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Landi I, Alkhabaz A, Abou Shaar B, Galzerano D, Albert-Brotons D, Tahir M, Eltayeb A, Alenazy A, Arshi F, Limongelli G, Bossone E, Vriz O. Non-atherosclerotic coronary artery disease: an overview of a heterogeneous disease. Coron Artery Dis 2024; 35:333-347. [PMID: 38206797 DOI: 10.1097/mca.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Anas Alkhabaz
- Heart Centre, King Faisal Specialist Hospital & Research Centre
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Bader Abou Shaar
- Heart Centre, King Faisal Specialist Hospital & Research Centre
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Mohammed Tahir
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Abdulla Eltayeb
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Ali Alenazy
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Fatima Arshi
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', AORN dei Colli, Monaldi Hospital
| | - Eduardo Bossone
- Department of Cardiology, Azienda Ospedaliera di Rilevanza Nazionale 'A. Cardarelli' Hospital, Naples, Italy
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital & Research Centre
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Alhabeeb W, Tash AA, Alshamiri M, Arafa M, Balghith MA, ALmasood A, Eltayeb A, Elghetany H, Hassan T, Alshemmari O. National Heart Center/Saudi Heart Association 2023 Guidelines on the Management of Hypertension. J Saudi Heart Assoc 2023; 35:16-39. [PMID: 37020975 PMCID: PMC10069676 DOI: 10.37616/2212-5043.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 03/17/2023] Open
Abstract
Background Hypertension is a highly prevalent disease in Saudi Arabia with poor control rates. Updated guidelines are needed to guide the management of hypertension and improve treatment outcomes. Methodology A panel of experts representing the National Heart Center (NHC) and the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to the local population, clinical practice and the healthcare system. The recommendations were reviewed to ensure scientific and medical accuracy. Recommendations Hypertension was defined and a new classification was proposed as relevant to the Saudi population. Recommendations on diagnosis, clinical evaluation, cardiovascular assessment were detailed, along with guidance on measurement modalities and screening/follow-up. Non-pharmacological management is the first line of hypertension treatment. Pharmacological therapy should be used appropriately as needed. Treatment priority is to control blood pressure regardless of the drug class used. The choice of treatment should be tailored to the patient profile in order to achieve treatment targets and ensure patient compliance. Recommendations were provided on pharmacological options available in Saudi Arabia, as well as guidance on the treatment of special conditions. Conclusion Hypertension management should be based on appropriate screening, timely diagnosis and lifestyle changes supplemented with pharmacological therapy, as needed. Clinical management should be individualized, and careful consideration should be given to special conditions and patient groups.
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Affiliation(s)
- Waleed Alhabeeb
- Department of Cardiac Sciences, King Saud University, Riyadh,
Saudi Arabia
| | - Adel A. Tash
- Consultant Cardiac Surgeon, Adult Cardiac Surgery, Ministry of Health,
Saudi Arabia
| | - Mostafa Alshamiri
- Professor of Cardiac Sciences, King Saud University Medical College, Riyadh,
Saudi Arabia
| | - Mohamed Arafa
- Professor of Cardiac Sciences, King Saud University,
Saudi Arabia
| | - Mohammed A. Balghith
- Senior Cardiologist, King Abdulaziz, National Guard Hospital, Riyadh,
Saudi Arabia
| | - Ali ALmasood
- Consultant Cardiologist, Specialized Medical Center, Riyadh,
Saudi Arabia
| | - Abdulla Eltayeb
- Senior Cardiologist, Almana Group of Hospitals, Dammam,
Saudi Arabia
| | - Hossam Elghetany
- Consultant Cardiologist, Dr. Soliman Fakeeh Hospital, Jeddah,
Saudi Arabia
| | - Taher Hassan
- Consultant Cardiologist, Bugshan Center,
Saudi Arabia
| | - Owayed Alshemmari
- Consultant Cardiologist Dr. Sulaiman Alhabib Hospital, Ar-Rayyan Hospital, Riyadh,
Saudi Arabia
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Shareef ZA, Hachim MY, Talaat IM, Bhamidimarri PM, Ershaid MNA, Ilce BY, Venkatachalam T, Eltayeb A, Hamoudi R, Hachim IY. DKK3's protective role in prostate cancer is partly due to the modulation of immune-related pathways. Front Immunol 2023; 14:978236. [PMID: 36845147 PMCID: PMC9947504 DOI: 10.3389/fimmu.2023.978236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023] Open
Abstract
While it is considered one of the most common cancers and the leading cause of death in men worldwide, prognostic stratification and treatment modalities are still limited for patients with prostate cancer (PCa). Recently, the introduction of genomic profiling and the use of new techniques like next-generation sequencing (NGS) in many cancers provide novel tools for the discovery of new molecular targets that might improve our understanding of the genomic aberrations in PCa and the discovery of novel prognostic and therapeutic targets. In this study, we investigated the possible mechanisms through which Dickkopf-3 (DKK3) produces its possible protective role in PCa using NGS in both the DKK3 overexpression PCa cell line (PC3) model and our patient cohort consisting of nine PCa and five benign prostatic hyperplasia. Interestingly, our results have shown that DKK3 transfection-modulated genes are involved in the regulation of cell motility, senescence-associated secretory phenotype (SASP), and cytokine signaling in the immune system, as well as in the regulation of adaptive immune response. Further analysis of our NGS using our in vitro model revealed the presence of 36 differentially expressed genes (DEGs) between DKK3 transfected cells and PC3 empty vector. In addition, both CP and ACE2 genes were differentially expressed not only between the transfected and empty groups but also between the transfected and Mock cells. The top common DEGs between the DKK3 overexpression cell line and our patient cohort are the following: IL32, IRAK1, RIOK1, HIST1H2BB, SNORA31, AKR1B1, ACE2, and CP. The upregulated genes including IL32, HIST1H2BB, and SNORA31 showed tumor suppressor functions in various cancers including PCa. On the other hand, both IRAK1 and RIOK1 were downregulated and involved in tumor initiation, tumor progression, poor outcome, and radiotherapy resistance. Together, our results highlighted the possible role of the DKK3-related genes in protecting against PCa initiation and progression.
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Affiliation(s)
- Zainab Al Shareef
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Mahmood Y. Hachim
- College of Medicine, Mohammed bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Iman M. Talaat
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Mai Nidal Asad Ershaid
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Burcu Yener Ilce
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Thenmozhi Venkatachalam
- Department of Physiology and Immunology, College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Abdulla Eltayeb
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Rifat Hamoudi
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Ibrahim Y. Hachim
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
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Abdelmawla M, Seleem W, Farooqui M, Eltayeb A, Elsayed Y. Prediction of weaning readiness off nasal CPAP in preterm infants using point-of-care lung ultrasound. Pediatr Pulmonol 2022; 57:2128-2135. [PMID: 35652432 DOI: 10.1002/ppul.26014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022]
Abstract
This study's primary aim was to assess whether end-expiratory lung ultrasound severity score (expLUSsc) at Day 3 of life, the second week of life, and before weaning off nasal continuous positive airway pressure (nCPAP) can predict the weaning readiness off nCPAP trial in preterm infants. The secondary aim was to evaluate the value of adding lung tidal recruitment (LTR) to expLUSsc (expLUSsc-plus-LTR) to improve predictability. We conducted a prospective study on premature infants <33 weeks of gestation. Point-of-care lung ultrasound (POC-LUS) was performed on Day 3, the second week of life, before and after the trial off nCPAP. expLUSsc, pleural thickness, and LTR were assessed. A receiver operator curve was constructed to evaluate the ability of POC-LUS to predict the weaning readiness off nCPAP. A total of 148 studies were performed on 39 infants, of them 12 weaned off nCPAP from the first trial and 27 infants failed attempts off nCPAP. An expLUSsc cut-off 8 before the first trial of weaning off nCPAP has a sensitivity and specificity of 88% and 90%, and positive and negative predictive values of 87% and 92%, respectively, with area under the curve (AUC) was 0.87 (CI: 0.8-0.93), p < .0001. If LTR is added to an expLUSsc cut-off 8 (expLUSsc-plus-LTR) before the first trial of weaning, then sensitivity and specificity of 95% and 90%, and positive and negative predictive values of 88% and 90%, respectively, with AUC was 0.95 (CI: 0.91-0.99), p < .0001. In conclusion, this study demonstrated the ability of POC-LUS to predict the weaning readiness off nCPAP in premature infants. The use of this simple bedside noninvasive test can potentially avoid the exposure of premature infants to multiple unsuccessful weaning cycles.
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Affiliation(s)
- Mohamed Abdelmawla
- Department of Pediatrics, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Wail Seleem
- Section of Neonatology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mansoor Farooqui
- Section of Neonatology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Abdulla Eltayeb
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Yasser Elsayed
- Section of Neonatology, University of Manitoba, Winnipeg, Manitoba, Canada
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Vriz O, Eltayeb A, Landi I, Anwar K, Alenazy A, Hiristova K, Kasprzak J, D'Andrea A, Amro B, Limongelli G, Bossone E, Imazio M. Transthoracic echocardiography for arrhythmic mitral valve prolapse: Phenotypic characterization as first step. Echocardiography 2022; 39:1158-1170. [PMID: 36029124 DOI: 10.1111/echo.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/09/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Mitral valve prolapse (MVP) is the most frequent valvulopathy with a prevalence of 1.2%-2.4% in general population and it is characterized by a benign course. Although it can be associated with some complications, ventricular arrhythmias (VA) and sudden cardiac death (SCD) as ultimate expressions, are the most worrying. The estimated risk of SCD in MVP is between 0.2% and 1.9% per year including both MVP patients with left ventricular (LV) dysfunction due to severe MR and MVP patients without significant MR. The latter ones constitute a particular phenotype called "malignant MVP" characterized by bileaflet myxomatous prolapse, ECG repolarization abnormalities and complex VAs (c-VAs) with polymorphic/right bundle branch block morphology (RBBB) and LV fibrosis of the papillary muscles (PMs) and inferobasal wall secondary to mechanical stretching visualized as late gadolinium enhancement (LGE) areas by cardiac magnetic resonance (CMR). In MVP, the first diagnostic approach is transthoracic echocardiography (TTE) that defines the presence of mitral annular disjunction (MAD) which seems to be associated with "arrhythmic MVP" (AMVP). From an ECG point of view, AMVP is characterized by frequent premature ventricular contractions (PVCs) arising from one or both PMs, fascicular tissue, and outflow tract, as well as by T-wave inversion in the inferolateral leads. The aim of the present paper is to describe TTE red flags that could identify MVP patients at high risk to develop complex arrhythmias as supported by the corresponding findings of LGE-CMR and anatomy studies. TTE could be a co-partner in phenotyping high-risk arrhythmic MVP patients.
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Affiliation(s)
- Olga Vriz
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Abdulla Eltayeb
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Kashif Anwar
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ali Alenazy
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Krassimira Hiristova
- Department of Noninvasive Diagnostic Imaging, National Heart Hospital, Sofia, Bulgaria
| | - Jarek Kasprzak
- Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, Luigi Vanvitelli University - Nocera Inferiore (ASL Salerno), Caserta, Italy
| | - Bandar Amro
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Eduardo Bossone
- Azienda Ospedaliera di Rilevanza Nazionale "A. Cardarelli" Hospital, Naples, Italy
| | - Massimo Imazio
- Department of Cardiology, University Hospital Santa Maria della Misericordia, Udine, Italy
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Vriz O, Eltayeb A, Anwar K, Alenazy A, Galzerano D, Mohammed A. P329 SEVERE ISOLATED MITRAL STENOSIS: ARE WE FACING DIFFERENT PHENOTYPES? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
The aim of the study was the evaluate the different characteristics between high gradients (HG) and low gradient (LG) mitral stenosis (MS) and, within the LG group those with high (LG–HF) or low flow (LG–LF). Moreover, we wanted to evaluated if there was any difference in overall complications and atrial fibrillation (AFib) incidence.
Methods
A total of 147 patients with isolated severe MS were retrospectively enrolled from the institutional echo database. Echocardiograms were read off line and clinical information were obtained from patients` records. Patients were divided into a group with HG (31 patients, mean MS gradient > 10 mmHg) and LG (116 patients, mean MS gradient ≤ 10 mmHg). The group of LG was then divided in low flow (Stroke volume index (SVi) ≤ 35 ml/m2, LF–LG: 68 patients) and in high flow (SVi > 35 ml/m2, HF–LG: 48 patients).
Results
The HG group was younger, although the difference did not reach statistical significance, higher percent of males (45% M vs 22% F, p = 0.02), higher heart rate (HR), left atrial volume, higher tricuspid regurgitation velocity and derived pulmonary artery systolic pressure (PASP), right ventricular fractional area changes (RV FAC) but similar RV longitudinal contraction. Moreover, the HG group had more severe MS calculated according to PHT. The group of LG was divided according to SVi: LF–LG compare to HG–MS had higher percent of females (45% F vs 13% M, p < 0.001), similar AFib (43% vs 32%, p=ns) and pre surgical complications (19% vs 16%, p=ns). LF–LG group had smaller LA volumes (LAV systole: 117±51 51 ml vs 148.6±38 ml, p < 0.0001), lower LV–S` (5.3±1.4 vs 6±1.6 cm/s, p = 0.004), lower tricuspid velocity regurgitation (TVR 2.47±0.5 vs 3.24±0.7 m/s, p < 0.0001), higher TAPSE/PASP (0.64±0.3 vs 0.45±0.29, p < 0.001), lower RV S` (9.79±2.01m/s vs 11.25±3.1 m/s, p = 0.01), higher RVFAC (38.5±9.6% vs 30.9±9.2%, p = 0.0005). The group of LG–LF had also less severe MS (1.3±0.6 cm2 vs 1.15±0.3 cm2, p < 0.01). The 3 groups of MS were similar in terms of cardiovascular risk factors.
Conclusion
Patients with HG MS were those with worst left ventricular involvement, higher PASP and lower RV function. However LF–LG MS were older and more females were included and even though they had smaller LA, lower values of PASP they had significantly higher percent of Afib and similar pre surgical complications. It could be speculated that LF–LG severe MS patients could be a different fenotype of the disease.
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Affiliation(s)
- O Vriz
- KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTER, RIYADH
| | - A Eltayeb
- KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTER, RIYADH
| | - K Anwar
- KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTER, RIYADH
| | - A Alenazy
- KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTER, RIYADH
| | - D Galzerano
- KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTER, RIYADH
| | - A Mohammed
- KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTER, RIYADH
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Vriz O, Fawzy N, Eltayeb A, Galzerano D, Anwar M, Mushtaq A, Shaik A, Elshaer A, Kinsara A, Feras K. Stuck mechanical valve complication in non-COVID-19 patients during COVID-19 pandemic: single center experience. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Stuck valve is a very rare and severe complication that occurs in mechanical valve replacement patients with ineffective anticoagulation. However, with COVID-19 restriction measures, it became challenging to regularly assess INR to make sure it falls within the target therapeutic range to prevent this complication.
Purpose
We wanted to explore how did the COVID-19 pandemic restrictions impacted mechanical valve replacement patients on chronic anticoagulation and the long-term consequences of limiting their access to health service.
Methods
We present a series of 10 patients on warfarin anticoagulation therapy who either underwent transthoracic echocardiography for a suspected stuck valve or were seen at the outpatient valve clinic with the residual consequences of a stuck valve during the COVID-19 restriction measures in our institute.
Results
Eight patients were female, two of whom were pregnant at the first trimester and eventually went on to receive an abortion; six patients received urgent valve replacement cardiac surgery; four patients were managed medically e.g. with heparin; none had thrombolytic therapy. Stuck prosthetic valves incident has increased significantly during this period, particularly those in the mitral position for which urgent replacement and prolonged hospitalization including intensive care admission, with high in-hospital mortality rates and high costs were necessary. Mean hospital admission time was 27.5 ± 18.5 days. The cost of treatment, as average estimated reimbursement, was 11,000 USD for medical admission only, and 43,200 USD when surgery was required, up to 64,000 USD when ECMO was part of patient management.
Conclusion
Despite governments’ efforts to implement telemedicine and virtual clinics, COVID-19 restrictions and health-messaging affected the routine follow-up of non-COVID-19 patients. We report dramatic consequences to this drastic change in healthcare: clinical complications, lost lives and inflated healthcare costs in patients with a prosthetic valve. We believe that non-COVID-19 patients have paid, and will continue to pay in the future, a price that is much greater than those patients who have suffered from COVID-19. Active engagement of patients should be implemented in a time of emergencies, and further studies should address the efficacy and cost-effectiveness of public policies aimed to decrease the burden of avoidable complications and missed diagnoses. Abstract Figure. Fluoroscopy in a 70 years old patient
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Affiliation(s)
- O Vriz
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - N Fawzy
- Alfaisal University, School of Medicine, Riyadh, Saudi Arabia
| | - A Eltayeb
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - D Galzerano
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M Anwar
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - A Mushtaq
- Alfaisal University, School of Medicine, Riyadh, Saudi Arabia
| | - A Shaik
- Alfaisal University, School of Medicine, Riyadh, Saudi Arabia
| | - A Elshaer
- Alfaisal University, School of Medicine, Riyadh, Saudi Arabia
| | - A Kinsara
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - K Feras
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Alharbi SM, Alfehaid A, Eltayeb A, Alsomali A, Galzerano D, Alamro B, Pirisi M, Troisi R, Vriz O. Cardiovascular adaptation after liver transplantation. Ventricular changes detect by 2d echocardiography and by speckle tracking. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Patients who underwent liver transplantation (LT) may suffer from heart disease that can be related to the liver disease itself or to other associated pathologies. It has been suggested that there is a specific heart disease associated with cirrhosis, termed cirrhotic cardiomyopathy which is characterized by the presence of increased baseline cardiac output, systolic and diastolic left ventricular (LV) dysfunction and increased in pulmonary artery systolic pressure (PASP). The aim of the study was to evaluate the cardiac structural and functional changes after LT and eventually to determine the improvement in PASP.
Method. 51 patients were considered for the analysis who had a good quality pre and post LT echocardiograms. The echo-study was done preLT and repeated within 4 months and 3 years after LT. All studies were red of-line, global longitudinal stains (GLS) of the LV and right ventricle (RV) were analyzed using TOMTEC application. A Paired T-test was used to compare the echocardiographic parameters. The group was also divided according to tertiles of pre LT PASP for the evaluation of pulmonary pressure.
Results . Patients` mean age was 58.1 ± 7.8 years, 32 (62.6%) men, mean time between the 2 echocardiographic studies was 529.2 ± 471 days. After LT all the patients were on immunosuppressant therapy (calcineurin inhibitors, ciclosporin and/or tacrolimus). After LT blood pressure (BP) (83.4 ± 16 vs 91.5 ± 14 mmHg, p = 0.009 for mean BP ), heart rate (72.5 ± 15.2 vs 80.6 ± 15.3 bpm, p = 0.004), increased as LV mass index (78.6 ± 21.1 to 91.4 ± 29, p= 0.003) and relative wall thickness (0.34 ± 0.06 to 0.39 ± 0.08, p = 0.001). LV ejection fraction did not change while there was a significant decrease in LV GLS (-20.9 ± 4.4% vs -17.4 ± 3.9%, p < 0.0001), impaired diastolic function (E/A 1.12 ± 0.5 vs 0.94 ± 0.4, p = 0.002) and increase in LV diastolic filling pressure (E/E’ 7.7 ± 3.6 vs 8.9 ± 3.6, p = 0.018). PASP increased (26.6 ± 8 vs 30.8 ± 11 mmHg, p = 0.018) and TAPSE (24.1 ± 4.5 vs 21.6 ± 3.9 mm, p = 0.002) decresed. The pre and post echo data, were divided in preLT PASP to see if there was any tendency to decrease in PASP after LT. A progressive increase in LV remodeling and impaired diastolic function, RV- pulmonary arterial coupling decreased as an index of RV maladaptation to the increase PASP as tertiles of in PASP increased.
Conclusion. Increased in BP has been found in patients after LT , likely related to immensuppressive therapy. LV remodeling, impaired diastolic function were likely a conseguence of increase in BP and the increased in PASP and worst RV- pulmonary circulation coupling was secondary to impaired diastolic function and increased filling pressure. After LT, patients require particular clinical attention and echocardiographic monitoring included GLS for target organ damage and prompt adequate therapy at least in terms of BP control to avoid later cardiovascular complications.
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Affiliation(s)
- SM Alharbi
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - A Alfehaid
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - A Eltayeb
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - A Alsomali
- Alfaisal University, School of Medicine, Riyadh, Saudi Arabia
| | - D Galzerano
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - B Alamro
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M Pirisi
- University of Eastern Piedmont, Internal Medicine, Novara, Italy
| | - R Troisi
- University Federico II, Chirurgia Generale, Naples, Italy
| | - O Vriz
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Adam M, Eltayeb A. Spontaneous remission in acute myeloid leukemia: A Case Report. Gulf J Oncolog 2014; 1:84-86. [PMID: 24610293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2013] [Indexed: 06/03/2023]
Abstract
UNLABELLED Spontaneous remission of Acute Myeloid leukaemia (AML) is an uncommon event, temporary and its mechanism is yet to be determined. We report here a case of spontaneous remission of AML in a 35 years old male who was diagnosed with AML (M4) in Jan 2011. He presented very ill with fever, bleeding tendency and oral candidacies. He received supportive care only and chemotherapy was withheld. His general condition improved and fever subsided. White blood cell (WBC) count started to drop spontaneously and gradually until he became leukopenic and developed febrile neutropenia. After the second recovery, his full blood count (FBC) and bone marrow examination showed haematological remission. He was followed up for six weeks after which relapse occurred. Chemotherapy was started immediately, but unfortunately was not continued because of sepsis. The patient died four weeks after relapse. Other reports on the spontaneous remission of AML showed a similar temporary period of remission with different duration, and then followed by relapse. Possible mechanisms of spontaneous remission in AML are discussed with a review of the literature. KEYWORDS Acute myeloid leukemia, spontaneous remission.
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Affiliation(s)
- M Adam
- Dr. Muna Adam, MBBS, MRCP (UK), Teaching assistant, Oncology Department, National Cancer Institute, University of Gezira, Wadmedani, Sudan. Tel No. 966 53883318
| | - A Eltayeb
- National Cancer Institute, University of Gezira, Wadmedani, Sudan
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Eltayeb A, Ibrahim K. Potential antileishmanial effect of three medicinal plants. Indian J Pharm Sci 2013; 74:171-4. [PMID: 23326001 PMCID: PMC3546337 DOI: 10.4103/0250-474x.103856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 03/16/2012] [Accepted: 03/23/2012] [Indexed: 11/25/2022] Open
Abstract
The antileishmanial activity of three organic solvent extracts and water residue of the plants: Acacia nilotica (Mimosaceae) (husk), Ambrosia miratima (Astraceae) (aerial shoot) and Azadarichta indica (Meliaceae) (leaves) were tested in vitro against Leishmania donovani promastigotes. The study revealed that the extracts of A. nilotica and A. miratima have effectious antileishmanial activity at concentrations (IC50) less than 8 μg/ml, while the extracts of A. indica lack antileishmanial activity. The chromatographic analysis of the ethyl acetate extract of A. nilotica, the most potent extract, resulted in four TLC fractions. Three of these fractions possessed antileishmanial activity. Phytochemical study of the potent fractions revealed the presence of poly hydroxyl compounds.
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Affiliation(s)
- A Eltayeb
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Khartoum, P.O. Box 1996, Sudan
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