A5068650785- Pleural and Pulmonary Diseases
- Ultrasound in Clinical Applications
- Amoebic Infections and Treatments
- Cystic Fibrosis Research Advances
- Antibiotics Pharmacokinetics and Efficacy
- Pneumonia and Respiratory Infections
- Occupational and environmental lung diseases
- Lung Cancer Diagnosis and Treatment
- Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Neonatal Respiratory Health Research
- Pericarditis and Cardiac Tamponade
- Asthma and respiratory diseases
- Pneumothorax, Barotrauma, Emphysema
- Trauma Management and Diagnosis
- Congenital Diaphragmatic Hernia Studies
- Analytical Methods in Pharmaceuticals
- Central Venous Catheters and Hemodialysis
- Inflammatory Biomarkers in Disease Prognosis
- Anesthesia and Sedative Agents
- Respiratory viral infections research
- Tracheal and airway disorders
- Carcinogens and Genotoxicity Assessment
- Cancer-related Molecular Pathways
- Sepsis Diagnosis and Treatment
- Parvovirus B19 Infection Studies
The University of Western Australia
2014-2022
Sir Charles Gairdner Hospital
2014-2022
Institute for Respiratory Health
2015-2022
Weatherford College
2019
Western Sydney University
2018
Auckland City Hospital
2015
Curtin University
2007
Rationale: Intrapleural tissue plasminogen activator (tPA)/deoxyribonuclease (DNase) therapy for pleural infection given at the time of diagnosis has been shown to significantly improve radiological outcomes. Published cases are limited only a single randomized controlled trial and few case reports.Objectives: Multinational observation series evaluate pragmatic "real-life" application tPA/DNase treatment in large cohort unselected patients.Methods: All patients from eight centers who...
Rationale: Intrapleural therapy with a combination of tissue plasminogen activator (tPA) 10 mg and DNase 5 administered twice daily has been shown in randomized open-label studies to successfully manage over 90% patients pleural infection without surgery. Potential bleeding risks associated intrapleural tPA its costs remain important concerns. The aim the ongoing Alteplase Dose Assessment for Pleural Therapy (ADAPT) project is investigate efficacy safety dose de-escalation tPA. first several...
Background Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means predicting at baseline presentation which will suffer a poor clinical outcome. A validated risk prediction score would allow early identification high-risk patients, potentially directing more aggressive treatment thereafter. Objectives To prospectively assess previously described (the RAPID (Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)) score)...
Intrapleural tissue plasminogen activator/deoxyribonuclease (tPA/DNase) therapy is increasingly used in pleural infection. Bleeding risks and costs associated with tPA remain the clinical concerns. Our dose de-escalation series aims to establish lowest effective dosing regimen for tPA/DNase. This study assesses intrapleural use of 2.5 mg tPA/5 DNase infection.Consecutive patients infection treated a starting regime were included from two centres Australia UK. Escalation was permitted if...
Pleural infection is a clinical challenge; its microbiology can be complex. Epidemiological and outcome data of pleural in adult Australians are lacking. We describe the bacteriology outcomes Australian adults with culture-positive (CPPI) over 6-year period.Cases CPPI were identified through Western public hospitals electronic record. Culture isolates, admission dates, vital status, co-morbidities, radiology, blood fluid tests extracted.In total, 601 cases (71.4% males; median age: 63 years...
Rationale: Pleural effusion commonly complicates community-acquired pneumonia and is associated with intense pleural inflammation. Whether antiinflammatory treatment corticosteroids improves outcomes unknown. Objectives: To assess the effects of in an adult population pneumonia-related effusion. Methods: The STOPPE (Steroid Therapy Outcome Parapneumonic Effusions) trial was a pilot, multicenter, double-blinded, placebo-controlled, randomized involving six Australian centers. Patients were...
Empyema is defined by the presence of bacteria and/or pus in pleural effusions. However, biology within human fluid has not been studied. Streptococcus pneumoniae most common cause pediatric and frequent adult empyema. We investigated whether S. can proliferate if growth affected cellular content characteristics pneumococcal surface proteins. Invasive isolates (n = 24) reference strain recovered from blood or empyema were inoculated (1.5×106CFU/mL) into sterile malignant samples 11). All 25)...
Abstract Allergic bronchopulmonary aspergillosis (ABPA) is common in cystic fibrosis (CF). Treatment challenging and the relapse rate high. Standard therapy oral steroids antifungals. However, long‐term systemic steroid often results adverse effects drug interactions between azoles CFTR modulators are a potential concern. Mepolizumab, an anti‐interleukin (IL)‐5 monoclonal antibody, can benefit patients with severe eosinophilic asthma there reports of mepolizumab use ABPA but not complicating...
Predicting survival of patients with malignant pleural effusions (MPEs) is notoriously difficult. A robust prognostic marker can guide clinical decision making. The neutrophil-to-lymphocyte ratio (NLR) in blood has been shown to predict many cancers. Pleural fluid bathes the tissues, thus NLR may reflect more closely local tumour environment. objective this study was explore significance effusion for MPE. We analysed matched and from 117 24 benign effusions. Those who had received recent...
Introduction Intrapleural tissue plasminogen activator (tPA) combined with human recombinant DNase (DNase) could be an effective alternative to surgery in managing pleural infection, as demonstrated the Multi-centre Sepsis Trial (MIST)-2. However, optimal delivery regimen is still unknown. The aim of this survey was identify current practice tPA/DNase use by physicians published interests and their opinions on dose de-escalation therapy. Methods Potential participants were identified using...
Abstract Background: Community-acquired pneumonia (CAP) is a major global disease. Parapneumonic effusions often complicate CAP and range from uninfected (simple) to infected (complicated) parapneumonic empyema (pus). patients who have pleural effusion at presentation are more likely require hospitalization, longer length of stay higher mortality than those without an effusion. Conventional management infection, with antibiotics chest tube drainage, fails in about 30% cases. Several...
A major complication of peritoneal dialysis is the development peritonitis, which associated with reduced technique and patient survival. The inflammatory response elicited by infection results in a fibrin debris-rich environment within cavity, may reduce effectiveness antimicrobial agents predispose to recurrence or relapse infection. Strategies enhance responses therefore have potential improve outcomes. This study presents pre-clinical data describing compatibility tPA DNase combination...
Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy is being increasingly employed as an alternative to surgical intervention for the treatment of complicated parapneumonic effusions empyema. Published cases are limited one randomized control trial few case reports. No data exist on employing sequential or repeated courses intrapleural tPA/DNase aid evacuation separate collections in patients' with a multiloculated pleural infection. This first report...
Pleural infection/empyema is common and its incidence continues to rise. Streptococcus pneumoniae the commonest bacterial cause of empyema in children among adults. The mesothelium represents first line defense against invading microorganisms, but mesothelial cell responses pathogens, including S. pneumoniae, have seldom been studied. We assessed viability vitro following exposure pathogens. Clinical isolates from 25 patients with invasive pneumococcal disease three reference strains were...
Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy has recently been shown to improve outcomes in pleural infection a randomized trial. Published literature, date, consists of only ∼50 patients who had received tPA/DNase. Safety data this regimen remain limited. Pleural contents often track along chest drains, but the effect tPA/DNase on subcutaneous tissues is unknown. We report patient treated another center was unintentionally administered up six...
Intrapleural tissue plasminogen activator/deoxyribonuclease (tPA/DNase) therapy has been rapidly adopted worldwide for treating pleural infection. This cross-sectional multicentre cohort study reports, the first time, long-term clinical, respiratory and functional outcomes ≥12 months following tPA/DNase treatment Four Australasian centres (Sir Charles Gairdner, Middlemore, Dunedin Wellington Hospitals) identified from their databases 223 patients who received intrapleural infection between...
Pleural effusions are common manifestations of a diverse spectrum disorders. The fluid contents complex and not yet fully characterized. It is increasingly recognized that pleural contains biologically active contents, including trace elements. These can contribute to disease pathogenesis, exemplified by our recent finding manganese an essential growth factor for Streptococcus pneumoniae (a cause empyema) in fluid.1 Trace elements fundamental numerous physiological processes health states.2...