Browsing by Author "Gleneagles Hospital"

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    Antiphosphatidylserine Immunoglobulin M and Immunoglobulin G Antibodies Are Higher in Vivax Than Falciparum Malaria, and Associated With Early Anemia in Both Species
    (2019-09-26) Bridget E. Barber; Matthew J. Grigg; Kim Piera; Fiona H. Amante; Timothy William; Michelle J. Boyle; Gabriela Minigo; Arjen M. Dondorp; James S. McCarthy; Nicholas M. Anstey; Menzies School of Health Research; QIMR Berghofer Medical Research Institute; Mahidol University; Nuffield Department of Clinical Medicine; Burnet Institute; Gleneagles Hospital; Queen Elizabeth Hospital
    © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. BACKGROUND: Anemia is a major complication of vivax malaria. Antiphosphatidylserine (PS) antibodies generated during falciparum malaria mediate phagocytosis of uninfected red blood cells that expose PS and have been linked to late malarial anemia. However, their role in anemia from non-falciparum Plasmodium species is not known, nor their role in early anemia from falciparum malaria. METHODS: We measured PS immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in Malaysian patients with vivax, falciparum, knowlesi, and malariae malaria, and in healthy controls, and correlated antibody titres with hemoglobin. PS antibodies were also measured in volunteers experimentally infected with Plasmodium vivax and Plasmodium falciparum. RESULTS: PS IgM and IgG antibodies were elevated in patients with vivax, falciparum, knowlesi, and malariae malaria (P < .0001 for all comparisons with controls) and were highest in vivax malaria. In vivax and falciparum malaria, PS IgM and IgG on admission correlated inversely with admission and nadir hemoglobin, controlling for parasitemia and fever duration. PS IgM and IgG were also increased in volunteers infected with blood-stage P. vivax and P. falciparum, and were higher in P. vivax infection. CONCLUSIONS: PS antibodies are higher in vivax than falciparum malaria, correlate inversely with hemoglobin, and may contribute to the early loss of uninfected red blood cells found in malarial anemia from both species.
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    Asian consensus on irritable bowel syndrome
    (2010-01-01) Kok Ann Gwee; Young Tae Bak; Uday Chand Ghoshal; Sutep Gonlachanvit; Oh Young Lee; Kwong Ming Fock; Andrew Seng Boon Chua; Ching Liang Lu; Khean Lee Goh; Chomsri Kositchaiwat; Govind Makharia; Hyo Jin Park; Full Young Chang; Shin Fukudo; Myung Gyu Choi; Shobna Bhatia; Meiyun Ke; Xiaohua Hou; Michio Hongo; Gleneagles Hospital; Korea University; Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow; Chulalongkorn University; Hanyang University; Changi General Hospital; Ipoh Gastro Centre; Veterans General Hospital-Taipei; University of Malaya; Mahidol University; All India Institute of Medical Sciences, New Delhi; Severance Hospital; National Yang-Ming University, School of Medicine; Tohoku University School of Medicine; The Catholic University of Korea; King Edward Memorial Hospital India; Peking Union Medical College; Huazhong University of Science and Technology; Tohoku University Hospital
    Background and Aims: Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia. Methods: A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement. Results: We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. Conclusions: This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS. © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
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    Consensus and contentious statements on the use of probiotics in clinical practice: A south east Asian gastro-neuro motility association working team report
    (2018-10-01) Kok Ann Gwee; Warren Wei Rhen Lee; Khoon Lin Ling; Choon Jin Ooi; Seng Hock Quak; Yock Young Dan; Kewin Tien Ho Siah; James Guoxian Huang; Andrew Seng Boon Chua; Ida Normiha Hilmi; Raja Affendi Raja Ali; Christina Ong; Marcellus Simadibrata; Murdani Abdullah; Jose D. Sollano; Somchai Leelakusolvong; Sutep Gonlachanvit; Yeong Yeh Lee; Jane D. Ricaforte-Campos; Yee Kian Yin; Kuck Meng Chong; Chong Yuen Wong; De La Salle Health Sciences Institute; National University Health System; Duke-NUS Medical School Singapore; University of Santo Tomas Hospital; University of Indonesia, RSUPN Dr. Cipto Mangunkusumo; University of Malaya; Chulalongkorn University; Yong Loo Lin School of Medicine; KK Women's And Children's Hospital; Faculty of Medicine, Siriraj Hospital, Mahidol University; Gleneagles Hospital; School of Medical Sciences - Universiti Sains Malaysia; Universiti Kebangsaan Malaysia; Klinik Pakar Y&C; Klnic Chong; KK Hospital; Ipoh Gastro Centre; Fatimah Hospital; General Hospital
    © 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd The concept of consuming microorganisms in the treatment of a medical condition and in health maintenance has gained much attraction, giving rise to an abundance of medical claims and of health supplements. This study identified relevant clinical questions on the therapeutic use of probiotics and reviewed the literature in irritable bowel syndrome, inflammatory bowel disease, impaired intestinal immunity, liver disease, intestinal infections, and common childhood digestive disorders. Statements were developed to address these clinical questions. A panel of experienced clinicians was tasked to critically evaluate and debate the available data. Both consensus and contentious statements are presented to provide to clinicians a perspective on the potential of probiotics and importantly their limitations.
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    Factors influencing diagnosis and treatment of osteoporosis after a fragility fracture among postmenopausal women in Asian countries: A retrospective study
    (2013-02-14) Annie W. Kung; Tao Fan; Ling Xu; Wei B. Xia; Il H. Park; Hak S. Kim; Siew P. Chan; Joon K. Lee; Leonard Koh; Yung K. Soong; Suppasin Soontrapa; Thawee Songpatanasilp; Thana Turajane; Marc Yates; Shuvayu Sen; The University of Hong Kong; Merck & Co., Inc.; Beijing Union Hospital; Peking Union Medical College; Kyungpook National University; Gangnam Severance Hospital; University of Malaya Medical Centre; Assunta Hospital; Gleneagles Hospital; Chang Gung University; Khon Kaen University; Phramongkutklao Army Hospital; Mahidol University;
    Background: A vast amount of literature describes the incidence of fracture as a risk for recurrent osteoporotic fractures in western and Asian countries. Osteoporosis evaluation and treatment after a low-trauma fracture, however, has not been well characterized in postmenopausal women in Asia. The purpose of this study was to characterize patient and health system characteristics associated with the diagnosis and management of osteoporosis among postmenopausal women hospitalized with a fragility fracture in Asia.Methods: Patient surveys and medical charts of postmenopausal women (N=1,122) discharged after a fragility hip fracture from treatment centers in mainland China, Hong Kong, Singapore, South Korea, Malaysia, Taiwan, and Thailand between July 1, 2006 and June 30, 2007 were reviewed for bone mineral density (BMD) measurement, osteoporosis diagnosis, and osteoporosis treatment.Results: The mean (SD) age was 72.9 (11.5) years. A BMD measurement was reported by 28.2% of patients, 51.5% were informed that they had osteoporosis, and 33.0% received prescription medications for osteoporosis in the 6 months after discharge. Using multivariate logistic regression analyses, prior history of fracture decreased the odds of a BMD measurement (OR 0.63, 95% CI 0.45-0.88). Having a BMD measurement increased the odds of osteoporosis diagnosis (OR 10.1, 95% CI 6.36-16.0), as did having health insurance (OR 4.95, 95% CI 1.51-16.21 for private insurance with partial self-payment relative to 100% self-payment). A history of fracture was not independently associated with an osteoporosis diagnosis (OR 0.80, 95% CI 0.56-1.15). Younger age reduced the odds of receiving medication for osteoporosis (OR 0.59, 95% CI 0.36-0.96 relative to age ≥65), while having a BMD measurement increased the odds (OR 1.79, 95% CI 1.23-2.61).Conclusions: Osteoporosis diagnosis and treatment in Asian countries were driven by BMD measurement but not by fracture history. Future efforts should emphasize education of general practitioners and patients about the importance of fracture. © 2013 Kung et al; licensee BioMed Central Ltd.
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    Genetic diversity and neutral selection in Plasmodium vivax erythrocyte binding protein correlates with patient antigenicity
    (2020-07-01) Jin Hee Han; Jee Sun Cho; Jessica J.Y. Ong; Ji Hoon Park; Myat Htut Nyunt; Edwin Sutanto; Hidayat Trimarsanto; Beyene Petros; Abraham Aseffa; Sisay Getachew; Kanlaya Sriprawat; Nicholas M. Anstey; Matthew J. Grigg; Bridget E. Barber; Timothy William; Gao Qi; Yaobao Liu; Richard D. Pearson; Sarah Auburn; Ric N. Price; Francois Nosten; Laurent Rénia; Bruce Russell; Eun Taek Han; The Jenner Institute; A-Star, Singapore Immunology Network; Medical College of Soochow University; Jiangsu Institute of Parasitic Diseases; Armauer Hansen Research Institute; Addis Ababa University; Eijkman Institute for Molecular Biology; Shoklo Malaria Research Unit; Menzies School of Health Research; University of Otago; Mahidol University; Nuffield Department of Medicine; Wellcome Sanger Institute; University of Oxford Medical Sciences Division; Kangwon National University; Gleneagles Hospital; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit; Queen Elizabeth Hospital
    © 2020 Han et al. Plasmodium vivax is the most widespread and difficult to treat cause of human malaria. The development of vaccines against the blood stages of P. vivax remains a key objective for the control and elimination of vivax malaria. Erythrocyte binding-like (EBL) protein family mem-bers such as Duffy binding protein (PvDBP) are of critical importance to erythrocyte invasion and have been the major target for vivax malaria vaccine development. In this study, we focus on another member of EBL protein family, P. vivax erythrocyte binding protein (PvEBP). PvEBP was first identified in Cambodian (C127) field isolates and has subse-quently been showed its preferences for binding reticulocytes which is directly inhibited by antibodies. We analysed PvEBP sequence from 316 vivax clinical isolates from eight coun-tries including China (n = 4), Ethiopia (n = 24), Malaysia (n = 53), Myanmar (n = 10), Papua New Guinea (n = 16), Republic of Korea (n = 10), Thailand (n = 174), and Vietnam (n = 25). PvEBP gene exhibited four different phenotypic clusters based on the insertion/deletion (indels) variation. PvEBP-RII (179–479 aa.) showed highest polymorphism similar to other EBL family proteins in various Plasmodium species. Whereas even though PvEBP-RIII-V (480–690 aa.) was the most conserved domain, that showed strong neutral selection pressure for gene purifying with significant population expansion. Antigenicity of both of PvEBP-RII (16.1%) and PvEBP-RIII-V (21.5%) domains were comparatively lower than other P. vivax antigen which expected antigens associated with merozoite invasion. Total IgG recognition level of PvEBP-RII was stronger than PvEBP-RIII-V domain, whereas total IgG inducing level was stronger in PvEBP-RIII-V domain. These results suggest that PvEBP-RII is mainly recognized by natural IgG for innate protection, whereas PvEBP-RIII-V stimulates IgG production activity by B-cell for acquired immunity. Overall, the low antigenic-ity of both regions in patients with vivax malaria likely reflects genetic polymorphism for strong positive selection in PvEBP-RII and purifying selection in PvEBP-RIII-V domain. These observations pose challenging questions to the selection of EBP and point out the importance of immune pressure and polymorphism required for inclusion of PvEBP as a vaccine candidate.
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    The haematological consequences of Plasmodium vivax malaria after chloroquine treatment with and without primaquine: A WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis
    (2019-08-01) Robert J. Commons; Julie A. Simpson; Kamala Thriemer; Cindy S. Chu; Nicholas M. Douglas; Tesfay Abreha; Sisay G. Alemu; Arletta Añez; Nicholas M. Anstey; Abraham Aseffa; Ashenafi Assefa; Ghulam R. Awab; J. Kevin Baird; Bridget E. Barber; Isabelle Borghini-Fuhrer; Umberto D'Alessandro; Prabin Dahal; André Daher; Peter J. De Vries; Annette Erhart; Margarete S.M. Gomes; Matthew J. Grigg; Jimee Hwang; Piet A. Kager; Tsige Ketema; Wasif A. Khan; Marcus V.G. Lacerda; Toby Leslie; Benedikt Ley; Kartini Lidia; Wuelton M. Monteiro; Dhelio B. Pereira; Giao T. Phan; Aung P. Phyo; Mark Rowland; Kavitha Saravu; Carol H. Sibley; André M. Siqueira; Kasia Stepniewska; Walter R.J. Taylor; Guy Thwaites; Binh Q. Tran; Tran T. Hien; José Luiz F. Vieira; Sonam Wangchuk; James Watson; Timothy William; Charles J. Woodrow; Francois Nosten; Philippe J. Guerin; Nicholas J. White; Ric N. Price; Melbourne School of Population and Global Health; Health Works, Amsterdam; Tergooiziekenhuizen; Cho Ray Hospital; Jimma University; Armauer Hansen Research Institute; Addis Ababa University; London School of Hygiene & Tropical Medicine; Columbia University Irving Medical Center; Fundacao Oswaldo Cruz; Menzies School of Health Research; Fundacao Universidade Federal de Rondonia; University of California, San Francisco; Centers for Disease Control and Prevention; Liverpool School of Tropical Medicine; Universidade Federal do Amapa; Manipal Academy of Higher Education; Kasturba Medical College, Manipal; University of Washington, Seattle; Mahidol University; Nuffield Department of Clinical Medicine; Universidade do Estado do Amazonas; Universidade Federal do Para; Universitat de Barcelona; Amsterdam UMC - University of Amsterdam; LSTMH; Medicines for Malaria Venture; Gleneagles Hospital; Ethiopian Public Health Institute; Nangarhar University; WorldWide Antimalarial Resistance Network (WWARN); Nusa Cendana University; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit; Organización Panamericana de Salud; Eijkman-Oxford Clinical Research Unit; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado; WorldWide Antimalarial Resistance Network (WWARN); International Centre for Diarrheal Diseases and Research; Centro de Pesquisa em Medicina Tropical de Rondônia (CEPEM); Ministry of Health; Secretaria de Saúde do Estado do Amapá; Oxford University Clinical Research Unit
    © 2019 The Author(s). Background: Malaria causes a reduction in haemoglobin that is compounded by primaquine, particularly in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The aim of this study was to determine the relative contributions to red cell loss of malaria and primaquine in patients with uncomplicated Plasmodium vivax. Methods: A systematic review identified P. vivax efficacy studies of chloroquine with or without primaquine published between January 2000 and March 2017. Individual patient data were pooled using standardised methodology, and the haematological response versus time was quantified using a multivariable linear mixed effects model with non-linear terms for time. Mean differences in haemoglobin between treatment groups at day of nadir and day 42 were estimated from this model. Results: In total, 3421 patients from 29 studies were included: 1692 (49.5%) with normal G6PD status, 1701 (49.7%) with unknown status and 28 (0.8%) deficient or borderline individuals. Of 1975 patients treated with chloroquine alone, the mean haemoglobin fell from 12.22 g/dL [95% CI 11.93, 12.50] on day 0 to a nadir of 11.64 g/dL [11.36, 11.93] on day 2, before rising to 12.88 g/dL [12.60, 13.17] on day 42. In comparison to chloroquine alone, the mean haemoglobin in 1446 patients treated with chloroquine plus primaquine was - 0.13 g/dL [- 0.27, 0.01] lower at day of nadir (p = 0.072), but 0.49 g/dL [0.28, 0.69] higher by day 42 (p < 0.001). On day 42, patients with recurrent parasitaemia had a mean haemoglobin concentration - 0.72 g/dL [- 0.90, - 0.54] lower than patients without recurrence (p < 0.001). Seven days after starting primaquine, G6PD normal patients had a 0.3% (1/389) risk of clinically significant haemolysis (fall in haemoglobin > 25% to < 7 g/dL) and a 1% (4/389) risk of a fall in haemoglobin > 5 g/dL. Conclusions: Primaquine has the potential to reduce malaria-related anaemia at day 42 and beyond by preventing recurrent parasitaemia. Its widespread implementation will require accurate diagnosis of G6PD deficiency to reduce the risk of drug-induced haemolysis in vulnerable individuals. Trial registration: This trial was registered with PROSPERO: CRD42016053312. The date of the first registration was 23 December 2016.
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    Identifying and combating the impacts of COVID-19 on malaria
    (2020-07-30) Stephen J. Rogerson; James G. Beeson; Moses Laman; Jeanne Rini Poespoprodjo; Timothy William; Julie A. Simpson; Ric N. Price; Melbourne School of Population and Global Health; Papua New Guinea Institute of Medical Research; Universitas Gadjah Mada; University of Melbourne; Menzies School of Health Research; Monash University; Mahidol University; Nuffield Department of Medicine; Burnet Institute; Gleneagles Hospital; Papuan Health and Community Development Foundation; Rumah Sakit Umum Daerah Kabupaten Mimika; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit; Mimika District Health Authority
    BACKGROUND: The COVID-19 pandemic has resulted in millions of infections, hundreds of thousands of deaths and major societal disruption due to lockdowns and other restrictions introduced to limit disease spread. Relatively little attention has been paid to understanding how the pandemic has affected treatment, prevention and control of malaria, which is a major cause of death and disease and predominantly affects people in less well-resourced settings. MAIN BODY: Recent successes in malaria control and elimination have reduced the global malaria burden, but these gains are fragile and progress has stalled in the past 5 years. Withdrawing successful interventions often results in rapid malaria resurgence, primarily threatening vulnerable young children and pregnant women. Malaria programmes are being affected in many ways by COVID-19. For prevention of malaria, insecticide-treated nets need regular renewal, but distribution campaigns have been delayed or cancelled. For detection and treatment of malaria, individuals may stop attending health facilities, out of fear of exposure to COVID-19, or because they cannot afford transport, and health care workers require additional resources to protect themselves from COVID-19. Supplies of diagnostics and drugs are being interrupted, which is compounded by production of substandard and falsified medicines and diagnostics. These disruptions are predicted to double the number of young African children dying of malaria in the coming year and may impact efforts to control the spread of drug resistance. Using examples from successful malaria control and elimination campaigns, we propose strategies to re-establish malaria control activities and maintain elimination efforts in the context of the COVID-19 pandemic, which is likely to be a long-term challenge. All sectors of society, including governments, donors, private sector and civil society organisations, have crucial roles to play to prevent malaria resurgence. Sparse resources must be allocated efficiently to ensure integrated health care systems that can sustain control activities against COVID-19 as well as malaria and other priority infectious diseases. CONCLUSION: As we deal with the COVID-19 pandemic, it is crucial that other major killers such as malaria are not ignored. History tells us that if we do, the consequences will be dire, particularly in vulnerable populations.
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    The International Criteria for Behçet's Disease (ICBD): A collaborative study of 27 countries on the sensitivity and specificity of the new criteria
    (2014-03-01) F. Davatchi; S. Assaad-Khalil; K. T. Calamia; J. E. Crook; B. Sadeghi-Abdollahi; M. Schirmer; T. Tzellos; C. C. Zouboulis; M. Akhlagi; A. Al-Dalaan; Z. S. Alekberova; A. A. Ali; A. Altenburg; E. Arromdee; M. Baltaci; M. Bastos; S. Benamour; I. Ben Ghorbel; A. Boyvat; L. Carvalho; W. Chen; E. Ben-Chetrit; C. Chams-Davatchi; J. A. Correia; J. Crespo; C. Dias; Y. Dong; F. Paixão-Duarte; K. Elmuntaser; A. V. Elonakov; J. Graña Gil; A. A. Haghdoost; R. M. Hayani; H. Houman; A. R. Isayeva; A. R. Jamshidi; P. Kaklamanis; A. Kumar; A. Kyrgidis; W. Madanat; A. Nadji; K. Namba; S. Ohno; I. Olivieri; J. Vaz Patto; N. Pipitone; M. V. De Queiroz; F. Ramos; C. Resende; C. M. Rosa; C. Salvarani; M. J. Serra; F. Shahram; H. Shams; K. E. Sharquie; M. Sliti-Khanfir; T. Tribolet De Abreu; C. Vasconcelos; J. Vedes; B. Wechsler; Y. K. Cheng; Z. Zhang; N. Ziaei; Tehran University of Medical Sciences; Alexandria Medical School; Mayo Clinic in Jacksonville, Florida; Medizinische Universitat Innsbruck; Stadtisches Klinikum Dessau; German Registry of Adamantiades-Behçet's Disease; King Saud University; V.A. Nasonova Research Institute of Rheumatology; The Aga Khan University Hospital; Mahidol University; Hospital São Teotónio; Centre Hospitalier Universitaire Ibn-Rochd; Department of Internal Medicine; Ankara Universitesi; Hospital Geral de Santo Antonio; Chang Gung University; Hadassah University Medical Centre; Centro Hospitalar e Universitario de Coimbra; Sao Joao Hospital; Peking Union Medical College; Fernando da Fonseca Hospital; Kadisia Clinic; Complejo Hospitalario Universitario Juan Canalejo; University of Baghdad; Azerbaycan Tibb Universiteti; Medical Center; All India Institute of Medical Sciences, New Delhi; Jordan Hospital; Hokkaido University School of Medicine; Potenza and Madonna Delle Grazie Hospital; Instituto Portugues de Reumatologia; Azienda Ospedaliera Santa Maria Nuova di Reggio Emilia; Santa Maria Hospital, Lisbon; University of Lisbon Faculty of Medicine, Institute of Molecular Medicine; Santo António dos Capuchos Hospital; Hospital do Espirito Santo; Hospital Sousa Martins; Hopital Universitaire Pitie Salpetriere; Gleneagles Hospital; Peking University
    Objective Behçet's disease (BD) is a chronic, relapsing, inflammatory vascular disease with no pathognomonic test. Low sensitivity of the currently applied International Study Group (ISG) clinical diagnostic criteria led to their reassessment. Methods An International Team for the Revision of the International Criteria for BD (from 27 countries) submitted data from 2556 clinically diagnosed BD patients and 1163 controls with BD-mimicking diseases or presenting at least one major BD sign. These were randomly divided into training and validation sets. Logistic regression, 'leave-one-country-out' cross-validation and clinical judgement were employed to develop new International Criteria for BD (ICBD) with the training data. Existing and new criteria were tested for their performance in the validation set. Results For the ICBD, ocular lesions, oral aphthosis and genital aphthosis are each assigned 2 points, while skin lesions, central nervous system involvement and vascular manifestations 1 point each. The pathergy test, when used, was assigned 1 point. A patient scoring ≥4 points is classified as having BD. In the training set, 93.9% sensitivity and 92.1% specificity were assessed compared with 81.2% sensitivity and 95.9% specificity for the ISG criteria. In the validation set, ICBD demonstrated an unbiased estimate of sensitivity of 94.8% (95% CI: 93.4-95.9%), considerably higher than that of the ISG criteria (85.0%). Specificity (90.5%, 95% CI: 87.9-92.8%) was lower than that of the ISG-criteria (96.0%), yet still reasonably high. For countries with at least 90%-of-cases and controls having a pathergy test, adding 1 point for pathergy test increased the estimate of sensitivity from 95.5% to 98.5%, while barely reducing specificity from 92.1% to 91.6%. Conclusion The new proposed criteria derived from multinational data exhibits much improved sensitivity over the ISG criteria while maintaining reasonable specificity. It is proposed that the ICBD criteria to be adopted both as a guide for diagnosis and classification of BD. © 2013 European Academy of Dermatology and Venereology.
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    Residual macrovascular risk in 2013: What have we learned?
    (2014-01-24) Jean Charles Fruchart; Jean Davignon; Michel P. Hermans; Khalid Al-Rubeaan; Pierre Amarenco; Gerd Assmann; Philip Barter; John Betteridge; Eric Bruckert; Ada Cuevas; Michel Farnier; Ele Ferrannini; Paola Fioretto; Jacques Genest; Henry N. Ginsberg; Antonio M. Gotto; Dayi Hu; Takashi Kadowaki; Tatsuhiko Kodama; Michel Krempf; Yuji Matsuzawa; Jesús M. Núñez-Cortés; Carlos C. Monfil; Hisao Ogawa; Jorge Plutzky; Daniel J. Rader; Shaukat Sadikot; Raul D. Santos; Evgeny Shlyakhto; Piyamitr Sritara; Rody Sy; Alan Tall; Chee E. Tan; Lale Tokgözoǧlu; Peter P. Toth; Paul Valensi; Christoph Wanner; Alberto Zambon; Junren Zhu; Paul Zimmet; R3i Foundation; Fondation coeur et arteres; Institut de Recherches Cliniques de Montreal; Cliniques Universitaires Saint-Luc, Brussels; King Saud University; Hopital Bichat-Claude-Bernard AP-HP; Assmann-Stiftung für Prävention; University of New South Wales (UNSW) Australia; UCL; Hopital Universitaire Pitie Salpetriere; Clinica Las Condes; Point Medical; Universita di Pisa; Universita degli Studi di Padova; McGill University Health Centre, Royal Victoria Hospital; Columbia University in the City of New York; Weill Cornell Medical College; Peking University; University of Tokyo; Centre Hospitalier Universitaire de Nantes; Osaka University; Hospital General Universitario Gregorio Maranon; University of Concepcion; Kumamoto University; Brigham and Women's Hospital and Harvard Medical School; Penn Cardiovascular Institute; Jaslok Hospital and Research Centre; Instituto do Coracao do Hospital das Clinicas; Almazov National Medical Research Centre; Mahidol University; University of the Philippines Manila; Columbia University, College of Physicians and Surgeons; Gleneagles Hospital; Hacettepe Universitesi; University of Illinois; Universite Paris 13; Universitatsklinikum Wurzburg; Fudan University; Baker Heart and Diabetes Institute
    Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptorα agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk. © 2014 Fruchart et al.; licensee BioMed Central Ltd.