Institution
Epsom and St Helier University Hospitals NHS Trust
Healthcare•London, United Kingdom•
About: Epsom and St Helier University Hospitals NHS Trust is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Randomized controlled trial. The organization has 467 authors who have published 433 publications receiving 6611 citations. The organization is also known as: Epsom & St Helier NHS Trust & Epsom & St. Helier NHS Trust.
Papers published on a yearly basis
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Trinity College, Dublin1, University of Cambridge2, Newcastle University3, Cambridge University Hospitals NHS Foundation Trust4, Papworth Hospital5, Western General Hospital6, Raigmore Hospital7, Boston Children's Hospital8, National Institute for Health Research9, University Hospitals Bristol NHS Foundation Trust10, Barts Health NHS Trust11, University Medical Center Freiburg12, University Hospital Southampton NHS Foundation Trust13, University of Southampton14, Epsom and St Helier University Hospitals NHS Trust15, Cincinnati Children's Hospital Medical Center16, University of Glasgow17, University of Rome Tor Vergata18, Great Ormond Street Hospital19, Tokyo Medical and Dental University20, King's College London21, Newcastle upon Tyne Hospitals NHS Foundation Trust22, Paris Descartes University23, French Institute of Health and Medical Research24, Howard Hughes Medical Institute25, University College London26, St James's University Hospital27, Babraham Institute28, Rockefeller University29
TL;DR: The severity of complications in some patients supports consideration of hematopoietic stem cell transplantation for severe childhood disease and clinical trials of selective PI3K&dgr; inhibitors offer new prospects for APDS treatment.
Abstract: Background Activated phosphoinositide 3-kinase δ syndrome (APDS) is a recently described combined immunodeficiency resulting from gain-of-function mutations in PIK3CD, the gene encoding the catalytic subunit of phosphoinositide 3-kinase δ (PI3Kδ). Objective We sought to review the clinical, immunologic, histopathologic, and radiologic features of APDS in a large genetically defined international cohort. Methods We applied a clinical questionnaire and performed review of medical notes, radiology, histopathology, and laboratory investigations of 53 patients with APDS. Results Recurrent sinopulmonary infections (98%) and nonneoplastic lymphoproliferation (75%) were common, often from childhood. Other significant complications included herpesvirus infections (49%), autoinflammatory disease (34%), and lymphoma (13%). Unexpectedly, neurodevelopmental delay occurred in 19% of the cohort, suggesting a role for PI3Kδ in the central nervous system; consistent with this, PI3Kδ is broadly expressed in the developing murine central nervous system. Thoracic imaging revealed high rates of mosaic attenuation (90%) and bronchiectasis (60%). Increased IgM levels (78%), IgG deficiency (43%), and CD4 lymphopenia (84%) were significant immunologic features. No immunologic marker reliably predicted clinical severity, which ranged from asymptomatic to death in early childhood. The majority of patients received immunoglobulin replacement and antibiotic prophylaxis, and 5 patients underwent hematopoietic stem cell transplantation. Five patients died from complications of APDS. Conclusion APDS is a combined immunodeficiency with multiple clinical manifestations, many with incomplete penetrance and others with variable expressivity. The severity of complications in some patients supports consideration of hematopoietic stem cell transplantation for severe childhood disease. Clinical trials of selective PI3Kδ inhibitors offer new prospects for APDS treatment.
306 citations
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TL;DR: Among women without diabetes who had a BMI of more than 35, the antenatal administration of metformin reduced maternal weight gain but not neonatal birth weight, and there were no between-group differences in the incidence of gestational diabetes, large-for-gestational-age neonates, or adverse neonatal outcomes.
Abstract: BackgroundObesity is associated with an increased risk of adverse pregnancy outcomes. Lifestyle-intervention studies have not shown improved outcomes. Metformin improves insulin sensitivity and in pregnant patients with gestational diabetes it leads to less weight gain than occurs in those who do not take metformin. MethodsIn this double-blind, placebo-controlled trial, we randomly assigned pregnant women without diabetes who had a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of more than 35 to receive metformin, at a dose of 3.0 g per day, or placebo (225 women in each group) from 12 to 18 weeks of gestation until delivery. The BMI was calculated at the time of study entry (12 to 18 weeks of gestation). The primary outcome was a reduction in the median neonatal birth-weight z score by 0.3 SD (equivalent to a 50% reduction, from 20% to 10%, in the incidence of large-for-gestational-age neonates). Secondary outcomes included maternal gestational weight gain a...
283 citations
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Katholieke Universiteit Leuven1, Sapienza University of Rome2, University of Paris3, University of Toulouse4, Harvard University5, Boston Children's Hospital6, University of California, Irvine7, University of Brescia8, Vita-Salute San Raffaele University9, Erasmus University Medical Center10, Hospital Clínico San Carlos11, Complutense University of Madrid12, Epsom and St Helier University Hospitals NHS Trust13, National Institutes of Health14, University of São Paulo15, University of Padua16, University of Naples Federico II17, Ghent University18, Nationwide Children's Hospital19, Marmara University20, Newcastle University21, University Hospital of Wales22, Universidad del Desarrollo23, Saint Louis University Hospital24, Ludwig Maximilian University of Munich25, Icahn School of Medicine at Mount Sinai26, University of Freiburg27, Children's Hospital of Philadelphia28, University of New South Wales29, Garvan Institute of Medical Research30
TL;DR: More than 30% of patients with IEI with SARS-CoV-2 infection had mild coronavirus disease 2019 (COVID-19) and risk factors predisposing to severe disease/mortality in the general population also seemed to affect patients withIEI, including more younger patients.
Abstract: Background There is uncertainty about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in individuals with rare inborn errors of immunity (IEI), a population at risk of developing severe coronavirus disease 2019. This is relevant not only for these patients but also for the general population, because studies of IEIs can unveil key requirements for host defense. Objective We sought to describe the presentation, manifestations, and outcome of SARS-CoV-2 infection in IEI to inform physicians and enhance understanding of host defense against SARS-CoV-2. Methods An invitation to participate in a retrospective study was distributed globally to scientific, medical, and patient societies involved in the care and advocacy for patients with IEI. Results We gathered information on 94 patients with IEI with SARS-CoV-2 infection. Their median age was 25 to 34 years. Fifty-three patients (56%) suffered from primary antibody deficiency, 9 (9.6%) had immune dysregulation syndrome, 6 (6.4%) a phagocyte defect, 7 (7.4%) an autoinflammatory disorder, 14 (15%) a combined immunodeficiency, 3 (3%) an innate immune defect, and 2 (2%) bone marrow failure. Ten were asymptomatic, 25 were treated as outpatients, 28 required admission without intensive care or ventilation, 13 required noninvasive ventilation or oxygen administration, 18 were admitted to intensive care units, 12 required invasive ventilation, and 3 required extracorporeal membrane oxygenation. Nine patients (7 adults and 2 children) died. Conclusions This study demonstrates that (1) more than 30% of patients with IEI had mild coronavirus disease 2019 (COVID-19) and (2) risk factors predisposing to severe disease/mortality in the general population also seemed to affect patients with IEI, including more younger patients. Further studies will identify pathways that are associated with increased risk of severe disease and are nonredundant or redundant for protection against SARS-CoV-2.
254 citations
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TL;DR: This paper reviews the current concepts and outlines appropriate management of conditions such as epilepsy, headache, benign intracranial hypertension, myasthenia gravis, multiple sclerosis, Bell's palsy and cerebrovascular disorders.
Abstract: Purpose of reviewNeurological disorders are common in women of childbearing age and can lead to maternal death, as evident from previous reports of the Confidential Enquiry into Maternal Deaths in England and Wales. In the last report (1997-1999) alone, there were 34 deaths indirectly caused by neur
235 citations
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TL;DR: An overview of the current situation regarding ESBLs is given, with a focus on the epidemiology and management of such infections.
Abstract: Extended spectrum β-lactamases (ESBLs) are enzymes produced by a variety of Gram negative bacteria which confer an increased resistance to commonly used antibiotics. They are a worrying global public health issue as infections caused by such enzyme-producing organisms are associated with a higher morbidity and mortality and greater fiscal burden. Coupled with increasing prevalence rates worldwide and an ever diminishing supply in the antibiotic armamentarium, these enzymes represent a clear and present danger to public health. This article aims to give an overview of the current situation regarding ESBLs, with a focus on the epidemiology and management of such infections.
192 citations
Authors
Showing all 474 results
Name | H-index | Papers | Citations |
---|---|---|---|
Paulus Kirchhof | 100 | 558 | 106459 |
Argyro Syngelaki | 59 | 201 | 11253 |
Richard P. Steeds | 44 | 287 | 7317 |
Ian Williamson | 36 | 82 | 5958 |
Adam E Frampton | 34 | 142 | 3027 |
Dipak Kotecha | 33 | 104 | 16903 |
Richard E. Field | 31 | 85 | 3313 |
Despina Perrea | 30 | 224 | 4253 |
Arun Sahai | 28 | 154 | 2438 |
Samik Banerjee | 24 | 88 | 1816 |
Stergios K. Doumouchtsis | 23 | 121 | 1836 |
Sonny K. F. Chong | 22 | 49 | 2541 |
Hugh Gallagher | 21 | 45 | 1551 |
Vasilios Pergialiotis | 21 | 152 | 1473 |
Christine P Burren | 20 | 63 | 1809 |