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Belfast, United Kingdom

McNicholl D.M.,Queens University of Belfast | Heaney L.G.,Regional Respiratory Center
Current Drug Safety | Year: 2010

Glucocorticoid therapy, the mainstay treatment of many chronic diseases, has many complications including osteoporosis. Premenopausal women requiring glucocorticoids are at a significant risk of developing glucocortiocoid-induced osteoporosis. Bisphosphonate therapy is a vital option in the prevention and treatment of glucocorticoid-induced osteoporosis. Animal studies with bisphosphonates have displayed maternal toxicity, foetal underdevelopment, embryolethality, hypocalcaemia and skeletal retardation during pregnancy. Bisphosphonates are therefore contra-indicated in pregnancy and have a FDA category C pregnancy risk. Their use in premenopausal women prior to conception may also pose a teratogenic risk because bisphosphonates remain in mineralised bone for several years. Consequently a clinical dilemma exists in treating and preventing glucocorticoid-induced osteoporosis in premenopausal women. This article aims to review the available evidence regarding the use of bisphosphonates in premenopausal woman. Bisphosphonate treatment of metastatic hypercalcaemia during pregnancy has not demonstrated adverse foetal events. Cases of preconception bisphosphonate exposure have failed to describe developmental or bone density abnormalities, however neonatal hypocalcaemia has occurred. Lower birth weight, lower gestational age at birth and higher rate of spontaneous abortion in mothers with preconception and first trimester bisphosphonate exposure have been described, however notable confounding factors and lack of adequate sample size make extrapolation of this data difficult. Human preconception and first trimester bisphosphonate use has to date not been associated with the same adverse effects evident in animals. Larger well-controlled studies in premenopausal women with preconception and peri-natal bisphosphonate exposure are required to confirm the safe use throughout pregnancy to both mother and foetus. © 2010 Bentham Science Publishers Ltd.

McClean M.,Royal Group of Hospitals | McClean M.,University of Ulster | Stanley T.,Royal Group of Hospitals | Stanley S.,Royal Group of Hospitals | And 8 more authors.
Journal of Medical Microbiology | Year: 2011

Breakthrough contamination of tuberculosis (TB) cultures is a problem in that it allows the overgrowth of another bacterium present in the sputum specimen, which can potentially mask the presence of Mycobacterium tuberculosis. The aim of this study was to isolate and characterize the bacterial organisms responsible for such overgrowth and contamination, and to examine their susceptibility to (i) various chemical selective decontamination steps and (ii) antibiotics in liquid culture media, in an attempt to develop a method to help alleviate contamination problems associated with the conventional isolation of M. tuberculosis from routine patient sputum specimens. Bacterial contaminants from 102 routine sputum cultures were identified molecularly by 16S rRNA gene PCR and direct sequencing from contaminated Lö wenstein-Jensen (LJ) slopes and BacT/Alert liquid medium. It was found that the contaminants from LJ slopes belonged to 11 different genera and were composed largely of Gram-negative organisms (84.9%; 45/53), whereas the liquid culture contaminants belonged to 13 different genera, with 37/66 isolates (56.1%) being Gram-negative. Pseudomonas aeruginosa was the dominant contaminant in both media. The effect of six different selective decontamination protocols was examined. Four of the six methods were effective at eliminating all culturable organisms present; these were 5% oxalic acid, 5% oxalic acid/2% NaOH, 5% oxalic acid/4% NaOH and 1% chlorhexidine. NaOH at a concentration of 2 or 4% was less effective as it was unable to eliminate all organisms of each species tested, with the exception of P. aeruginosa. In conclusion, breakthrough contamination of TB cultures is due to a diverse range of at least 17 different bacterial genera, with P. aeruginosa and Staphylococcus epidermidis accounting for the dominant contaminating flora. Employment of chemical decontaminating protocols solely involving NaOH may lead to higher rates of contamination. Where such contamination is encountered, TB laboratories should consider the reprocessing of such sputum samples with an alternative decontamination method such as 1% chlorhexidine. © 2011 SGM.

Cassidy C.M.,Queens University of Belfast | Donnelly R.F.,Queens University of Belfast | Elborn J.S.,Queens University of Belfast | Magee N.D.,Regional Respiratory Center | Tunney M.M.,Queens University of Belfast
Journal of Photochemistry and Photobiology B: Biology | Year: 2012

This study aimed to determine if Photodynamic Antimicrobial Chemotherapy (PACT) was effective in the treatment of Burkholderia cepacia complex infection and whether a synergistic effect was evident if PACT was used in combination with antibiotics. The susceptibility of both planktonic and biofilm cultures of B. cepacia complex strains to methylene blue (MB) and meso-tetra(n-methyl-4- pyridyl)porphine tetra-tosylate (TMP)-mediated PACT was determined alone and in combination with antibiotics used in the treatment of Cystic Fibrosis pulmonary infection caused by these bacteria. When B. cepacia complex strains were grown planktonically, high levels of kill of were achieved with both TMP and MB-mediated PACT with strain and photosensitizer specific differences apparent. When strains were grown in biofilm, antibiotic treatment alone was bactericidal in 17/36 (47%) strain/antibiotic combinations tested. When antibiotic treatment was combined with PACT, bactericidal activity was apparent for 33/36 (92%) strain/antibiotic combinations. No antagonism was detected between PACT and antibiotic treatment with the combination synergistic for 6/36 (17%) and indifferent for 30/36 (83%) strain/antibiotic combinations. PACT could be a viable treatment option, either alone or in combination with antibiotics for treatment of B. cepacia complex pulmonary infection. © 2011 Elsevier B.V. All rights reserved.

McKeagney T.F.P.,Regional Respiratory Center | Addley K.,Northern Ireland Civil Service | Asanati K.,University of Surrey | Asanati K.,University of Glasgow
Occupational Medicine | Year: 2015

Background Respiratory physicians are likely to encounter occupational lung disease (OLD) in their daily practice. Aims To assess the profile of cases being encountered by general respiratory physicians in Northern Ireland (NI) and determine satisfaction with training, confidence in diagnosis and management of OLD. Methods An online survey of all consultant respiratory physicians currently practising in NI. Questions assessed the numbers of new cases seen over the preceding year, case type, satisfaction with specialist registrar training in OLD and degree of confidence in the diagnosis and management of these conditions. Results Of the 40 consultants identified, the response rate was 80% (n = 32) with 94% of respondents (n = 30) indicating they had dealt with patients suspected of having occupation-related respiratory symptoms. The most commonly encountered OLDs were pleural plaques (91% of respondents), occupational asthma (88%), asbestosis (84%), non-asbestosis pulmonary fibrosis (76%), hypersensitivity pneumonitis (67%) and mesothelioma (66%). Just over one third of consultants (36%, n = 10) indicated a lack of confidence in diagnosis and management of OLD with almost half (48%) dissatisfied with OLD training as a registrar and a further 78% (n = 25) indicating they would value additional training in OLD as a consultant. Conclusions The majority of respiratory consultants in NI encountered OLD in their day to day practice and half were dissatisfied with their specialist registrar training in OLD and express a lack of confidence in the diagnosis and management of these conditions. This highlights the need for additional training at both registrar and consultant level. © 2015 The Author.

Gamble J.,Queens University of Belfast | Gamble J.,Regional Respiratory Center | Stevenson M.,Queens University of Belfast | Heaney L.G.,Queens University of Belfast | Heaney L.G.,Regional Respiratory Center
Respiratory Medicine | Year: 2011

Background: Difficult to control asthma accounts for significant morbidity and healthcare cost, and non-adherence to medication is a common cause. It remains unclear if targeting non-adherence in this population improves healthcare outcomes. Methods: All subjects were referred to a Specialist Difficult Asthma Service (60% from Respiratory physicians); poor adherence was identified using prescription refill records for inhaled combination therapy. A sequential 2 phase study examined the effect of identifying and targeting non-adherence to inhaled long-acting β-agonist/inhaled steroid combination therapy; phase 1 - an observational study utilising objective measures of non-adherence to facilitate a medical concordance discussion followed by phase 2, a 12 month prospective single blind randomised controlled trial where subjects with persistent poor adherence were randomised to a nurse-led menu driven intervention. Results: A total of 239 patients were assessed; 31 of 83 subjects (37%) who were initially non-adherent, significantly improved adherence after concordance interview, with reduced prescribed daily dose of ICS (data p < 0.001), rescue prednisolone courses (data, p < 0.001) and hospital admissions (data, p = 0.006). With the menu driven intervention, adherence also improved (intervention 37.6% to 61.9%, control group 31.7% to 28.8%) with reduced maintenance oral steroid dose in subjects on maintenance steroids. Conclusion: Poor adherence in difficult-to control asthma is common, but when identified and targeted can be improved and this is associated with large improvements in important healthcare outcomes. Previous nihilism towards non-adherence in this population is not supported by this study. © 2011 Elsevier Ltd. All rights reserved.

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