15.3%). Across 8 non-bubble classes, 3/62 pupils tested positive but these were unrelated to the original index case (participation rate 22.5%, IQR 9.7-32.3%). All three were asymptomatic and tested positive in one setting on the same day. In contrast, secondary transmission to previously-negative household contacts from infected index pupils was 17.1% (6/35) rising to 27.7% (13/47) when considering all potentialinfections in household contacts. Environmental contamination with SARS-CoV-2 was rare in schools; fomite SARS-CoV-2 was identified in 4/189 (2.1%) samples in bubble classrooms, 2/127 (1.6%) samples in non-bubble classrooms, and 5/130 (3.8%) samples in washrooms. This contrasted with fomites in households, where SARS-CoV-2 was identified in 60/248 (24.2%) bedroom samples, 66/241 (27.4%) communal room samples, and 21/188 (11.2%) bathroom samples. Air sampling identified SARS-CoV-2 RNA in just 1/68 (1.5%) of school air samples, compared with 21/85 (24.7%) of air samples taken in homes.Interpretation: There was no evidence of large scale SARS-Co
Kemp HI, Eliahoo J, Vase L, et al., 2020, Meta-analysis comparing placebo responses in clinical trials of painful HIV-associated sensory neuropathy and diabetic polyneuropathy, Scandinavian Journal of Pain, Vol: 20, Pages: 439-449, ISSN: 1877-8860
Background and aims The placebo response has been identified as one factor responsible for the lack of therapeutic trials with positive outcomes in neuropathic pain. Reviews have suggested that certain neuropathic pain conditions, including HIV-associated sensory neuropathy (HIV-SN), exhibit a greater placebo response than other neuropathic aetiologies. If true, such a finding could substantially affect clinical trial design and therapeutic developments for these conditions. This study aimed to identify any difference in placebo response between trials of systemic pharmacological intervention in HIV-SN and a comparable neuropathic condition, diabetic polyneuropathy (DPN) and to identify factors influencing the placebo response. Methods A systematic review search to identify randomised, double-blind studies of systemic pharmacological interventions for painful HIV-SN and DPN published between January 1966 and June 2019 was performed. A meta-analysis of the magnitude of placebo response and the proportion of placebo responders was conducted and compared between the two disease conditions. A meta-regression was used to assess for any study and participant characteristics that were associated with the placebo response. Only studies meeting a methodological quality threshold were included. Results Seventy-five trials were identified. There was no statistically significant difference in the proportion of placebo responders (HIV-SN = 0.35; versus DPN = 0.27, p = 0.129). The difference observed in the magnitude of the placebo response [pain reduction of 1.68 (1.47-1.88) DPN; 2.38 (1.87-2.98) in HIV-SN] was based on only 2 trials of HIV-SN and 35 of DPN. Potential factors influencing the placebo response such as psychological measures, were reported inconsistently. Conclusions We found no statistically significant difference in the placebo response rate between painful HIV-SN and DPN. Too few studies were available that reported the
Khan SA, Clements O, Kim JU, et al., 2020, Reply to: 'Letter regarding [Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: A systematic review and meta-analysis]', JOURNAL OF HEPATOLOGY, Vol: 72, Pages: 1217-1217, ISSN: 0168-8278
Clements O, Eliahoo J, Kim JU, et al., 2020, Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: A systematic review and meta-analysis, Journal of Hepatology, Vol: 72, Pages: 95-103, ISSN: 0168-8278
Background & AimsCholangiocarcinoma (CCA) carries a poor prognosis, is increasing in incidence and its causes are poorly understood. Although some risk factors are known, they vary globally and collectively account for a minority of cases. The aim of this study was to perform a comprehensive meta-analysis of risk factors for intrahepatic (iCCA) and extrahepatic cholangiocarcinoma (eCCA), from Eastern and Western world studies.MethodsA literature search of case-control studies was performed to identify potential risk factors for iCCA and eCCA. Pooled odds ratios (ORs) with 95% CIs and heterogeneity were calculated. Funnel plots were used to assess publication bias, and meta-regression was used to select risk factors for comparison between Eastern and Western studies.ResultsA total of 13 risk factors were selected from 25 case-control studies in 7 geographically diverse countries. The strongest risk factors for both iCCA and eCCA were biliary cysts and stones, cirrhosis, hepatitis B and hepatitis C. Choledochal cysts conferred the greatest risk of both iCCA and eCCA with pooled ORs of 26.71 (95% CI 15.80–45.16) and 34.94 (24.36–50.12), respectively. No significant associations were found between hypertension and obesity for either iCCA or eCCA. Comparing Eastern and Western populations, there was a difference for the association of hepatitis B with iCCA (coefficient = −0.15195; 95% CI −0.278 to −0.025; p = 0.022).ConclusionThis is the most comprehensive meta-analysis of CCA risk factors to date. Some risk factors, such as diabetes, although less strong, are increasing globally and may be contributing to rising rates of this cancer.
Youssaf A, Kim J, Eliahoo J, et al., 2019, Ablative therapy for unresectable intrahepatic cholangiocarcinoma: A systematic review and meta-analysis, Journal of Clinical and Experimental Hepatology, Vol: 9, Pages: 740-748, ISSN: 0973-6883
Background: Intrahepatic cholangiocarcinoma (iCCA) is usually a fatal malignancy with rising incidence globally. Surgical resection currently remains the only curative treatment. However, as only a minority of iCCA are amenable to resection, new therapeutic modalities are needed. Aims: Our aims were to systematically review and perform a meta-analysis on the existing literature regarding the use of ablative therapies in iCCA; and to assess their efficacy as a treatment modality by calculating pooled survival results and investigate associations between prognostic factors and survival. Methods: A comprehensive search of the PubMed database for relevant articles was performed. Studies assessing survival in patients with iCCA undergoing ablation were included. Data were extracted on patient, tumour and treatment characteristics and survival. Random effects meta-analysis was used to pool the data. Galbraith plots were used to investigate heterogeneity; bubble plots were formulated using regression-based meta-analysis. Results: 10 studies were included in the final analysis, yielding an aggregate of 206 patients (69.5% male, median age 51.2-72.5) and 320 tumours. 70.4% of patients were recurrent cases of iCCA and 29.6% primary iCCA. Median overall survival ranged from 8.7 to 52.4 months. Pooled survival rates for 1, 3 and 5-year survival were 76% (95% CI: 68-83%), 33% (21-44%) and 16% (7-26%), respectively. No significant association was found between the median age, number of tumours or median tumour size and 1-year survival. Conclusion: Ablative therapies display promising potential as treatment modalities for iCCA. However, further research is necessary to validate these findings.
Francis-Morris A, Mackie NE, Eliahoo J, et al., 2019, Compromised CD4:CD8 ratio recovery in people living with HIV aged over 50 years: an observational study, HIV Medicine, Vol: 21, Pages: 109-118, ISSN: 1464-2662
ObjectivesPersistent CD4:CD8 ratio inversion (< 1) is associated with mortality in older people. We investigated the interaction of the effects of baseline CD8 count and age at HIV diagnosis on CD4:CD8 ratio recovery with antiretroviral therapy (ART).MethodsAn observational study (1 January 2007 to 31 December 2016) was carried out using routinely collected data from the HIV outpatient services at Imperial College Healthcare NHS Trust, London, UK. CD4 and CD8 counts, prior to and during ART, treatment during primary HIV infection (PHI) and HIV‐1 viral load were included in univariate and multivariate analyses using Cox proportional hazard regression.ResultsData were included for 876 patients starting ART, where HIV suppression was achieved. Of these patients, 741 of 876 (84.6%) were male and 507 of 876 (57.9%) were Caucasian. The median time on ART was 38 [interquartile range (IQR) 17–66] months. CD8 count change on ART was bidirectional; low CD8 counts (≤ 600 cells/μL) increased and high CD8 counts (> 900 cells/μL) decreased. The median pre‐ART CD4:CD8 ratio was 0.41 (IQR 0.24–0.63), and recovery (≥ 1) occurred in 274 of 876 patients (31.3%). Pre‐ and post‐ART CD4:CD8 ratios were lower in those aged > 50 years compared with young adults aged 18–30 years (P < 0.001 and P = 0.002, respectively). After adjustment, younger age at HIV diagnosis (P < 0.001) and treatment during PHI (P < 0.001) were favourable for CD4:CD8 ratio normalization.ConclusionsOlder age (> 50 years) at HIV diagnosis was associated with persistent CD4:CD8 ratio inversion, whereas treatment of PHI was protective. These findings confirm the need for testing and early treatment of people aged > 50 years, and could be used in a risk management algorithm for enhanced surveillance.
Hargreaves S, Seedat F, Car J, et al., 2014, Screening for latent TB, HIV, and hepatitis B/C in new migrants in a high prevalence area of London, UK: a cross-sectional study, BMC INFECTIOUS DISEASES, Vol: 14, ISSN: 1471-2334
Thomson EC, Fleming VM, Main J, et al., 2011, Predicting spontaneous clearance of acute hepatitis C virus in a large cohort of HIV-1-infected men, GUT, Vol: 60, Pages: 837-845, ISSN: 0017-5749
Taher SE, Inder JW, Soltan SA, et al., 2011, Prostaglandin E2 vaginal gel or tablets for the induction of labour at term: a randomised controlled trial, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 118, Pages: 719-725, ISSN: 1470-0328
Tan T, Cabrita IZ, Hensman D, et al., 2010, Assessment of cardiac valve dysfunction in patients receiving cabergoline treatment for hyperprolactinaemia, CLINICAL ENDOCRINOLOGY, Vol: 73, Pages: 369-374, ISSN: 0300-0664
Mehta SR, Thomas EL, Patel N, et al., 2010, Proton magnetic resonance spectroscopy and ultrasound for hepatic fat quantification, HEPATOLOGY RESEARCH, Vol: 40, Pages: 399-406, ISSN: 1386-6346
Morin SHX, Cobbold JFL, Lim AKP, et al., 2009, Incidental findings in healthy control research subjects using whole-body MRI, EUROPEAN JOURNAL OF RADIOLOGY, Vol: 72, Pages: 529-533, ISSN: 0720-048X
Tyrer P, Oliver-Africano P, Romeo R, et al., 2009, Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities: a randomised controlled trial (NACHBID), HEALTH TECHNOLOGY ASSESSMENT, Vol: 13, Pages: 1-+, ISSN: 1366-5278
Thomson EC, Nastouli E, Main J, et al., 2009, Delayed anti-HCV antibody response in HIV-positive men acutely infected with HCV, AIDS, Vol: 23, Pages: 89-93, ISSN: 0269-9370
Tyrer P, Oliver-Africano PC, Ahmed Z, et al., 2008, Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial., Lancet, Vol: 371, Pages: 57-63, ISSN: 1474-547X
BACKGROUND: Aggressive challenging behaviour is frequently reported in adults with intellectual disability and it is often treated with antipsychotic drugs. However, no adequate evidence base for this practice exists. We compared flexible doses of haloperidol (a typical, first-generation antipsychotic drug), risperidone (an atypical, second-generation antipsychotic), and placebo, in the treatment of this behaviour. METHODS: 86 non-psychotic patients presenting with aggressive challenging behaviour from ten centres in England and Wales, and one in Queensland, Australia, were randomly assigned to haloperidol (n=28), risperidone (n=29), or placebo (n=29). Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug effects, and carer uplift (positive feelings about the care of the disabled person) and burden, together with total costs, were recorded at 4, 12, and 26 weeks. The primary outcome was change in aggression after 4 weeks' treatment, which was recorded with the modified overt aggression scale (MOAS). Analysis was by intention to treat. This study is registered as ISRCTN 11736448. FINDINGS: 80 patients had adherence of 80% or more to prescribed drug. Aggression decreased substantially with all three treatments by 4 weeks, with the placebo group showing the greatest change (median decrease in MOAS score after 4 weeks=9 [95% CI 5-14] for placebo, 79% from baseline; 7 [4-14] for risperidone, 58% from baseline; 6.5 [5-14] for haloperidol, 65% from baseline; p=0.06). Furthermore, although no important differences between the treatments were recorded, including adverse effects, patients given placebo showed no evidence at any time points of worse response than did patients assigned to either of the antipsychotic drugs. INTERPRETATION: Antipsychotic drugs should no longer be regarded as an acceptable routine treatment for aggressive challenging behaviour in people with intellectual disability.
Soljak M, Majeed A, Eliahoo J, et al., 2007, Ethnic inequalities in the treatment and outcome of diabetes in three English Primary Care Trusts, Vol: 6, ISSN: 1475-9276
BACKGROUND:Although the prevalence of diabetes is three to five times higher in UK South Asians than Whites, there are no reports of the extent of ethnicity recording in routine general practice, and few population-based published studies of the association between ethnicity and quality of diabetes care and outcomes. We aimed to determine the association between ethnicity and healthcare factors in an English population.METHODS:Data was obtained in 2002 on all 21,343 diabetic patients registered in 99% of all computerised general practitioner (GP) practices in three NW London Primary Care Trusts (PCTs), covering a total registered population of 720,000. Previously practices had been provided with training, data entry support and feedback. Treatment and outcome measures included drug treatment and blood pressure (BP), total cholesterol and haemoglobin A1c (HbA1c) levels.RESULTS:Seventy per cent of diabetic patients had a valid ethnicity code. In the relatively older White population, we expected a smaller proportion with a normal BP, but BP differences between the groups were small and suggested poorer control in non-White ethnic groups. There were also significant differences between ethnic groups in the proportions of insulin-treated patients, with a smaller proportion of South Asians - 4.7% compared to 7.1% of Whites - receiving insulin, although the proportion with a satisfactory HbA1c was smaller- 25.6% compared to 37.9%.CONCLUSION:Recording the ethnicity of existing primary care patients is feasible, beginning with patients with established diseases such as diabetes. We have shown that the lower proportion of South Asian patients with good diabetes control, and who are receiving insulin, is at least partly due to poorer standards of care in South Asians, although biological and cultural factors could also contribute. This study highlights the need to capture ethnicity data in clinical trials and in routine care, to specifically investigate the reasons for these
Hargreaves S, Friedland JS, Gothard P, et al., 2006, Impact on and use of health services by international migrants: questionnaire survey of inner city London A&E attenders, BMC HEALTH SERVICES RESEARCH, Vol: 6
Saxena S, Eliahoo J, Majeed A, 2002, Socioeconomic and ethnic group differences in self reported health status and use of health services by children and young people in England: cross sectional study, BMJ-BRITISH MEDICAL JOURNAL, Vol: 325, Pages: 520-523, ISSN: 1756-1833
Majeed A, Eliahoo J, Bardsley M, et al., 2002, Variation in coronary artery bypass grafting, angioplasty, cataract surgery, and hip replacement rates among primary care groups in London: association with population and practice characteristics, JOURNAL OF PUBLIC HEALTH MEDICINE, Vol: 24, Pages: 21-26, ISSN: 0957-4832
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