1
|
Saifullah M, Laghzaoui O, Ozyahyalar H, Irfan A. The CRISPR-Cas9 induced CCR5 Δ32 mutation as a potent gene therapy methodology for resistance to HIV-1 variant: a review. Eur Rev Med Pharmacol Sci 2024; 28:2430-2463. [PMID: 38567606 DOI: 10.26355/eurrev_202403_35751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Human Immunodeficiency Virus (HIV) has continuously been the greatest epidemic for humanity over a period spanning almost five decades. With no specific cure or treatment available to date despite extensive research, the C-C Chemokine Receptor 5, Delta 32 (CCR5 Δ32) allele genetic point mutation plays an imperative role in the prevention of acquired immunodeficiency syndrome (AIDS). This comprehensive study aims to review the induction of the homozygous recessive deletion genotype using the Clustered Regularly Interspaced Short Palindromic Repeats, Cas 9 Enzyme (CRISPR-Cas9), and hematopoietic stem cell transplantation under positive selection pressure for active immunity in seropositive patients' populations as the phenotype. A methodology is proposed to trigger a significant increase in the expression of Delta 32 beneficial mutant alleles within controlled modern healthcare facilities utilizing totipotent stem cells through somatic gene therapy. It acts upon two dysfunctional CCR5 genes, translating mutant G protein-coupled co-receptors, whose primary function is similar to that of C-X-C Motif Chemokine receptor 4 (CXCR4), by blocking the entry of viral RNA into the CD4+ T helper lymphocytes, halting infection and seizing viral life cycle. This modification is endemic in Northern Europe, where it naturally pertains to the Caucasian descent population samples in the form of polymorphism, p (X=0.01), where X is the probability of frequency of complete immunity against HIV-1 in population samples. The epigenetics of the single nucleotide polymorphism (SNP) are analyzed as they play a significant role in immunity distribution. Furthermore, a comparative analysis within the ethical boundaries of CRISPR-Cas9 is conducted to discuss the practical aspects and challenges of the presented methodologies and treatment alternatives. Additionally, the study assembles all available data and summarizes preexisting research while providing a promising solution to this ethical dilemma. Finally, a methodology is devised to answer the question of whether the variant-specific epidemic of AIDS caused by HIV-1 can be cured via artificially inducing immunity by CRISPR-Cas9.
Collapse
Affiliation(s)
- M Saifullah
- University of Bonn, Medical School, Venusberg-Campus 1, Bonn, Germany.
| | | | | | | |
Collapse
|
2
|
Irfan A, Riggs DW, Koromia G, DeFilippis AP, Soliman EZ, Bhatnagar A, Carll AP. Smoking-associated Electrocardiographic Abnormalities Predict Cardiovascular Mortality: Insights from NHANES. Res Sq 2024:rs.3.rs-3615687. [PMID: 38260619 PMCID: PMC10802705 DOI: 10.21203/rs.3.rs-3615687/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background— Smoking is associated with arrhythmia and sudden cardiac death, but the biological mechanisms remain unclear. Abnormal electrocardiogram (ECG) durations of ventricular repolarization (QT interval), atrial depolarization (P wave), and atrioventricular depolarization (PR interval and segment), predict cardiac arrhythmia and mortality. Objectives— To elucidate how smoking affects cardiac excitation, we assessed in a nationally representative sample (NHANES III) associations between cotinine, abnormalities in P duration, PR interval, PR segment, rate-corrected QT (QTc), QRS duration, and JT interval, and long-term mortality. Methods— We analyzed data from 5,633 adults using survey-weighted multinomial logistic regression to estimate associations between tobacco use (>15 ng/ml serum cotinine) and short (<5th percentile) or long (>95th percentile) ECG intervals, relative to reference (5 - 95th percentile). Results— After adjustment for demographics, risk factors, and conduction-altering medications, smoking was associated with a higher odds of short PR interval, PR segment, and QRS, and long JT. Broader ECG effects of smoking were also assessed by survey-weighted linear regression of continuous cotinine and ECG intervals, which revealed cotinine inversely associated with PR segment and QTc. Over a 22-year follow-up, many ECG abnormalities predicted cardiovascular mortality in smokers, including long JT, QRS, and QTc, and short QRS. Conclusions— Smoking increases likelihood for rapid atrioventricular conduction, rapid ventricular depolarization, and slow ventricular repolarization. The ventricular electrophysiologic abnormalities associated with smoking also predict cardiovascular mortality in smokers; however, traditional ECG measures of cardiac risk like QTc can overlook these ventricular defects and their independent predictive value in smokers.
Collapse
|
3
|
Bhandari R, Abdulhay N, Alexander T, Rubenstein J, Meyer A, Annie FH, Kaleem U, Wiener RC, Sedney C, Thompson E, Irfan A. Characterization of patients receiving surgical versus non-surgical treatment for infective endocarditis in West Virginia. PLoS One 2023; 18:e0289622. [PMID: 37963173 PMCID: PMC10645336 DOI: 10.1371/journal.pone.0289622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) has increased in rural states such as West Virginia (WV) with high injection drug use. IE is medically managed with antimicrobial treatment alone or combined with surgical treatment. This study aimed to characterize the predictors associated with surgical treatment and rates of inpatient mortality and readmission among IE patients in WV's rural centers. METHODS This retrospective review of electronic health records includes all adults hospitalized for IE at major rural tertiary cardiovascular centers in WV during 2014-2018. Descriptive statistics were presented on demographics, history of injection drug use, clinical characteristics, and hospital utilization by surgery status, and multivariable logistic regression examined the association of surgery with key predictor variables, generating odds ratios (OR). RESULTS Of the 780 patients with IE, 38% had surgery, with a 26-fold increase in patients undergoing surgery between 2014-2018. Comparing surgery and non-surgery patients revealed significant differences. Surgery patients were significantly younger (median age 35.6 vs. 40.5 years; p<0.001); had higher rates of drug use history (80% vs. 65%; p<0.001), psychiatric disorders (57% vs. 31%; p<0.001), and readmissions (18% vs.12%; p = 0.015). Surgery patients had lower rates of discharge against medical advice (11% vs.17%; p = 0.028) and in-hospital mortality (5% vs.12%; p<0.001). In the multivariable logistic regression, surgery was associated with injection drug use (OR: 1.9; 95% CI:1.09-3. 3), indications for surgery (OR: 1.68; 95% CI:1.48-1.91), left-sided IE (OR: 2.14; 95%CI:1.43-3.19) and later years (OR:3.75; 95%CI:2.5-5.72). CONCLUSION This study characterizes the predictors associated with surgical treatment and rates of inpatient mortality and readmission among IE patients across rural WV. The decision to perform cardiac surgery on IE patients is complex. Results with increased injection drug use-associated IE emphasize the importance of comprehensive care by a multidisciplinary team for optimal management of patients with IE.
Collapse
Affiliation(s)
- Ruchi Bhandari
- School of Public Health, West Virginia University, Morgantown, WV, United States of America
| | - Noor Abdulhay
- School of Public Health, West Virginia University, Morgantown, WV, United States of America
| | - Talia Alexander
- School of Public Health, West Virginia University, Morgantown, WV, United States of America
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Rubenstein
- School of Public Health, West Virginia University, Morgantown, WV, United States of America
| | - Andrew Meyer
- School of Public Health, West Virginia University, Morgantown, WV, United States of America
| | - Frank H. Annie
- Health Education and Research Institute, Charleston Area Medical Center, Charleston, West Virginia, United States of America
| | - Umar Kaleem
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States of America
| | - R. Constance Wiener
- School of Dentistry, West Virginia University, Morgantown, WV, United States of America
| | - Cara Sedney
- School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Ellen Thompson
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States of America
| | - Affan Irfan
- Mayo Clinic Health System, Rochester, MN, United States of America
| |
Collapse
|
4
|
Irfan A, Cochrun S, He K, Okorji L, Parmar AD. Towards identifying a learning curve for robotic abdominal wall reconstruction: a cumulative sum analysis. Hernia 2023; 27:671-676. [PMID: 37160504 DOI: 10.1007/s10029-023-02794-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/22/2023] [Accepted: 04/15/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Over the past decade, an increase has been seen in robotics used for hernia repair, specifically robotic abdominal wall reconstruction (rAWR). However, the learning curve for rAWR can be steep and presently, little is understood regarding the optimal case volume required to achieve proficiency. The aim of our study was to review skill acquisition and describe the learning curve for rAWR. METHODS A retrospective, single-surgeon case series of consecutive patients who underwent rAWR from 2018 to 2022. The primary outcome was operative time, obtained from console time identified through the MyIntutive application. A one-sided cumulative sum analysis (CUSUM) curve for the total operative time was derived based on the mean operative time of chronological procedures (207 min). RESULTS 185 patients underwent rAWR between 2018 and 2022. These patients were more likely to be female, Caucasian, and have undergone two previous hernia repairs. ASA complexity increased over time with ASA 3 being predominant from 2020 onwards. The median hernia length was 15.0 cm and the median width was 7 cm. Average operative time was 207.8 min and decreased over time. The CUSUM analysis identified four phases of skill acquisition with the following case volumes: Initial Learning Curve (0-20), Stabilization Phase (21-55), Second Learning Curve (56-70), 4) Skill Proficiency (> 70). CONCLUSION In the early learning curve of rAWR, operative time decreased consistently after 70 cases, with an initial inflection after 20 cases. We identified varying stages of skill acquisition that are likely typical of a surgeon as they would progress through the learning curve of advanced robotic surgery. Future studies are needed to confirm the optimal case volume for determining the skill level for the performance of rAWR.
Collapse
Affiliation(s)
- A Irfan
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA
| | - S Cochrun
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA
| | - K He
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA
| | - L Okorji
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA
| | - Abhishek D Parmar
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA.
| |
Collapse
|
5
|
Irfan A, Khalaf Z, Hamidpour S, Abbasi S. Incidental Thyroid Carcinomas versus Benign Thyroid Cases. A Clinico-Radiological Comparison. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.108] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
We aim to identify the clinico-radiological characteristics unique to incidental thyroid carcinomas (ITCs) in comparison to benign thyroid cases. Previous studies show a positive correlation between ITCs and a euthyroid state. Currently nodules greater than 4 cm (N>4cm) with or without a negative fine needle aspiration (FNA) are excised because of a higher risk of malignancy.
Methods/Case Report
A 6-year retrospective study was performed on 227 thyroidectomy specimens collected during 2017-2022. 146 patients were benign. 26 patients with a negative/absent FNA were found to have ITCs. 55 patients had malignant thyroids (MTs). Age, gender, compressive symptoms, thyroid hormone status, presence of nodules, number of nodules, N>4cm, suspicious radiologic findings, personal history of other malignancies, family history of thyroid cancer (FHTCA) and a family history of thyroid disease were analyzed between the benign and ITC groups. A t-test was utilized for numerical variables and a chi-square test for categorical values. For any significant correlations, a maximum likelihood estimate was used to calculate the odds ratio.
Results (if a Case Study enter NA)
Incidence of ITC amongst all specimen was 11.4% (26/227). 32% (26/81) of all reported MTs were ITCs. Papillary thyroid carcinomas accounted for 92.3% (24/26) of ITCs, follicular carcinomas accounted for 7% (2/26). 3/26 patients with ITC, 4/146 patients with benign thyroids and 5/55 patients with MT had a FHTCA. We found a significant correlation between FHTCA and thyroid malignancy [MT + ITC; odds ratio = 4.11 (CI = 1.198 – 14.154)]. A FHTCA was associated with more than a 4 times likelihood of having ITC compared to those without a family history (odds ratio = 4.77) (CI [1 - 22.782]). Other variables did not show any statistically significant differences between the ITC and benign groups.
Conclusion
Although previous studies report a correlation between ITCs and a euthyroid status and N>4cm, our study didn’t confirm it. However, this may be due to our smaller sample size. In our patient population, an FHTCA was associated with significantly higher incidence of ITCs which may outline a subpopulation that should be considered for more aggressive screening. No other variables were statistically significant.
Collapse
Affiliation(s)
- A Irfan
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| | - Z Khalaf
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| | - S Hamidpour
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| | - S Abbasi
- Hematology and Oncology, Kansas University Medical Center , Kansas City, Kansas , United States
| |
Collapse
|
6
|
Khalaf Z, Irfan A, Mateescu V. Synchronous Bilateral Testicular Tumors with Different Histology: Case Report and Review of Literature. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.150] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Germ cell tumor (GCT) is the most common cancer among males in the 20–39 year-old age range, representing 21% of invasive cancer diagnoses. Majority of bilateral testicular tumors are metachronous. The synchronous tumors comprise approximately 0.5%-1% of all cases. Most of the synchronous tumors share the same histologic pattern, predominantly seminoma. The synchronous bilateral testicular GCTs (SBTGCTs) with discordant subtypes are extremely rare.
Methods/Case Report
A 26-year-old male presented with left testicular pain, the ultrasound revealed bilateral testicular masses with calcifications and microlithiasis in the right side. His serum markers showed elevated alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG). Lactate dehydrogenase (LDH) was normal. He underwent bilateral orchiectomy. The pathology report showed a non-seminomatous mixed germ cell tumor, 2.0 cm in greatest dimension, predominantly embryonal carcinoma (90%), with a minor yolk sac tumor component (10%), lymphovascular invasion, Germ-cell neoplasia in situ (GCNIS) and calcifications in the left testicle, and a seminoma, 0.3 cm in greatest dimension with GCNIS and calcifications in the right testicle. The pathologic staging was pT2pNX for the left testicle and pT1pNX for the right testicle. Computed tomography (CT) revealed two mildly enlarged left sided para-aortic retroperitoneal lymph nodes. Radical pelvic lymph node dissection was performed. The pathology report showed four para-aortic lymph nodes positive for metastatic carcinoma. Tumor was positive for CD30 in the embryonal component, positive for Glypican-3 in the yolk sac tumor component, and seminoma was positive for PLAP. The final staging was IIB for the left testicle and IA for the right testicle. He underwent 4 cycles of Etoposide and Cisplatin chemotherapy (EP). He is in complete remission after 10 months of his diagnosis.
Results (if a Case Study enter NA)
NA.
Conclusion
The SBTGCTs with discordant subtypes represent a rare entity with no standard therapy. Our patient was treated with 4 cycles of chemotherapy and achieved complete remission.
Collapse
Affiliation(s)
- Z Khalaf
- Pathology, University Health TMC , Kansas City, Missouri , United States
| | - A Irfan
- Pathology, University Health TMC , Kansas City, Missouri , United States
| | - V Mateescu
- Pathology, University Health TMC , Kansas City, Missouri , United States
| |
Collapse
|
7
|
Irfan A, Lankachandra K. The Changing Epidemiology of the Respiratory Syncytial Virus in Light of the COVID-19 Pandemic. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.281] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
The epidemiology of a virus can be based on its evolving virulence, environmental and societal factors. Here we analyze the impact of the COVID-19 pandemic on the Respiratory Syncytial Virus (RSV).
Methods/Case Report
A 5-year retrospective study performed at Truman Medical Center, Kansas City, Missouri, analyzed 390 RSV positive cases by Lab PCR (polymerase chain reaction) for adult and pediatric patients, between the months of July- December, 2017-2021. Cases were divided into two groups - pre-pandemic and pandemic. Data was collected for both groups and categorized by age, gender, admission rate, summer months (July-September), winter months (October-December) and COVID-vaccination-status. A chi-square analysis was used to compare the above categorized data between both groups.
Results (if a Case Study enter NA)
Out of 390 cases, the annual incidence of RSV, pre-pandemic averaged at 71. This number fell drastically to 9 cases in 2020 followed by an overwhelming 168 cases in 2021. The incidence of cases in 2021 was higher in the summer months compared to pre-pandemic days, p<.00001. Additionally, the incidence of cases in children <5 years was greater during 2021, p=0.0014. Of note, no individuals <20 years of age, reported positive in 2020. Of the population eligible for the COVID19 vaccine, 24% of those who tested positive had also been vaccinated. There was no significant difference reported with regards to other age groups, gender or admission rates.
Conclusion
Adequate social distancing and non-pharmaceutical interventions (masks, handwashing etc.) can explain the sharp decline in cases in 2020. RSV appears to have evolved to a more virulent strain ever since, resulting in more infections during the summer months, especially targeting children under the age of 5.
Collapse
Affiliation(s)
- A Irfan
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| | - K Lankachandra
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| |
Collapse
|
8
|
Irfan A, Hamdan H. A Case of Acute Disseminated Histoplasmosis of the Liver in a Patient Receiving Amphotericin-B Therapy. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.118] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Acute disseminated histoplasmosis (DH), caused by Histoplasma Capsulatum (HC), occurs primarily in immunocompromised hosts. It is characterized by an abrupt onset of symptoms (fever, malaise, hepatosplenomegaly, lymphadenopathy, anemia, leucopenia and thrombocytopenia) and a lack of granulomatous inflammatory response. If left untreated, death occurs within three months of the disease. The treatment of choice is a two-week course of Amphotericin-B (AmpB-Tx). Studies show a drop in fungal load in 85% of blood cultures and a drop of 1.6 U and 2.1 U in serum and urine antigen levels of histoplasmosis respectively, within 14 days of treatment thereby making it unlikely to see liver failure secondary to acute DH in a patient receiving AmpB-Tx.
Methods/Case Report
We present a case of a 41-year-old male, newly diagnosed with HIV (CD4=44; viral load=5,350,000) and DH on AmpB-Tx. At presentation, his liver function tests (LFT’s) were mildly elevated (Bilirubin =2.7mg/dL; ALP=259U/L; AST=271U/L; ALT=71U/L). On Day-9 of AmpB-Tx, he became somnolent and jaundiced with hepatosplenomegaly and ascites. His LFTs were markedly raised, showing an obstructive pattern (Bilirubin=16mg/dL; ALP=1578U/L; AST=261U/L; ALT=213U/L). On Day-11 of treatment, we received a liver biopsy for HIV cholangiopathy versus drug induced hepatotoxicity. The clinicians considered DH to be a less likely cause since the patient was already on AmpB-Tx. The liver biopsy showed hepatocytes with cholestasis, minimal acute portal inflammation and numerous portal tract and parenchymal macrophages laden with fungal organisms. Gomori-Methenamine-Silver stain confirmed the fungal organisms as being HC. This diagnosis prompted the continuation of AmpB-Tx past 14 days. The patient’s LFT’s reached maximum values of Bilirubin=18mg/dL; ALP=1680U/L; AST=355U/L; ALT=324U/L. After 25 days of AmpB-Tx, his LFT’s trended downwards with a resolution of his hepatic encephalopathy and jaundice. While a 14 day course was initially intended, AmpB-Tx was continued for a total of 28 days until a resolution of symptoms was achieved.
Results (if a Case Study enter NA)
NA.
Conclusion
Our case identifies a patient with progressive hepatic histoplasmosis in spite of AmpB-Tx. Keeping in mind and identifying such cases on pathology can alter the course of treatment for patients.
Collapse
Affiliation(s)
- A Irfan
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| | - H Hamdan
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| |
Collapse
|
9
|
Irfan A, Jiles C, Hamdan H. The Accidental Discovery of a Rare and Diagnostically Challenging Antibody, Anti Diegoa. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.332] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Anti Diegoa antibody (DiA) is a rare antibody, associated with severe hemolytic disease of the newborn. It is seen in American Indians and Asians of Mongoloid descent. Only 2.6% of Hispanics and <0.01% of Caucasians and African Americans have this antibody, making it challenging to diagnose. We present a case of a DiA discovered accidentally.
Methods/Case Report
A 31-year-old G4P3 Hispanic female at 35 weeks 5 days of gestation presented with limited prenatal care and gestation complicated by chronic deep vein thrombosis, on enoxaparin. Her gestational history was significant for Anti-E Antibody (Anti-E) with a gel titer of 1:8 during her second gestation. During her current pregnancy her Anti-E Ab gel titer was 1:32 and an Anti-c Antibody (Anti-c) was also detected. R1R1 panel was used to detect further antibodies since the patient was Anti-E and Anti-c. The initial gel panel could not rule out Duffy Antibody (FyA) and Kidd Antibody (JkB). Two R1R1 panels had already been cross matched and both were compatible. A second gel panel showed Kell antigen (KpA), FyA and JkB, all with a +2 positivity in a R1R1 cell panel (Cell X). Antigen typing labelled the patient as JkB+ and FyA-. One compatible unit was FyB- making FyA- unlikely. One of the cross matched compatible units was FyA+. An additional homozygous R1R1 cell was negative for FyA. Therefore FyA- was ruled out. The positivity on Cell X was then thought to be KpA. A solid phase panel (Cell Y) was conducted and was positive, supporting KpA as the causative factor. A decision was made to repeat our test using the initial patient sample plus a CBC tube. This demonstrated KpA negativity, negating KpA as the causative factor. However the Cell Y positivity in the solid phase panel was still questionable. DiA, a low frequency antibody is also found on this cell. This led to further testing. Another R1R1 cell showed +3 positivity for DiA. Antibody identification confirmed this as DiA with a titer of 2. The patient underwent induction of labor and delivered a healthy neonate.
Results (if a Case Study enter NA)
N/A
Conclusion
Since DiA is located in the same panel as KpA, the positive result was presumed to be secondary to KpA. However repeat testing demonstrated KpA negativity and thereby unmasked DiA as the culprit.
Collapse
Affiliation(s)
- A Irfan
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| | - C Jiles
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| | - H Hamdan
- Pathology, University of Missouri Kansas City , North Kansas City, Missouri , United States
| |
Collapse
|
10
|
Bhandari R, Alexander T, Annie FH, Kaleem U, Irfan A, Balla S, Wiener RC, Cook C, Nanjundappa A, Bates M, Thompson E, Smith GS, Feinberg J, Fisher MA. Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization. PLoS One 2022; 17:e0271510. [PMID: 35839224 PMCID: PMC9286279 DOI: 10.1371/journal.pone.0271510] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Life-threatening infections such as infective endocarditis (IE) are increasing simultaneously with the injection drug use epidemic in West Virginia (WV). We utilized a newly developed, statewide database to describe epidemiologic characteristics and healthcare utilization among patients with (DU-IE) and without (non-DU-IE) drug use-associated IE in WV over five years. Materials and methods This retrospective, observational study, incorporating manual review of electronic medical records, included all patients aged 18–90 years who had their first admission for IE in any of the four university-affiliated referral hospitals in WV during 2014–2018. IE was identified using ICD-10-CM codes and confirmed by chart review. Demographics, clinical characteristics, and healthcare utilization were compared between patients with DU-IE and non-DU-IE using Chi-square/Fisher’s exact test or Wilcoxon rank sum test. Multivariable logistic regression analysis was conducted with discharge against medical advice/in-hospital mortality vs. discharge alive as the outcome variable and drug use as the predictor variable. Results Overall 780 unique patients had confirmed first IE admission, with a six-fold increase during study period (p = .004). Most patients (70.9%) had used drugs before hospital admission, primarily by injection. Compared to patients with non-DU-IE, patients with DU-IE were significantly younger (median age: 33.9 vs. 64.1 years; p < .001); were hospitalized longer (median: 25.5 vs. 15 days; p < .001); had a higher proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates (42.7% vs. 29.9%; p < .001), psychiatric disorders (51.2% vs. 17.3%; p < .001), cardiac surgeries (42.9% vs. 26.6%; p < .001), and discharges against medical advice (19.9% vs. 1.4%; p < .001). Multivariable regression analysis showed drug use was an independent predictor of the combined outcome of discharge against medical advice/in-hospital mortality (OR: 2.99; 95% CI: 1.67–5.64). Discussion and conclusion This multisite study reveals a 681% increase in IE admissions in WV over five years primarily attributable to injection drug use, underscoring the urgent need for both prevention efforts and specialized strategies to improve outcomes.
Collapse
Affiliation(s)
- Ruchi Bhandari
- School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
- * E-mail:
| | - Talia Alexander
- School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
| | - Frank H. Annie
- Health Education and Research Institute, Charleston Area Medical Center, Charleston, West Virginia, United States of America
| | - Umar Kaleem
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, United States of America
| | - Affan Irfan
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, United States of America
| | - Sudarshan Balla
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - R. Constance Wiener
- School of Dentistry, West Virginia University, Morgantown, West Virginia, United States of America
| | - Chris Cook
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Aravinda Nanjundappa
- Department of Cardiovascular Medicine, Charleston Area Medical Center, Charleston, West Virginia, United States of America
| | - Mark Bates
- Department of Cardiovascular Medicine, Charleston Area Medical Center, Charleston, West Virginia, United States of America
| | - Ellen Thompson
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, United States of America
| | - Gordon S. Smith
- School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
| | - Judith Feinberg
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Melanie A. Fisher
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| |
Collapse
|
11
|
Irfan A, Ahmed I. 40 Across the Pond: Why Are Junior Doctors Seeking Surgical Training Abroad? Br J Surg 2021. [DOI: 10.1093/bjs/znab134.111] [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 loss of junior doctors from the NHS has been an ongoing issue. A subset are now seeking surgical training in other systems, such as the US. This is a costly and difficult process and many enter into undesignated positions with no guarantee of a job. With so much career uncertainty, why are trainees willing to take the risk?
Method
We performed a survey of trainees who graduated from British medical schools; all are currently enrolled in a US surgical training programme. They were asked about their experiences and perceptions of
Results
Nine trainees completed the survey. The most common time for trainees to move was during or after foundation training and the majority initially matched into preliminary positions. The most common reason cited to move was to receive better quality training. Many perceived the US training to be better and felt that they had a reasonable work-life balance.
Conclusions
The potential loss of the future NHS surgical workforce is worrying. Our survey highlights that surgical trainees place a high value on the quality of their training and were willing to enter an intense and uncertain process to achieve it. This needs to be addressed to retain potential trainees.
Collapse
Affiliation(s)
- A Irfan
- UAB Hospital, Birmingham, USA
| | - I Ahmed
- NHS Grampian, Aberdeen, United Kingdom
| |
Collapse
|
12
|
Mohammed A, Velu AB, Al-Hakami AM, Meenakshisundaram B, Esther P, Abdelwahid SA, Irfan A, Prasanna R, Anantharam D, Harish CC. Novel Piperine compound AB05 (N-5-(3,4-dimethoxyphenyl) -2E,4E pentadienylpiperidine) inhibits H1N1 influenza virus propagation in vitro. Trop Biomed 2020; 37:1062-1073. [PMID: 33612758 DOI: 10.47665/tb.37.4.1062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pandemic H1N1 influenza virus respiratory illness has become an inevitable global health concern. With antigenic drift, it becomes necessary to have drugs over tailor-made HIN1 vaccine every year. In the current study, we screened many Piperine derivative in which, N-5-(3,4-dimethoxyphenyl)-2E,4E-pentadienylpiperidine (AB05) and was further studied for anti-H1N1influenza virus activity and compared with other stains in-vitro on MDCK cell line. Initial cytotoxic doses of AB05 for the MDCK cell line were > 25µM. The results showed a dose-dependent reduction of the viral plaque's in the adsorption assay with EC50 of 0.33 µM. The mechanism of AB05 was by inhibition of matured viral release as evaluated by the time of virus addition with incubation of 6-10 hours. With the promising H1N1 virucidal activity of AB05, we included various strains of human influenza virus to screen AB05 inhibition of Neuraminidase (NA). The result showed 70% NA inhibition in WSN (H1N1), 90% in H3N2 and Influenza B and 49% in Tamiflu resistant H1N1). Further our In silco docking studies substantiated experimental results by showing the difference in binding and cooperation between H1N1 and N3N2. Together these observations illustrate that Piperine derivative AB05 is a promising lead molecule which needs further evaluation in animal models.
Collapse
Affiliation(s)
- A Mohammed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, K.S.A
| | - A B Velu
- Lankenau Institute for Medical Research, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - A M Al-Hakami
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, K.S.A.,Center of Tropical Diseases, College of Medicine, King Khalid University, Abha, K.S.A.,Center for Stem Cell Research, College of Medicine, King Khalid University, Abha, K.S.A
| | - B Meenakshisundaram
- Department of Geriatrics, Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - P Esther
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, K.S.A.,Center of Tropical Diseases, College of Medicine, King Khalid University, Abha, K.S.A
| | - S A Abdelwahid
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, K.S.A.,Center of Tropical Diseases, College of Medicine, King Khalid University, Abha, K.S.A
| | - A Irfan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, K.S.A
| | - R Prasanna
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, K.S.A
| | - D Anantharam
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, K.S.A.,Center for Stem Cell Research, College of Medicine, King Khalid University, Abha, K.S.A
| | - C C Harish
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, K.S.A.,Center of Tropical Diseases, College of Medicine, King Khalid University, Abha, K.S.A.,Center for Stem Cell Research, College of Medicine, King Khalid University, Abha, K.S.A
| |
Collapse
|
13
|
Arshad S, Hussain I, Ibrahim M, Imran M, A. Assiri M, Thind S, Bilal M, Irfan A, G. Al-Sehemi A. Biochemical studies on protein, phenolic contents and antioxidant activities of Sida cordifolia extracts. B CHEM SOC ETHIOPIA 2020. [DOI: 10.4314/bcse.v34i2.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The study aimed to characterize the antioxidant properties regarding the Sida cordifolia with special reference to its detailed biochemical analysis. The study revealed that chlorophyll A (0.9 ± 0.3 mg/g), total chlorophyll content (3.0 ± 0.7 mg/g), total carotenoid content (0.3 ± 0.1 mg/g), total soluble proteins (7.5 ± 0.1 mg/g), and total phenolic contents (5.6 ± 1.3 mg/g) were found highest in flower tissue of S. cordifolia. However, peroxidase (POD) contents (118 ± 31 units/g), superoxide dismutase (SOD) activity (64 ± 1.5 units/g) were maximum in the leaf tissues, while catalase (CAT) contents (133 ± 25 units/g), ascorbate peroxidase (APX) contents (145 ± 44 units/g) were also found more in the flowers of S. cordifolia rather than other parts. Our results conclude that leaves, stem, flower of S. cordifolia could be exploited in pharmacology due to presence of different antioxidants reflected in flower and leaf extract make them potent and profound therapeutic agents.
KEY WORDS: Alkaloids, Flavonoids, Phenolics, Antioxidant, Sida cordifolia
Bull. Chem. Soc. Ethiop. 2020, 34(2), 427-434
DOI: https://dx.doi.org/10.4314/bcse.v34i2.18
Collapse
|
14
|
Irfan A, Koromia GA, Abusnina W, DeFilippis AP, Studeny M, Lorkiewicz P, Bhatnagar A, Carll A. COMPARISON OF THE EFFECTS OF MAINSTREAM CIGARETTE SMOKING AND NICOTINE ON ELECTROCARDIOGRAM. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32528-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
15
|
Acosta G, Amro A, Aguilar R, Abusnina W, Bhardwaj N, Koromia GA, Studeny M, Irfan A. Clinical Determinants of Myocardial Injury, Detectable and Serial Troponin Levels among Patients with Hypertensive Crisis. Cureus 2020; 12:e6787. [PMID: 32140347 PMCID: PMC7045977 DOI: 10.7759/cureus.6787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 01/21/2023] Open
Abstract
Introduction There is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known. Methods A retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). Logistic regression was used to determine the important predictors of myocardial injury evidenced by troponin elevation >99th percentile of upper reference level (URL), detectable troponin (> 0.015 ng/ml), and increase in serial troponin levels. Results The 99th percentile of the initial troponin level among all patients was 0.433 ng/ml. A total of 15% had a myocardial injury, and the significant risk factors associated with it were body mass index (BMI) < 30 kg/m2 (odds ratio [OR] 0.50, confidence interval [CI] 0.28-0.89), congestive heart failure (CHF; OR 4.28, CI 2.21-8.25) and prior use of aspirin (OR 1.98, CI 1.08-3.63). About 35% had detectable troponin, and BMI < 30 kg/m2 (OR 0.62, CI 0.40-0.97), CHF (OR 3.49, CI 2.06-5.9), elevated creatinine (OR 1.17, CI 1.02-1.34) and age <61 years (OR 0.59, CI 0.38-0.94) were associated with it. The factors associated with an increase in serial troponin were BMI < 30 Kg/m2 (OR 0.56, CI 0.36-0.87), CHF (OR 1.78, CI 1.06-3.0), coronary artery disease (CAD; OR 2.08, CI 1.28-3.36) and non-Caucasian race (OR 0.52, CI 0.29-0.93). Conclusion About one-third of patients with the hypertensive crisis have detectable troponin. Still, among these, less than half have troponin levels >99th percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients.
Collapse
Affiliation(s)
| | - Ahmed Amro
- Cardiology, Marshall University, Huntington, USA
| | - Rodrigo Aguilar
- Internal Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA
| | | | - Niharika Bhardwaj
- Clinical and Translational Science, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA
| | | | - Mark Studeny
- Cardiology, Marshall University, Huntington, USA
| | - Affan Irfan
- Cardiology, Marshall University, Huntington, USA
| |
Collapse
|
16
|
Irfan A, Kanbour M, Acosta G, Studeny M. P142Additional cost of two-day Myocardial Perfusion Scan: Rationale for Study comparing CCTA vs Stress only SPECT-MPI for the Diagnosis of Coronary Artery Disease among obese inpatients. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Irfan
- University of Louisville School of Medicine, Louisville, United States of America
| | - M Kanbour
- Marshall University, Huntington, United States of America
| | - G Acosta
- Marshall University, Huntington, United States of America
| | - M Studeny
- Marshall University, Huntington, United States of America
| |
Collapse
|
17
|
Amro A, Baez GA, Koromia GA, Bhardwaj N, Aguilar R, El-Hamdani M, Irfan A. ALBUMIN LEVEL AS A RISK MARKER AND PREDICTOR OF PERIPARTUM CARDIOMYOPATHY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
18
|
Irfan A, Li Y, Bhatnagar A, Soliman EZ. Association between serum cotinine levels and electrocardiographic left atrial abnormality. Ann Noninvasive Electrocardiol 2018; 24:e12586. [PMID: 30152127 DOI: 10.1111/anec.12586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/24/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although the harmful effect of tobacco exposure on cardiovascular disease (CVD) and its risk factors are well established, the constituents of cigarette-smoke and the pathophysiological mechanism involved are unknown. Recently, deep terminal negativity of P wave in V1 (DTNPV1) has emerged as a marker of left atrial abnormality that predicts atrial fibrillation, stroke, and death due to all-cause or CVD. Therefore, we examined the association between serum cotinine levels with abnormal DTNPV1 using the Third National Health and Nutrition Examination Survey. METHODS This analysis included 4,507 participants (mean age 58 ± 13 years, 53% women, 49% non-Hispanic white) of NHANES III, without history of CVD or major electrocardiographic abnormalities and not on heart rate modifying medications. Multivariable logistic regression analysis was used to examine the association between serum cotinine and abnormal DTNPV1-defined from automatically processed electrocardiograms as values of the amplitude of the terminal negative phase of P wave in lead V1 exceeding 100 μV. RESULTS Abnormal DTNPV1 was detected in 2.3% (n = 105) of the participants. In a model adjusted for demographics and CVD risk factors, each 10 ng/ml serum cotinine was associated with 2% increased odds of abnormal DTNPV1 (odds ratio 1.02, 95% confidence interval 1.01-1.03, p-value < 0.001). This association was consistent in subgroups stratified by age, sex, race, smoking status, hypertension, diabetes, dyslipidemia, and chronic obstructive pulmonary disease. CONCLUSION Elevated serum cotinine levels are associated with an abnormal DTNPV1. This suggests that nicotine exposure can lead to left atrial abnormalities, a possible mechanism for increased risk of CVD.
Collapse
Affiliation(s)
- Affan Irfan
- Department of Cardiology Services and Department of Clinical & Translational Sciences, Marshall University, Huntington, West Virginia.,Department of Physiology, University of Louisville, Louisville, Kentucky.,Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky
| | - Yabing Li
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Aruni Bhatnagar
- Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina.,Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina
| |
Collapse
|
19
|
G. Al-Sehemi A, Irfan A, Al Fahad A, Alfaifi M. Radical scavenging activity of some natural tropolones by density functional theory. B CHEM SOC ETHIOPIA 2017. [DOI: 10.4314/bcse.v31i1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
20
|
Agarwal A, Johnston BC, Vernooij RWM, Carrasco-Labra A, Brignardello-Petersen R, Neumann I, Akl EA, Sun X, Briel M, Busse JW, Ebrahim S, Granados CE, Iorio A, Irfan A, Martínez García L, Mustafa RA, Ramirez-Morera A, Selva A, Solà I, Sanabrai AJ, Tikkinen KAO, Vandvik PO, Zhang Y, Zazueta OE, Zhou Q, Schunemann HJ, Guyatt GH, Alonso-Coello P. Authors seldom report the most patient-important outcomes and absolute effect measures in systematic review abstracts. J Clin Epidemiol 2016; 81:3-12. [PMID: 27555080 DOI: 10.1016/j.jclinepi.2016.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 07/08/2016] [Accepted: 08/09/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Explicit reporting of absolute measures is important to ensure treatment effects are correctly interpreted. We examined the extent to which authors report absolute effects for patient-important outcomes in abstracts of systematic review (SR). STUDY DESIGN AND SETTING We searched OVID MEDLINE and Cochrane Database of Systematic Reviews to identify eligible SRs published in the year 2010. Citations were stratified into Cochrane and non-Cochrane reviews, with repeated random sampling in a 1:1 ratio. Paired reviewers screened articles and recorded abstract characteristics, including reporting of effect measures for the most patient-important outcomes of benefit and harm. RESULTS We included 96 Cochrane and 94 non-Cochrane reviews. About 117 (77.5%) relative measures were reported in abstracts for outcomes of benefit, whereas only 34 (22.5%) absolute measures were reported. Similarly, for outcomes of harm, 41 (87.2%) relative measures were provided in abstracts, compared with only 6 (12.8%) absolute measures. Eighteen (9.5%) abstracts reported both absolute and relative measures for outcomes of benefit, whereas only two (1.1%) abstracts reported both measures for outcomes of harm. Results were similar between Cochrane and non-Cochrane reviews. CONCLUSION SR abstracts seldom report measures of absolute effect. Journal editors should insist that authors report both relative and absolute effects for patient-important outcomes.
Collapse
Affiliation(s)
- Arnav Agarwal
- School of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Bradley C Johnston
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, Ontario M5T 3M6, Canada; Systematic Overviews through advancing Research Technology (SORT), Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, University of Toronto, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Department of Anesthesia & Pain Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8, Canada.
| | - Robin W M Vernooij
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Alonso Carrasco-Labra
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone 943, Santiago, Chile
| | - Romina Brignardello-Petersen
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone 943, Santiago, Chile
| | - Ignacio Neumann
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O Higgins 340, Santiago, Región Metropolitana, Chile
| | - Elie A Akl
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh, Beirut 1107 2020, Lebanon
| | - Xin Sun
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu 610041, China
| | - Matthias Briel
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Spitalstrasse 12, Basel 4031, Switzerland
| | - Jason W Busse
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Shanil Ebrahim
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Carlos E Granados
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Área de investigaciones, Facultad de Medicina, Universidad de La Sabana, Campus del Puente del Común Km, 7 Autopista Norte, Chía, Colombia
| | - Alfonso Iorio
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Affan Irfan
- Internal Medicine Residency Program, University of Illinois, Urbana-Champaign, 506 S. Mathews Ave., Urbana, IL 61801, USA
| | - Laura Martínez García
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Reem A Mustafa
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Departments of Medicine and Biomedical & Health Informatics, University of Missouri-Kansas City, School of Medicine, M4-303, 2411 Holmes St, Kansas City, MO, USA
| | - Anggie Ramirez-Morera
- CCSS Permanent Medical Advisor, Health Care Development Division, IHCAI Foundation & Central America Cochrane, 1st Ave., 35th and 37th St, Number 3530, Barrio Escalante, San José, Costa Rica
| | - Anna Selva
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Ivan Solà
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Andrea J Sanabrai
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Kari A O Tikkinen
- Departments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Helsinki 00029, Finland
| | - Per O Vandvik
- Norwegian Knowledge Centre for the Health Services, P.O. Box 4404 Nydalen, Oslo 0403 Norway
| | - Yuqing Zhang
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Oscar E Zazueta
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Qi Zhou
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Holger J Schunemann
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Pablo Alonso-Coello
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP-IIB Sant Pau), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid 28029, Spain
| |
Collapse
|
21
|
G. Al-Sehemi A, Irfan A, A. Alrumman S, E. Hesham A. Antibacterial activities, DFT and QSAR studies of quinazolinone compounds. B CHEM SOC ETHIOPIA 2016. [DOI: 10.4314/bcse.v30i2.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
22
|
Akl EA, Carrasco-Labra A, Brignardello-Petersen R, Neumann I, Johnston BC, Sun X, Briel M, Busse JW, Ebrahim S, Granados CE, Iorio A, Irfan A, Martínez García L, Mustafa RA, Ramírez-Morera A, Selva A, Solà I, Sanabria AJ, Tikkinen KAO, Vandvik PO, Vernooij RWM, Zazueta OE, Zhou Q, Guyatt GH, Alonso-Coello P. Reporting, handling and assessing the risk of bias associated with missing participant data in systematic reviews: a methodological survey. BMJ Open 2015; 5:e009368. [PMID: 26423858 PMCID: PMC4593136 DOI: 10.1136/bmjopen-2015-009368] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To describe how systematic reviewers are reporting missing data for dichotomous outcomes, handling them in the analysis and assessing the risk of associated bias. METHODS We searched MEDLINE and the Cochrane Database of Systematic Reviews for systematic reviews of randomised trials published in 2010, and reporting a meta-analysis of a dichotomous outcome. We randomly selected 98 Cochrane and 104 non-Cochrane systematic reviews. Teams of 2 reviewers selected eligible studies and abstracted data independently and in duplicate using standardised, piloted forms with accompanying instructions. We conducted regression analyses to explore factors associated with using complete case analysis and with judging the risk of bias associated with missing participant data. RESULTS Of Cochrane and non-Cochrane reviews, 47% and 7% (p<0.0001), respectively, reported on the number of participants with missing data, and 41% and 9% reported a plan for handling missing categorical data. The 2 most reported approaches for handling missing data were complete case analysis (8.5%, out of the 202 reviews) and assuming no participants with missing data had the event (4%). The use of complete case analysis was associated only with Cochrane reviews (relative to non-Cochrane: OR=7.25; 95% CI 1.58 to 33.3, p=0.01). 65% of reviews assessed risk of bias associated with missing data; this was associated with Cochrane reviews (relative to non-Cochrane: OR=6.63; 95% CI 2.50 to 17.57, p=0.0001), and the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology (OR=5.02; 95% CI 1.02 to 24.75, p=0.047). CONCLUSIONS Though Cochrane reviews are somewhat less problematic, most Cochrane and non-Cochrane systematic reviews fail to adequately report and handle missing data, potentially resulting in misleading judgements regarding risk of bias.
Collapse
Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Alonso Carrasco-Labra
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Evidence Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Romina Brignardello-Petersen
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Evidence Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ignacio Neumann
- Department of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bradley C Johnston
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Xin Sun
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Clinical Research and Evaluation Unit, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Matthias Briel
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Jason W Busse
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Shanil Ebrahim
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Palo Alto, California, USA
| | - Carlos E Granados
- Área de investigaciones, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
| | - Alfonso Iorio
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Affan Irfan
- Department of Cardiology, University of Louisville, Louisville, Kentucky, USA
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Reem A Mustafa
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Departments of Medicine, Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Anggie Ramírez-Morera
- Health Care Development Division, IHCAI Foundation & Central America Cochrane, San José, Costa Rica
| | - Anna Selva
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Kari A O Tikkinen
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Departments of Urology and Public Health, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Per O Vandvik
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | - Robin W M Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Oscar E Zazueta
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Qi Zhou
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| |
Collapse
|
23
|
Abbas G, Hassan A, Irfan A, Mir M, Mariya-al-Rashida, Wu G. A new pentacoordinate polymeric copper(II) complex with 2-amino-2-methyl-1,3-propandiol: Structural investigations using XRD and DFT. J STRUCT CHEM+ 2015. [DOI: 10.1134/s0022476615010138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
24
|
Irfan A, Twerenbold R, Wildi K, Maria RG, Jaeger C, Freese M, Reichlin T, Mueller C. ASSOCIATION OF ALBUMIN AND HIGH SENSITIVE CARDIAC TROPONIN T AND I LEVELS AMONG CHEST PAIN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
G. Al-Sehemi A, Irfan A, M. Asiri A, A. Ammar Y. Synthesis, characterization and density functional theory study of low cost hydrazone sensitizers. B CHEM SOC ETHIOPIA 2015. [DOI: 10.4314/bcse.v29i1.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
26
|
Cho JH, Kutti Sridharan G, Kim SH, Kaw R, Abburi T, Irfan A, Kocheril AG. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis. BMC Cardiovasc Disord 2014; 14:64. [PMID: 24884693 PMCID: PMC4029836 DOI: 10.1186/1471-2261-14-64] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated whether right ventricular dysfunction (RVD) as assessed by echocardiogram can be used as a prognostic factor in hemodynamically stable patients with acute pulmonary embolism (PE). Short-term mortality has been investigated only in small studies and the results have been controversial. METHODS A PubMed search was conducted using two keywords, "pulmonary embolism" and "echocardiogram", for articles published between January 1st 1998 and December 31st 2011. Out of 991 articles, after careful review, we found 12 articles that investigated the implications of RVD as assessed by echocardiogram in predicting short-term mortality for hemodynamically stable patients with acute PE. We conducted a meta-analysis of these data to identify whether the presence of RVD increased short-term mortality. RESULTS Among 3283 hemodynamically stable patients with acute PE, 1223 patients (37.3%) had RVD, as assessed by echocardiogram, while 2060 patients (62.7%) had normal right ventricular function. Short-term mortality was reported in 167 (13.7%) out of 1223 patients with RVD and in 134 (6.5%) out of 2060 patients without RVD. Hemodynamically stable patients with acute PE who had RVD as assessed by echocardiogram had a 2.29-fold increase in short-term mortality (odds ratio 2.29, 95% confidence interval 1.61-3.26) compared with patients without RVD. CONCLUSIONS In hemodynamically stable patients with acute PE, RVD as assessed by echocardiogram increases short-term mortality by 2.29 times. Consideration should be given to obtaining echocardiogram to identify high-risk patients even if they are hemodynamically stable.
Collapse
Affiliation(s)
- Jae Hyung Cho
- Department of Hospital Medicine, Cleveland Clinic, OH, 9500 Euclid Avenue, M2-Annex, Cleveland, OH 44195, USA.
| | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Irfan A. Influence of the substitution on the electronic properties of perylene-3,4:9,10- bis(dicarboximides): density functional theory study. B CHEM SOC ETHIOPIA 2014. [DOI: 10.4314/bcse.v28i1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
29
|
G. Al-Sehemi A, Saied A. A. Al-Amri R, Irfan A. Synthesis, characterization and density functional theory investigations of monoacyl aniline derivatives. B CHEM SOC ETHIOPIA 2014. [DOI: 10.4314/bcse.v28i1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
30
|
Alonso-Coello P, Carrasco-Labra A, Brignardello-Petersen R, Neumann I, Akl EA, Sun X, Johnston BC, Briel M, Busse JW, Glujovsky D, Granados CE, Iorio A, Irfan A, Martínez García L, Mustafa RA, Ramirez-Morera A, Solà I, Tikkinen KAO, Ebrahim S, Vandvik PO, Zhang Y, Selva A, Sanabria AJ, Zazueta OE, Vernooij RWM, Schünemann HJ, Guyatt GH, Guyatt GH. A methodological survey of the analysis, reporting and interpretation of Absolute Risk ReductiOn in systematic revieWs (ARROW): a study protocol. Syst Rev 2013; 2:113. [PMID: 24330779 PMCID: PMC3867670 DOI: 10.1186/2046-4053-2-113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinicians, providers and guideline panels use absolute effects to weigh the advantages and downsides of treatment alternatives. Relative measures have the potential to mislead readers. However, little is known about the reporting of absolute measures in systematic reviews. The objectives of our study are to determine the proportion of systematic reviews that report absolute measures of effect for the most important outcomes, and ascertain how they are analyzed, reported and interpreted. METHODS/DESIGN We will conduct a methodological survey of systematic reviews published in 2010. We will conduct a 1:1 stratified random sampling of Cochrane vs. non-Cochrane systematic reviews. We will calculate the proportion of systematic reviews reporting at least one absolute estimate of effect for the most patient-important outcome for the comparison of interest. We will conduct multivariable logistic regression analyses with the reporting of an absolute estimate of effect as the dependent variable and pre-specified study characteristics as the independent variables. For systematic reviews reporting an absolute estimate of effect, we will document the methods used for the analysis, reporting and interpretation of the absolute estimate. DISCUSSION Our methodological survey will inform current practices regarding reporting of absolute estimates in systematic reviews. Our findings may influence recommendations on reporting, conduct and interpretation of absolute estimates. Our results are likely to be of interest to systematic review authors, funding agencies, clinicians, guideline developers and journal editors.
Collapse
Affiliation(s)
- Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Irfan A, Reichlin T, Twerenbold R, Meister M, Moehring B, Wildi K, Bassetti S, Zellweger C, Gimenez MR, Hoeller R, Murray K, Sou SM, Mueller M, Mosimann T, Reiter M, Haaf P, Ziller R, Freidank H, Osswald S, Mueller C. Early diagnosis of myocardial infarction using absolute and relative changes in cardiac troponin concentrations. Am J Med 2013; 126:781-788.e2. [PMID: 23870791 DOI: 10.1016/j.amjmed.2013.02.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 01/15/2013] [Revised: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Absolute changes in high-sensitivity cardiac troponin T (hs-cTnT) seem to have higher diagnostic accuracy in the early diagnosis of acute myocardial infarction compared with relative changes. It is unknown whether the same applies to high-sensitivity cardiac troponin I (hs-cTnI) assays and whether the combination of absolute and relative change might further increase accuracy. METHODS In a prospective, international multicenter study, high-sensitivity cardiac troponin (hs-cTn) was measured with 3 novel assays (hs-cTnT, Roche Diagnostics Corp, Indianapolis, Ind; hs-cTnI, Beckman Coulter Inc, Brea, Calif; hs-cTnI, Siemens, Munich, Germany) in a blinded fashion at presentation and after 1 and 2 hours in a blinded fashion in 830 unselected patients with suspected acute myocardial infarction. The final diagnosis was adjudicated by 2 independent cardiologists. RESULTS The area under the receiver operating characteristic curve for diagnosing acute myocardial infarction was significantly higher for 1- and 2-hour absolute versus relative hs-cTn changes for all 3 assays (P < .001). The area under the receiver operating characteristic curve of the combination of 2-hour absolute and relative change (hs-cTnT 0.98 [95% confidence interval {CI}, 0.97-0.99]; hs-cTnI, Beckman Coulter Inc, 0.97 [95% CI, 0.96-0.99]; hs-cTnI, Siemens, 0.96 [95% CI, 0.93-0.99]) were high and provided some benefit compared with the use of absolute change alone for hs-cTnT, but not for the hs-cTnI assays. Reclassification analysis confirmed the superiority of absolute changes versus relative changes. CONCLUSIONS Absolute changes seem to be the preferred metrics for both hs-cTnT and hs-cTnI in the early diagnosis of acute myocardial infarction. The combination of absolute and relative changes provides a small added value for hs-cTnT, but not for hs-cTnI.
Collapse
Affiliation(s)
- Affan Irfan
- Department of Cardiology, University Hospital Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Irfan A, Reichlin T, Twerenbold R, Wildi K, Mueller C. COMBINATION OF ABSOLUTE AND RELATIVE CHANGES IN CARDIAC TROPONIN CONCENTRATIONS IN THE EARLY DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60233-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Irfan A, Reichlin T, Twerenbold R, Wildi K, Mueller C. DETERMINANTS OF EARLY CHANGES IN HIGH-SENSITIVE TROPONIN LEVELS AMONG PATIENTS WITH NON-ACUTE MYOCARDIAL INFARCTION CAUSE OF CHEST PAIN. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60232-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Irfan A, Reichlin T, Twerenbold R, Wildi K, Mueller C. THE PROGNOSTIC VALUE OF ABSOLUTE AND RELATIVE CHANGES IN CARDIAC TROPONIN CONCENTRATIONS AMONG NON-ACUTE MYOCARDIAL INFARCTION PATIENTS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60236-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Irfan A, Reichlin T, Twerenbold R, Wildi K, Mueller C. HEMODYNAMIC CARDIAC STRESS INDUCED MYOCARDIAL ISCHEMIA AS DETECTED BY THE RELEASE OF CARDIAC BIOMARKERS: CARDIAC TROPONIN T AND I, CK-MB AND MYOGLOBIN. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
36
|
Irfan A, Hublikar S, Cho JH, Hill J. The value of history and goals of care with code status; even in an emergency setting. Case Reports 2013; 2013:bcr-2012-006962. [DOI: 10.1136/bcr-2012-006962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
37
|
Haaf P, Twerenbold R, Reichlin T, Faoro J, Reiter M, Meune C, Steuer S, Bassetti S, Ziller R, Balmelli C, Campodarve I, Zellweger C, Kilchenmann A, Irfan A, Papassotiriou J, Drexler B, Mueller C. Mid-regional pro-adrenomedullin in the early evaluation of acute chest pain patients. Int J Cardiol 2012. [PMID: 23199555 DOI: 10.1016/j.ijcard.2012.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the utility of mid-regional pro-adrenomedullin (MR-proADM) in the early diagnosis and risk stratification of patients with acute chest pain in comparison with established and novel biomarkers and risk scores. METHODS In this prospective, observational, international, multi-center trial (APACE), MR-proADM was determined in 1179 unselected patients with acute chest pain. Patients were followed for 24 months. RESULTS MR-proADM concentrations at presentation were higher in patients with AMI (median: 0.78 nmol/l, IQR 0.60-1.13) than in patients with other diagnoses (0.64 nmol/l, IQR 0.49-0.86 nmol/l; p<0.001). The diagnostic accuracy of MR-proADM for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.66. Adding MR-proADM to hs-cTnT could not improve its diagnostic accuracy for AMI (p=0.431). Seventy-six percent of all deaths occurred in the fourth quartile of MR-proADM (>0.90 nmol/l). Adding MR-proADM to the TIMI-score (AUC 0.87) predicted 1-year mortality more accurately than the TIMI-score alone (AUC 0.82; p<0.001). Net reclassification improvement (TIMI vs. additionally MR-proADM) amounted to 0.137 (p=0.012). MR-proADM had higher prognostic accuracy as compared to hs-cTnT in patients with AMI (p=0.015) and in those without AMI (p=0.003). MR-proADM at presentation was tantamount to GRACE score and BNP as to its prognostic accuracy for mortality. The AUC for the prediction of cardiovascular events amounted to 0.63. CONCLUSIONS While MR-proADM does not have clinical utility in the early diagnosis of AMI or predicting cardiovascular events in patients with acute chest pain, it may provide prognostic value for all-cause mortality.
Collapse
Affiliation(s)
- Philip Haaf
- Department of Internal Medicine, Division of Cardiology, University Hospital, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Breidthardt T, Irfan A, Klima T, Drexler B, Balmelli C, Arenja N, Socrates T, Ringger R, Heinisch C, Ziller R, Schifferli J, Meune C, Mueller C. Pathophysiology of lower extremity edema in acute heart failure revisited. Am J Med 2012; 125:1124.e1-1124.e8. [PMID: 22921885 DOI: 10.1016/j.amjmed.2011.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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] [Received: 10/07/2011] [Revised: 12/21/2011] [Accepted: 12/21/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pathophysiology and key determinants of lower extremity edema in patients with acute heart failure are poorly investigated. METHODS We prospectively enrolled 279 unselected patients presenting to the Emergency Department with acute heart failure. Lower extremity edema was quantified at predefined locations. Left ventricular ejection fraction, central venous pressure quantifying right ventricular failure, biomarkers to quantify hemodynamic cardiac stress (B-type natriuretic peptide), and the activity of the arginine-vasopressin system (copeptin) also were recorded. RESULTS Lower extremity edema was present in 218 (78%) patients and limited to the ankle in 22%, reaching the lower leg in 40%, reaching the upper leg in 11%, and was generalized (anasarca) in 3% of patients. Patients in the 4 strata according to the presence and extent of lower leg edema had comparable systolic blood pressure, left ventricular ejection fraction, central venous pressure, and B-type natriuretic peptide levels, as well as copeptin and glomerular filtration rate (P=NS for all). The duration of dyspnea preceding the presentation was longer in patients with more extensive edema (P=.006), while serum sodium (P=.02) and serum albumin (P=.03) was lower. CONCLUSION Central venous pressure, hemodynamic cardiac stress, left ventricular ejection fraction, and the activity of the arginine-vasopressin system do not seem to be key determinants of the presence or extent of lower extremity edema in acute heart failure.
Collapse
Affiliation(s)
- Tobias Breidthardt
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Irfan A, Twerenbold R, Reiter M, Reichlin T, Stelzig C, Freese M, Haaf P, Hochholzer W, Steuer S, Bassetti S, Zellweger C, Freidank H, Peter F, Campodarve I, Meune C, Mueller C. Determinants of high-sensitivity troponin T among patients with a noncardiac cause of chest pain. Am J Med 2012; 125:491-498.e1. [PMID: 22482847 DOI: 10.1016/j.amjmed.2011.10.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [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] [Received: 05/19/2011] [Revised: 10/23/2011] [Accepted: 10/24/2011] [Indexed: 01/20/2023]
Abstract
BACKGROUND It is unknown to what extent noncardiac causes, including renal dysfunction, may contribute to high-sensitivity cardiac troponin T levels. METHODS In an observational international multicenter study, we enrolled consecutive patients presenting with acute chest pain to the emergency department. Of 1181 patients enrolled, 572 were adjudicated by 2 independent cardiologists to have a noncardiac cause of chest pain. Multiple linear regression analyses were used to determine the important predictors of log-transformed high-sensitivity cardiac troponin T. Kaplan-Meier curve was used to assess the prognostic significance of high-sensitivity cardiac troponin T>0.014 μg/L (99th percentile). RESULTS A total of 88 patients (15%) had high-sensitivity cardiac troponin T>0.014 μg/L. Less than 50% of cardiac troponins could be explained by known cardiac or noncardiac diseases. In decreasing order of importance, age, estimated glomerular filtration rate, hypertension, previous myocardial infarction, and chronic kidney disease (adjusted r(2) 0.44) emerged as significant factors in linear regression analysis to predict high-sensitivity cardiac troponin T. High-sensitivity cardiac troponin T was best explained by a linear curve with age as ≤0.014 μg/L. Patients with high-sensitivity cardiac troponin T levels>0.014 μg/L were at increased risk for all-cause mortality (hazard ratio 3.0; 95% confidence interval, 0.8-10.6; P=.02) during follow-up. CONCLUSION Among the known covariates, age and not renal dysfunction is the most important determinant of high-sensitivity cardiac troponin T. Because known cardiac and noncardiac factors, including renal dysfunction, explain less than 50% of high-sensitivity cardiac troponin T levels among patients with a noncardiac cause of chest pain, unknown or underestimated cardiac involvement during the acute presenting condition seems to be the major cause of elevated high-sensitivity cardiac troponin T.
Collapse
Affiliation(s)
- Affan Irfan
- Department of Internal Medicine, University Hospital Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Meune C, Reichlin T, Irfan A, Schaub N, Twerenbold R, Meissner J, Reiter M, Lüthi A, Haaf P, Balmelli C, Drexler B, Winkler K, Hochholzer W, Osswald S, Mueller C. How Safe Is the Outpatient Management of Patients with Acute Chest Pain and Mildly Increased Cardiac Troponin Concentrations? Clin Chem 2012; 58:916-24. [DOI: 10.1373/clinchem.2011.178053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The appropriate management of patients discharged from the emergency department (ED) with increased high-sensitivity cardiac troponin T (hs-cTnT) but normal or borderline-high conventional cardiac troponin concentrations is unknown.
METHODS
We investigated 643 consecutive ED patients with acute chest pain who had been discharged for outpatient management after acute myocardial infarction (AMI) had been ruled out by serial measurements of conventional cardiac troponin. hs-cTnT was measured blindly, and we calculated the rates of all-cause mortality (primary endpoint) and subsequent AMI (secondary endpoint) at 30, 90, and 360 days.
RESULTS
hs-cTnT concentrations were increased (>14 ng/L) in 114 patients (18%) but <30 ng/L in 95% of these patients. Of those 114 patients, 96 (84%) had an adjudicated noncoronary cause of chest pain. Thirty-day mortality (95% CI) was 0.9% (0.1%–6.1%), 90-day mortality was 2.7% (0.9%–8.1%), and 360-day mortality was 5.2% (2.2%–11.9%) in patients with increased hs-cTnT; respective rates (95% CI) of AMI were 0.0%, 1.9% (0.5%–7.2%), and 7.6% (3.7%–15.3%). Increased hs-cTnT was associated with increased mortality and AMI at 90 days (P = 0.006 and P = 0.081, respectively) and 360 days (P = 0.001 for both).
CONCLUSIONS
hs-cTnT is a strong prognosticator of intermediate and long-term mortality and AMI in low-risk patients discharged from the ED after AMI has been ruled out. The relatively low rate of 30-day events may suggest that patients without acute coronary syndrome and small increases in cardiac troponin are in need of further investigations and treatments, but not necessarily immediate hospitalization.
Collapse
Affiliation(s)
- Christophe Meune
- Department of Internal Medicine, University Hospital, Basel, Switzerland
- Paris Descartes University, Cardiology department, Cochin Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Tobias Reichlin
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Affan Irfan
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | - Nora Schaub
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | - Raphael Twerenbold
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | - Julia Meissner
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | - Miriam Reiter
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | - Adrian Lüthi
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | - Philip Haaf
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | - Cathrin Balmelli
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | - Beatrice Drexler
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | - Katrin Winkler
- Servicio de Pneumologia, Hospital del Mar–Institut Municipal d'Investigació Mèdica (IMIM), Universitat Pompeu Fabra, Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Barcelona, Spain
- Servicio de Urgencias, Hospital del Mar–IMIM, Barcelona, Spain
| | - Willibald Hochholzer
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Christian Mueller
- Department of Internal Medicine, University Hospital, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
41
|
Meune C, Twerenbold R, Drexler B, Balmelli C, Wolf C, Haaf P, Reichlin T, Irfan A, Reiter M, Zellweger C, Meissner J, Stelzig C, Freese M, Capodarve I, Mueller C. Midregional pro-A-type natriuretic peptide for diagnosis and prognosis in patients with suspected acute myocardial infarction. Am J Cardiol 2012; 109:1117-23. [PMID: 22257708 DOI: 10.1016/j.amjcard.2011.11.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 11/30/2011] [Accepted: 11/30/2011] [Indexed: 11/20/2022]
Abstract
We hypothesized that midregional pro-A-type natriuretic peptide (MR-proANP), the stable midregional epitope of proANP, might be useful in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction (AMI). In this multicenter study we measured MR-proANP, cardiac troponin T (cTnT), and high-sensitive cTnT (hs-cTnT) at presentation in 675 consecutive patients presenting to the emergency department with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed 360 days for mortality and AMI. AMI was the final diagnosis in 119 patients (18%). Median MR-proANP levels at presentation were significantly higher in patients with AMI (189 pmol/L, interquartile range 97 to 341) versus patients with another final diagnosis (83 pmol/L, 49 to 144, p <0.001). However, neither the combination of MR-proANP with cTnT nor its combination with hs-cTnT significantly improved diagnostic accuracy as quantified by area under the receiver operating characteristic curve (0.91 vs 0.89 for cTnT alone, p = 0.086; 0.95 vs 0.96 for hs-cTnT, respectively, p = 0.02). Cumulative 360-day mortality/AMI rates were 2.4% in the first, 3.6% in the second, 9.5% in the third, and 18.8% in the fourth quartiles of MR-proANP (p <0.001). MR-proANP (area under the curve 0.76) predicted mortality/AMI independently of and more accurately than cTnT (area under the curve 0.62), hs-cTnT (area under the curve 0.71), and Thrombolysis In Myocardial Infarction risk score (area under the curve 0.72). Net reclassification improvements offered by the additional use of MR-proANP were 0.388 (p <0.001), 0.425 (p <0.001), and 0.217 (p = 0.007), respectively. In conclusion, MR-proANP improves risk prediction for 360-day mortality/AMI but does not seem to help in the early diagnosis of AMI.
Collapse
Affiliation(s)
- Christophe Meune
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Meune C, Balmelli C, Marxer T, Meissner J, Twerenbold R, Reiter M, Reichlin T, Haaf P, Drexler B, Irfan A, Stelzig C, Freese M, Winkler K, Mueller C. High-sensitive Troponin, B-type natriuretic peptide and coronary angiogram findings in patients with non ST-segment elevation acute coronary syndrome. Int J Cardiol 2011; 153:335-7. [DOI: 10.1016/j.ijcard.2011.09.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 09/17/2011] [Indexed: 12/01/2022]
|
43
|
Meune C, Balmelli C, Twerenbold R, Reichlin T, Reiter M, Haaf P, Steuer S, Bassetti S, Sakarikos K, Campodarve I, Zellweger C, Irfan A, Drexler B, Mueller C. Patients with acute coronary syndrome and normal high-sensitivity troponin. Am J Med 2011; 124:1151-7. [PMID: 22014790 DOI: 10.1016/j.amjmed.2011.07.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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] [Received: 05/21/2011] [Revised: 07/09/2011] [Accepted: 07/11/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Failure to identify patients with acute coronary syndrome (ACS) is a serious clinical problem. The incidence, characteristics, and outcome of ACS patients with normal high-sensitivity cardiac troponin T (hs-cTnT) levels at presentation are unknown. METHODS In a prospective multicenter study, hs-cTnT was determined in a blinded fashion in 1181 consecutive patients presenting with acute chest pain to the emergency department. The final diagnosis of ACS was adjudicated by 2 independent cardiologists. Patients were followed for 12 months. RESULTS ACS was the adjudicated diagnosis in 351 patients (30%), including 187 patients with acute myocardial infarction (AMI) and 164 patients with unstable angina (UA). At presentation, hs-cTnT was normal (<.014 ug/L) in 112 ACS patients (32%), including 11 patients (6%) with AMI and 101 patients (62%) with UA (P <.001). Multivariable analysis revealed previous statin treatment, younger age, preserved renal function, and the absence of ST deviation on the electrocardiogram as independently associated with normal hs-cTnT levels. Mortality rates in ACS patients with normal hs-cTnT level were 0.0% at 30 days, 0.0% at 90 days, and 2.0% (95% confidence interval, 0.5-7.9) at 360 days, which was significantly lower than in ACS patients with elevated hs-cTnT level at presentation (17.5% at 360 days, P <.001). Conversely, AMI rates at 360 days was higher in ACS patients with normal versus elevated hs-cTnT levels (P=.004). CONCLUSION Almost one third of ACS patients have normal hs-cTnT levels at presentation, mostly patients with UA. ACS patients with normal hs-cTnT have a very low mortality, but an increased rate of AMI during the subsequent 360 days.
Collapse
Affiliation(s)
- Christophe Meune
- Department of Internal Medicine, Division of Cardiology, University Hospital, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Hussnain SZ, Afghan S, Haq MI, Mughal SM, Shahazad A, Hussain K, Nawaz K, Pan YB, Jackson P, Batool A, Irfan A. First Report of Ratoon Stunt of Sugarcane Caused by Leifsonia xyli subsp. xyli in Pakistan. Plant Dis 2011; 95:1581. [PMID: 30731987 DOI: 10.1094/pdis-02-11-0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sugarcane (Saccharum hybrids), the second largest cash crop of Pakistan, is planted on 1.029 million ha with an annual production of 50 million tons. During a survey of the sugarcane crop in Faisalabad, Sargodha, and the Dera Ghazi Khan Division of the Punjab Province of Pakistan from 2007 to 2010, symptoms consistent with ratoon stunting, including stunted growth and reddening of the vascular bundles at the nodal regions (1), was observed on sugarcane cvs. CP77-400, SPF-241, CP72-2086, and NCo-310. CP72-2086 and NCo-310 showed severely stunted growth in both crop cycles. A chemical test was performed for detecting ratoon stunt from the field. Longitudinal sections of mature nodes were treated with a combination of hydrogen peroxide and hydrochloric acid. Healthy canes developed a blue-green color in the parenchymatous tissue around the fibrovascular bundles, diseased cane did not. This field test illustrated that as much as 25% of the plants were infected by ratoon stunt in the survey area. Aerobic bacteria were isolated from a stunted sample (NCo-310) on modified sugarcane medium (17 g of cornmeal agar, 8 g of peptone from soy meal, 1 g of K2HPO4, 1 g of KH2PO4, 0.2 g of MgSO4·7H2O, 0.5 g of glucose, 1 g of cysteinefree base, 2 g of bovine serum albumin, and 15 mg of bovine hemin chloride) and incubated for 3 to 4 weeks at 28°C. Light, off-white, round, and raised growth bacterial colonies (1.5 to 4.5 × 0.2 to 0.35 μm). Isolates were positive for the gram and catalase reactions and negative for oxidase, aesculin hydrolysis, urease production, and motility. The pathogen was identified as Leifsonia xyli subsp. xyli (formerly Clavibacter xyli subsp. xyli) based on its morphological characteristics (2). A direct antigen coating-ELISA was developed with antiserum raised against L. xyli subsp. xyli at the National Institute for Biotechnology and Genetic Engineering, Faisalabad, Pakistan. Infected or suspected to be infected plants of different cultivars were used for an ELISA test. Results showed that sugarcane cvs. NCo-310 (Log 1.342 CFU/ml) and CP72-2086 (Log 0.118 CFU/ml) had higher L. xyli subsp. xyli titres than the other cultivars tested (SPF-213 [Log 0.071CFU/ml], CPF-237 [Log 0.077CFU/ml], HSF-240 [Log 0.069 CFU/ml], NSG-555 [Log 0.060 CFU/ml], SPSG-26 [Log 0.076 CFU/ml], SPSG-79 [Log 0.074 CFU/ml], SPF-238 [Log 0.057 CFU/ml], and CP77-400 [Log 0.063 CFU/ml]). Cv. SPF-241 (Log 0.107 CFU/ml) was weakly positive for ratoon stunt (4). Axillary buds of sugarcane were injected via a sterile hypodermic syringe with an 18-gauge needle to deliver a bacterial suspension of 109 cells/ml (3). Inoculated sugarcane plants were examined at intervals over 9 months for the development of symptoms and the presence of bacteria. Cultivars were evaluated on the basis of average number of colonized vascular bundles. SPF-213, CPF-237, HSF-240, NSG-555, SPSG-26, SPSG-79, SPF-238, and CP77-400 were resistant; SPF-241 showed moderate resistance and CP72-2086 and NCo-310 were highly susceptible to ratoon stunt. The pathogen was reisolated from the inoculated plants and identified as L. xyli subsp. xyli by bacteriological tests and its serological reaction. To our knowledge, this is the first report of ratoon stunt of sugarcane in Punjab Province of Pakistan. References: (1) M. J. Davis et al. Science 210:1365, 1980. (2) L. I. Evtushenko et al. Int. J. Syst. Evol. Microbiol. 50:371, 2000. (3) M. P. Nayiager et al. Phytopathol. Z. 99:273, 1980. (4) G.-P. Rao and G.-P. Singh. Sugar Tech. 2:35, 2000.
Collapse
Affiliation(s)
- S-Z Hussnain
- Shakarganj Sugar Research Institute, Toba Road, Jhang, Pakistan
| | - S Afghan
- Shakarganj Sugar Research Institute, Toba Road, Jhang, Pakistan
| | - M-I Haq
- PMAS Arid Agriculture University, Department of Plant Pathology, Murree Road, Rawalpindi, Pakistan
| | - S-M Mughal
- PMAS Arid Agriculture University, Department of Plant Pathology, Murree Road, Rawalpindi, Pakistan
| | - A Shahazad
- Shakarganj Sugar Research Institute, Toba Road, Jhang, Pakistan
| | - K Hussain
- University of Gujrat, Department of Botany, Gujrat, Pakistan
| | - K Nawaz
- University of Gujrat, Department of Botany, Gujrat, Pakistan
| | - Y-B Pan
- USDA-ARS, MSA, SRU, Research Plant Molecular Geneticist, Houma, LA
| | - P Jackson
- CSIRO Davis Laboratory, Private Mail Bag PO Aitkenvale, 4814 Australia
| | - A Batool
- Shakarganj Sugar Research Institute, Toba Road, Jhang, Pakistan
| | - A Irfan
- PMAS Arid Agriculture University, Department of Plant Pathology, Murree Road Rawalpindi, Pakistan
| |
Collapse
|
45
|
Irfan A, Haaf P, Meissner J, Twerenbold R, Reiter M, Reichlin T, Schaub N, Zbinden A, Heinisch C, Drexler B, Winkler K, Mueller C. Systolic blood pressure at Emergency Department presentation and 1-year mortality in acute chest pain patients. Eur J Intern Med 2011; 22:495-500. [PMID: 21925059 DOI: 10.1016/j.ejim.2011.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 06/09/2011] [Accepted: 06/10/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND High blood pressure at rest has been an established risk factor for cardiovascular disease. However the relationship between Systolic Blood Pressure (SBP) and 1-year-mortality among acute chest pain patients presenting to Emergency Department (ED); and effects of preexisting renal insufficiency, hemodynamic stress - as quantified by Brain Natriuretic Peptide (BNP) and chest pain duration, on this relationship is unknown. METHODS Data was used from APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation), a prospective observational multicenter study of 1240 ED chest pain patients. SBP at presentation was categorized into quartiles: Q1≤127mmHg; Q2 128-142mmHg; Q3 143-160mmHg; Q4≥161mmHg. RESULTS 60 deaths occurred during 1-year. One-year-mortality-rate showed lower Hazard Ratios for Q2, Q3 and Q4 vs Q1 (HR [95% CI]; 0.39 (0.19-0.78), 0.34 (0.17-0.70), 0.35 (0.17-0.72); p<0.01 respectively). Cox model adjusted for various demographic and treatment variables showed that participants in Q3 and Q4 had better prognoses than Q1. Patients showed progressively better prognosis from Q2 through Q4 vs Q1 only in patients who presented to ED with for more than 12h of chest pain duration. Patients with renal insufficiency had lower SBP at presentation than others (p=0.001). There was no association between the outcome and interaction variable of SBP quartiles and BNP (p=0.27). CONCLUSION Acute chest pain patients presenting to ED exhibit an inverse association between SBP at presentation and 1-year-mortality; a relationship which appears stronger in those who present with chest pain of greater than 12h duration.
Collapse
Affiliation(s)
- Affan Irfan
- Department of Internal Medicine, University Hospital, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Irfan A, Zellweger MJ, Mueller C. "Universal definition" methodology and conclusions are a concern. J Am Coll Cardiol 2011; 58:313-4; author reply 314-5. [PMID: 21737029 DOI: 10.1016/j.jacc.2011.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 03/08/2011] [Indexed: 11/28/2022]
|
47
|
Reichlin T, Irfan A, Twerenbold R, Reiter M, Hochholzer W, Burkhalter H, Bassetti S, Steuer S, Winkler K, Peter F, Meissner J, Haaf P, Potocki M, Drexler B, Osswald S, Mueller C. Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Circulation 2011; 124:136-45. [PMID: 21709058 DOI: 10.1161/circulationaha.111.023937] [Citation(s) in RCA: 333] [Impact Index Per Article: 25.6] [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: 12/20/2022]
Abstract
BACKGROUND Current guidelines for the diagnosis of acute myocardial infarction (AMI), among other criteria, also require a rise and/or fall in cardiac troponin (cTn) levels. It is unknown whether absolute or relative changes in cTn have higher diagnostic accuracy and should therefore be preferred. METHODS AND RESULTS In a prospective, observational, multicenter study, we analyzed the diagnostic accuracy of absolute (Δ) and relative (Δ%) changes in cTn in 836 patients presenting to the emergency department with symptoms suggestive of AMI. Blood samples for the determination of high-sensitive cTn T and cTn I ultra were collected at presentation and after 1 and 2 hours in a blinded fashion. The final diagnosis was adjudicated by 2 independent cardiologists. The area under the receiver operating characteristic curve for diagnosing AMI was significantly higher for 2-hour absolute (Δ) versus 2-hour relative (Δ%) cTn changes (area under the receiver operating characteristic curve [95% confidence interval], high-sensitivity cTn T: 0.95 [0.92 to 0.98] versus 0.76 [0.70 to 0.83], P<0.001; cTn I ultra: 0.95 [0.91 to 0.99] versus 0.72 [0.66 to 0.79], P<0.001). The receiver operating characteristic curve-derived cutoff value for 2-hour absolute (Δ) change was 0.007 μg/L for high-sensitivity cTn T and 0.020 μg/L for cTn I ultra (both cutoff levels are half of the 99th percentile of the respective cTn assay). Absolute changes were superior to relative changes in patients with both low and elevated baseline cTn levels. CONCLUSIONS Absolute changes of cTn levels have a significantly higher diagnostic accuracy for AMI than relative changes, and seem therefore to be the preferred criteria to distinguish AMI from other causes of cTn elevations. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER: NCT00470587.
Collapse
Affiliation(s)
- Tobias Reichlin
- From the Departments of Cardiology, Kantonsspital Olten, Olten, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Meissner J, Irfan A, Twerenbold R, Mueller S, Reiter M, Haaf P, Reichlin T, Schaub N, Winkler K, Pfister O, Heinisch C, Mueller C. Use of neutrophil count in early diagnosis and risk stratification of AMI. Am J Med 2011; 124:534-42. [PMID: 21507368 DOI: 10.1016/j.amjmed.2010.10.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [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] [Received: 07/21/2010] [Revised: 10/05/2010] [Accepted: 10/07/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neutrophils are rapidly released into the circulation upon acute stress such as trauma or acute myocardial infarction (AMI). We hypothesized that neutrophil count might provide incremental value in the early diagnosis and risk stratification of AMI. METHODS We conducted a prospective observational multicenter study to examine the diagnostic accuracy of the combination of neutrophil count and cardiac troponin T from 1125 consecutive patients who presented to the Emergency Department with symptoms suggestive of acute myocardial infarction. The final diagnosis was adjudicated by 2 independent cardiologists. RESULTS Neutrophil count was higher in patients with acute myocardial infarction compared with other diagnoses (median 6.7 vs. 5.0×10(9)/L, respectively, P <.001). The accuracy of the neutrophil count for diagnosing acute myocardial infarction, quantified by the area under the receiver operating characteristic curve (AUC) was 0.69, which was significantly lower than that of cardiac troponin T (AUC 0.89, P <.001). The combination of the neutrophil count and cardiac troponin T did not improve the early diagnosis of acute myocardial infarction versus cardiac troponin T alone (P=.79). The prognostic accuracy of neutrophil count for death and AMI was significantly lower than that of cardiac troponin T. However, patients in the highest tertile of neutrophil count had a significantly increased risk of death and AMI at 90 and 360 days compared with patients in the lowest tertile (hazard ratios 2.47 [95% confidence interval, 1.63-3.72] and 2.28 [95% confidence interval, 1.55-3.36], respectively). CONCLUSION The neutrophil count does not improve the early diagnosis of AMI in patients presenting with chest pain but identifies patients at increased risk of death.
Collapse
Affiliation(s)
- Julia Meissner
- Department of Internal Medicine, University Hospital Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Alonso-Coello P, Irfan A, Solà I, Gich I, Delgado-Noguera M, Rigau D, Tort S, Bonfill X, Burgers J, Schunemann H. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care 2011; 19:e58. [PMID: 21127089 DOI: 10.1136/qshc.2010.042077] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite the increasing number of manuals on how to develop clinical practice guidelines (CPGs) there remain concerns about their quality. The aim of this study was to review the quality of CPGs across a wide range of healthcare topics published since 1980. METHODS The authors conducted a literature search in MEDLINE to identify publications assessing the quality of CPGs with the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument. For the included guidelines in each study, the authors gathered data about the year of publication, institution, country, healthcare topic, AGREE score per domain and overall assessment. RESULTS In total, 42 reviews were selected, including a total of 626 guidelines, published between 1980 and 2007, with a median of 25 CPGs. The mean scores were acceptable for the domain 'Scope and purpose' (64%; 95% CI 61.9 to 66.4) and 'Clarity and presentation' (60%; 95% CI 57.9 to 61.9), moderate for domain 'Rigour of development' (43%; 95% CI 41.0 to 45.2), and low for the other domains ('Stakeholder involvement' 35%; 95% CI 33.9 to 37.5, 'Editorial independence' 30%; 95% CI 27.9 to 32.3, and 'Applicability' 22%; 95% CI 20.4 to 23.9). From those guidelines that included an overall assessment, 62% (168/270) were recommended or recommended with provisos. There was a significant improvement over time for all domains, except for 'Editorial independence.' CONCLUSIONS This review shows that despite some increase in quality of CPGs over time, the quality scores as measured with the AGREE Instrument have remained moderate to low over the last two decades. This finding urges guideline developers to continue improving the quality of their products. International collaboration could help increasing the efficiency of the process.
Collapse
Affiliation(s)
- Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department, Institute of Biomedical Research IIB Sant Pau, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Bajaj RR, Mohammad A, Hong T, Irfan A, Sharieff W, Bagnall A, Christie JA, Kutryk MJB, Chisholm RJ, Cheema AN. Comparison of abciximab and eptifibatide on angiographic and clinical outcomes in rescue percutaneous coronary intervention for failed fibrinolytic therapy. J Invasive Cardiol 2010; 22:347-352. [PMID: 20679668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Adjunctive administration of the glycoprotein IIb/IIIa platelet receptor antagonist (GPA), abciximab, improves outcomes in patients undergoing rescue percutaneous coronary intervention (PCI). However, it is unknown if other GPAs provide a similar benefit in this setting. OBJECTIVE We sought to compare angiographic and clinical outcomes of patients receiving abciximab or eptifibatide as an adjunct to rescue PCI. METHODS In this prospective, nonrandomized study, consecutive patients who underwent rescue PCI and received adjunctive preprocedural GPA comprised the study population. Thrombolysis in myocardial infarction (TIMI) flow, corrected TIMI frame count (CTFC) and myocardial blush grade (MBG) were determined before and immediately after rescue PCI. Residual ST-segment elevation at 90-120 minutes and peak creatine kinase (CK) values for 48 hours after PCI were recorded. Major adverse cardiac events (MACE) including death, reinfarction and target vessel revascularization (TVR) were determined at discharge, 1 and 6 months. RESULTS A total of 241 patients were included in the study. 162 patients received abciximab and 79 received eptifibatide. There were no differences in baseline clinical and angiographic characteristics between groups. Post-PCI TIMI flow was similar but post-PCI CTFC was significantly lower (17 +/- 10 vs. 22 +/- 18; p = 0.01) and post-PCI MBG significantly higher (2.8 +/- 0.5 vs. 2.6 +/- 0.6; p = 0.01) in the abciximab group. Patients in the abciximab group had less ST-segment elevation (1.0 +/- 0.9 vs. 1.5 +/- 1.0 mm; p = 0.003) and lower peak CK (2,484 +/- 2,176 vs. 2,650 +/- 2,798 U/L; p = 0.001) after PCI. On multivariate analyses, abciximab administration (OR = 0.50, CI = 0.26, 0.96; p = 0.03), pre-PCI TIMI 3 flow (OR = 0.22, CI = 0.05, 0.99; p = 0.04) and female gender (OR = 0.24, CI = 0.08, 0.66; p = 0.006) were positive and cardiogenic shock (OR = 2.76, CI = 1.16, 6.58; p = 0.02) was a negative predictor of normal epicardial perfusion post PCI. Abciximab administration (OR = 0.46, CI = 0.24, 0.87; p = 0.02) and pre-PCI CTFC < 25 (OR = 0.09, CI = 0.02, 0.31, 0.0001) were positive predictors and cardiogenic shock (OR = 3.96, CI = 1.55, 10.12; p = 0.004) was a negative predictor of normal myocardial perfusion post-PCI as determined by CTFC. Abciximab administration (OR = 0.31, CI = 0.15, 0.63; p = 0.001) and pre-PCI MBG 3 (OR = 0.07, CI = 0.02, 0.23; p < 0.0001) were positive predictors of normal myocardial perfusion post-PCI as determined by MBG. In-hospital, 1- and 6-month clinical events and MACE rates did not differ between groups. CONCLUSIONS In the setting of rescue PCI, adjunctive administration of abciximab resulted in greater improvement in angiographic and electrical estimates of myocardial perfusion and smaller infarct size compared to eptifibatide. These findings suggest that all GPA may not provide equal benefit in rescue PCI.
Collapse
Affiliation(s)
- Ravi R Bajaj
- Terrence Donnelly Heart Center and the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|