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Sanchez-Ruiz JA, Leibman NI, Larson NB, Jenkins GD, Ahmed AT, Nunez NA, Biernacka JM, Winham SJ, Weinshilboum RM, Wang L, Frye MA, Ozerdem A. Age-Dependent Sex Differences in the Prevalence of Selective Serotonin Reuptake Inhibitor Treatment: A Retrospective Cohort Analysis. J Womens Health (Larchmt) 2023; 32:1229-1240. [PMID: 37856151 PMCID: PMC10621660 DOI: 10.1089/jwh.2022.0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Background: Antidepressants are among the most prescribed medications in the United States. The aim of this study was to explore the prevalence of antidepressant prescriptions and investigate sex differences and age-sex interactions in adults enrolled in the Right Drug, Right Dose, Right Time: Using Genomic Data to Individualize Treatment (RIGHT) study. Materials and Methods: We conducted a retrospective analysis of the RIGHT study. Using electronic prescriptions, we assessed 12-month prevalence of antidepressant treatment. Sex differences and age-sex interactions were evaluated using multivariable logistic regression and flexible recursive smoothing splines. Results: The sample consisted of 11,087 participants (60% women). Antidepressant prescription prevalence was 22.24% (27.96% women, 13.58% men). After adjusting for age and enrollment year, women had significantly greater odds of antidepressant prescription (odds ratio = 2.29; 95% confidence interval = 2.07, 2.54). Furthermore, selective serotonin reuptake inhibitors (SSRIs) had a significant age-sex interaction. While SSRI prescriptions in men showed a sustained decrease with age, there was no such decline for women until after reaching ∼50 years of age. There are important limitations to consider in this study. Electronic prescription data were cross-sectional; information on treatment duration or adherence was not collected; this cohort is not nationally representative; and enrollment occurred over a broad period, introducing confounding by changes in temporal prescribing practices. Conclusions: Underscored by the significant interaction between age and sex on odds of SSRI prescription, our results warrant age to be incorporated as a mediator when investigating sex differences in mental illness, especially mood disorders and their treatment.
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Affiliation(s)
| | - Nicole I. Leibman
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nicholas B. Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory D. Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed T. Ahmed
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Nicolas A. Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joanna M. Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Stacey J. Winham
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard M. Weinshilboum
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Liewei Wang
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A. Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Alzamil AZ, Alshehri FH, Alghamdi MA, Ahmed AT. Knowledge and practice of family medicine residents towards screening for gestational diabetes and undiagnosed diabetes mellitus in pregnancy in 1st and 2nd health clusters Riyadh Saudi Arabia. Medical Science 2022. [DOI: 10.54905/disssi/v26i122/ms154e2221] [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: 11/05/2022]
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Joseph B, Nandakumar AL, Ahmed AT, Gopal N, Murad MH, Frye MA, Tobin WO, Singh B. Prevalence of bipolar disorder in multiple sclerosis: a systematic review and meta-analysis. Evid Based Ment Health 2021; 24:88-94. [PMID: 33328183 PMCID: PMC10231514 DOI: 10.1136/ebmental-2020-300207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disabling, demyelinating disease of the central nervous system and is often associated with psychiatric comorbidities. Some studies suggest increased prevalence of bipolar disorder (BD) in MS. OBJECTIVE To conduct a systematic review and meta-analysis assessing the prevalence of BD in adults with MS. METHODS We registered this review with PROSPERO and searched electronic databases (Ovid MEDLINE, Central, Embase, PsycINFO and Scopus) for eligible studies from earliest inception to October 2020. Prevalence data of BD in adult patients with MS were extracted. Meta-analysis was conducted using random-effects model. FINDINGS Of the 802 articles that were screened, 23 studies enrolling a total of 68 796 patients were included in the systematic review and meta-analysis. The pooled prevalence rate of BD in patients with MS was 2.95% (95% CI 2.12% to 4.09%) with higher prevalence in the Americas versus Europe. The lifetime prevalence of BD was 8.4% in patients with MS. Subgroup analysis showed a higher prevalence of BD in MS in females (7.03%) than in males (5.64%), which did not reach statistical significance (p=0.53). CONCLUSIONS This meta-analysis suggests a high lifetime prevalence of BD in patients with MS. Patients with MS should be routinely screened for BD. Further assessment of bipolar comorbidity in MS through prospective studies may help in developing effective management strategies and may improve treatment outcomes in patients with MS.
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Affiliation(s)
- Boney Joseph
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ahmed T Ahmed
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Clinical and Translational Science Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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MahmoudianDehkordi S, Ahmed AT, Bhattacharyya S, Han X, Baillie RA, Arnold M, Skime MK, John-Williams LS, Moseley MA, Thompson JW, Louie G, Riva-Posse P, Craighead WE, McDonald W, Krishnan R, Rush AJ, Frye MA, Dunlop BW, Weinshilboum RM, Kaddurah-Daouk R. Alterations in acylcarnitines, amines, and lipids inform about the mechanism of action of citalopram/escitalopram in major depression. Transl Psychiatry 2021; 11:153. [PMID: 33654056 PMCID: PMC7925685 DOI: 10.1038/s41398-020-01097-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for major depressive disorder (MDD), yet their mechanisms of action are not fully understood and their therapeutic benefit varies among individuals. We used a targeted metabolomics approach utilizing a panel of 180 metabolites to gain insights into mechanisms of action and response to citalopram/escitalopram. Plasma samples from 136 participants with MDD enrolled into the Mayo Pharmacogenomics Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS) were profiled at baseline and after 8 weeks of treatment. After treatment, we saw increased levels of short-chain acylcarnitines and decreased levels of medium-chain and long-chain acylcarnitines, suggesting an SSRI effect on β-oxidation and mitochondrial function. Amines-including arginine, proline, and methionine sulfoxide-were upregulated while serotonin and sarcosine were downregulated, suggesting an SSRI effect on urea cycle, one-carbon metabolism, and serotonin uptake. Eighteen lipids within the phosphatidylcholine (PC aa and ae) classes were upregulated. Changes in several lipid and amine levels correlated with changes in 17-item Hamilton Rating Scale for Depression scores (HRSD17). Differences in metabolic profiles at baseline and post-treatment were noted between participants who remitted (HRSD17 ≤ 7) and those who gained no meaningful benefits (<30% reduction in HRSD17). Remitters exhibited (a) higher baseline levels of C3, C5, alpha-aminoadipic acid, sarcosine, and serotonin; and (b) higher week-8 levels of PC aa C34:1, PC aa C34:2, PC aa C36:2, and PC aa C36:4. These findings suggest that mitochondrial energetics-including acylcarnitine metabolism, transport, and its link to β-oxidation-and lipid membrane remodeling may play roles in SSRI treatment response.
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Affiliation(s)
- Siamak MahmoudianDehkordi
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC USA
| | - Ahmed T. Ahmed
- grid.66875.3a0000 0004 0459 167XDepartment of Neurology, Mayo Clinic, Rochester, MN USA
| | - Sudeepa Bhattacharyya
- grid.252381.f0000 0001 2169 5989Department of Biological Sciences and Arkansas Biosciences Institute, Arkansas State University, Jonesboro, AR USA
| | - Xianlin Han
- grid.267309.90000 0001 0629 5880University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | | | - Matthias Arnold
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC USA ,grid.4567.00000 0004 0483 2525Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Michelle K. Skime
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Lisa St. John-Williams
- grid.26009.3d0000 0004 1936 7961Proteomics and Metabolomics Shared Resource, Center for Genomic and Computational Biology, Duke University, Durham, NC 27710 USA
| | - M. Arthur Moseley
- grid.26009.3d0000 0004 1936 7961Proteomics and Metabolomics Shared Resource, Center for Genomic and Computational Biology, Duke University, Durham, NC 27710 USA
| | - J. Will Thompson
- grid.26009.3d0000 0004 1936 7961Proteomics and Metabolomics Shared Resource, Center for Genomic and Computational Biology, Duke University, Durham, NC 27710 USA
| | - Gregory Louie
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC USA
| | - Patricio Riva-Posse
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - W. Edward Craighead
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - William McDonald
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Ranga Krishnan
- grid.262743.60000000107058297Department of Psychiatry, Rush Medical College, Chicago, IL USA
| | - A. John Rush
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Professor Emeritus, Department of Pediatrics, Duke University School of Medicine, Durham, NC USA ,grid.416992.10000 0001 2179 3554Department of Psychiatry, Texas Tech University, Health Sciences Center, Permian Basin, TX USA
| | - Mark A. Frye
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Boadie W. Dunlop
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Richard M. Weinshilboum
- grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN USA
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC, USA. .,Department of Medicine, Duke University, Durham, NC, USA. .,Duke Institute of Brain Sciences, Duke University, Durham, NC, USA.
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Prutsky GJ, Padhya D, Ahmed AT, Almasri J, Farah WH, Prokop LJ, Murad MH, Alsawas M. Is Unplanned PICU Readmission a Proper Quality Indicator? A Systematic Review and Meta-analysis. Hosp Pediatr 2021; 11:167-174. [PMID: 33504562 DOI: 10.1542/hpeds.2020-0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Unplanned PICU readmissions within 48 hours of discharge (to home or a different hospital setting) are considered a quality metric of critical care. OBJECTIVE We sought to determine identifiable risk factors associated with early unplanned PICU readmissions. DATA SOURCES A comprehensive search of Medline, Embase, the Cochrane Database of Systematic Reviews, and Scopus was conducted from each database's inception to July 16, 2018. STUDY SELECTION Observational studies of early unplanned PICU readmissions (<48 hours) in children (<18 years of age) published in any language were included. DATA EXTRACTION Two reviewers selected and appraised studies independently and abstracted data. A meta-analysis was performed by using the random-effects model. RESULTS We included 11 observational studies in which 128 974 children (mean age: 5 years) were evaluated. The presence of complex chronic diseases (odds ratio 2.42; 95% confidence interval 1.06 to 5.55; I 2 79.90%) and moderate to severe disability (odds ratio 2.85; 95% confidence interval 2.40 to 3.40; I 2 11.20%) had the highest odds of early unplanned PICU readmission. Other significant risk factors included an unplanned index admission, initial admission to a general medical ward, spring season, respiratory diagnoses, and longer initial PICU stay. Readmission was less likely after trauma- and surgery-related index admissions, after direct admission from home, or during the summer season. Modifiable risk factors, such as evening or weekend discharge, revealed no statistically significant association. Included studies were retrospective, which limited our ability to account for all potential confounders and establish causality. CONCLUSIONS Many risk factors for early unplanned PICU readmission are not modifiable, which brings into question the usefulness of this quality measure.
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Affiliation(s)
- Gabriela J Prutsky
- Department of Pediatrics, Mayo Clinic Health System, Mankato, Minnesota; .,Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Dipti Padhya
- Pediatric Critical Care, Department of Pediatrics, Cedar-Sinai Hospital, Los Angeles, California
| | - Ahmed T Ahmed
- Depression Center, Department of Psychiatry and Psychology
| | - Jehad Almasri
- Internal Medicine, Piedmont Athens Regional Health System, Athens, Georgia; and
| | - Wigdan H Farah
- Internal Medicine, St Joseph Mercy Ann Arbor, Ann Arbor, Michigan
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Evidence-Based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and
| | - Mouaz Alsawas
- Evidence-Based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and
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Ahmed AT, MahmoudianDehkordi S, Bhattacharyya S, Arnold M, Liu D, Neavin D, Moseley MA, Thompson JW, Williams LSJ, Louie G, Skime MK, Wang L, Riva-Posse P, McDonald W, Bobo WV, Craighead WE, Krishnan R, Weinshilboum RM, Dunlop BW, Millington DS, Rush AJ, Frye MA, Kaddurah-Daouk R. Acylcarnitine metabolomic profiles inform clinically-defined major depressive phenotypes. J Affect Disord 2020; 264:90-97. [PMID: 32056779 PMCID: PMC7024064 DOI: 10.1016/j.jad.2019.11.122] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/17/2019] [Accepted: 11/29/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acylcarnitines have important functions in mitochondrial energetics and β-oxidation, and have been implicated to play a significant role in metabolic functions of the brain. This retrospective study examined whether plasma acylcarnitine profiles can help biochemically distinguish the three phenotypic subtypes of major depressive disorder (MDD): core depression (CD+), anxious depression (ANX+), and neurovegetative symptoms of melancholia (NVSM+). METHODS Depressed outpatients (n = 240) from the Mayo Clinic Pharmacogenomics Research Network were treated with citalopram or escitalopram for eight weeks. Plasma samples collected at baseline and after eight weeks of treatment with citalopram or escitalopram were profiled for short-, medium- and long-chain acylcarnitine levels using AbsoluteIDQ®p180-Kit and LC-MS. Linear mixed effects models were used to examine whether acylcarnitine levels discriminated the clinical phenotypes at baseline or eight weeks post-treatment, and whether temporal changes in acylcarnitine profiles differed between groups. RESULTS Compared to ANX+, CD+ and NVSM+ had significantly lower concentrations of short- and long-chain acylcarnitines at both baseline and week 8. In NVSM+, the medium- and long-chain acylcarnitines were also significantly lower in NVSM+ compared to ANX+. Short-chain acylcarnitine levels increased significantly from baseline to week 8 in CD+ and ANX+, whereas medium- and long-chain acylcarnitines significantly decreased in CD+ and NVSM+. CONCLUSIONS In depressed patients treated with SSRIs, β-oxidation and mitochondrial energetics as evaluated by levels and changes in acylcarnitines may provide the biochemical basis of the clinical heterogeneity of MDD, especially when combined with clinical characteristics.
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Affiliation(s)
- Ahmed T. Ahmed
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Siamak MahmoudianDehkordi
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States; Duke Institute of Brain Sciences, Duke University, Durham, NC, United States.
| | - Sudeepa Bhattacharyya
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
| | - Matthias Arnold
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States; Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Duan Liu
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States.
| | - Drew Neavin
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States.
| | - M. Arthur Moseley
- Duke Proteomics and Metabolomics Shared Resource, Center for Genomic and Computational Biology, Durham, NC, USA
| | - J. Will Thompson
- Duke Proteomics and Metabolomics Shared Resource, Center for Genomic and Computational Biology, Durham, NC, USA
| | - Lisa St John Williams
- Duke Proteomics and Metabolomics Shared Resource, Center for Genomic and Computational Biology, Durham, NC, United States.
| | - Gregory Louie
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.
| | - Michelle K. Skime
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Liewei Wang
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States.
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.
| | - William McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - W. Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ranga Krishnan
- Department of Psychiatry, Rush Medical College, Chicago, IL, United States.
| | - Richard M. Weinshilboum
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Boadie W. Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - David S. Millington
- Professor Emeritus, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - A. John Rush
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC.,Department of Psychiatry, Texas Tech University, Health Sciences Center, Permian Basin, TX, USA,Professor Emeritus, Duke-National University of Singapore, Singapore
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States; Duke Institute of Brain Sciences, Duke University, Durham, NC, United States.
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Bhattacharyya S, Dunlop BW, Mahmoudiandehkordi S, Ahmed AT, Louie G, Frye MA, Weinshilboum RM, Krishnan RR, Rush AJ, Mayberg HS, Craighead WE, Kaddurah-Daouk R. Pilot Study of Metabolomic Clusters as State Markers of Major Depression and Outcomes to CBT Treatment. Front Neurosci 2019; 13:926. [PMID: 31572108 PMCID: PMC6751322 DOI: 10.3389/fnins.2019.00926] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
Abstract
Major depressive disorder (MDD) is a common and disabling syndrome with multiple etiologies that is defined by clinically elicited signs and symptoms. In hopes of developing a list of candidate biological measures that reflect and relate closely to the severity of depressive symptoms, so-called “state-dependent” biomarkers of depression, this pilot study explored the biochemical underpinnings of treatment response to cognitive behavior therapy (CBT) in medication-free MDD outpatients. Plasma samples were collected at baseline and week 12 from a subset of MDD patients (N = 26) who completed a course of CBT treatment as part of the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study. Targeted metabolomic profiling using the AbsoluteIDQ® p180 Kit and LC-MS identified eight “co-expressed” metabolomic modules. Of these eight, three were significantly associated with change in depressive symptoms over the course of the 12-weeks. Metabolites found to be most strongly correlated with change in depressive symptoms were branched chain amino acids, acylcarnitines, methionine sulfoxide, and α-aminoadipic acid (negative correlations with symptom change) as well as several lipids, particularly the phosphatidlylcholines (positive correlation). These results implicate disturbed bioenergetics as an important state marker in the pathobiology of MDD. Exploratory analyses contrasting remitters to CBT versus those who failed the treatment further suggest these metabolites may serve as mediators of recovery during CBT treatment. Larger studies examining metabolomic change patterns in patients treated with pharmacotherapy or psychotherapy will be necessary to elucidate the biological underpinnings of MDD and the -specific biologies of treatment response.
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Affiliation(s)
- Sudeepa Bhattacharyya
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Siamak Mahmoudiandehkordi
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Ahmed T Ahmed
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Gregory Louie
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University, Durham, NC, United States.,Duke Institute for Brain Sciences, Duke University, Durham, NC, United States
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Richard M Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
| | - Ranga R Krishnan
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - A John Rush
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Psychiatry, Texas Tech University, Health Sciences Center, Permian Basin, TX, United States.,Duke-NUS Medical School, Singapore, Singapore
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.,Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University, Durham, NC, United States.,Duke Institute for Brain Sciences, Duke University, Durham, NC, United States
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Tibbo ME, Limberg AK, Salib CG, Ahmed AT, van Wijnen AJ, Berry DJ, Abdel MP. Acquired Idiopathic Stiffness After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2019; 101:1320-1330. [PMID: 31318813 PMCID: PMC6641113 DOI: 10.2106/jbjs.18.01217] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 02/01/2023]
Abstract
BACKGROUND Stiffness is a common reason for suboptimal clinical outcomes after primary total knee arthroplasty (pTKA). There is a lack of consensus regarding its definition, which is often conflated with its histopathologic subcategory-i.e., arthrofibrosis. There is value in refining the definition of acquired idiopathic stiffness in an effort to select for patients with arthrofibrosis. We conducted a systematic review and meta-analysis to establish a consensus definition of acquired idiopathic stiffness, determine its prevalence after pTKA, and identify potential risk factors for its development. METHODS MEDLINE, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Scopus databases were searched from 2002 to 2017. Studies that included patients with stiffness after pTKA were screened with strict inclusion and exclusion criteria to isolate the subset of patients with acquired idiopathic stiffness unrelated to known extrinsic or surgical causes. Three authors independently assessed study eligibility and risk of bias and collected data. Outcomes of interest were then analyzed according to age, sex, and body mass index (BMI). RESULTS In the 35 included studies (48,873 pTKAs), the mean patient age was 66 years. In 63% of the studies, stiffness was defined as a range of motion of <90° or a flexion contracture of >5° at 6 to 12 weeks postoperatively. The prevalence of acquired idiopathic stiffness after pTKA was 4%, and this did not differ according to age (4%, I = 95%, among patients <65 years old and 5%, I = 96%, among those ≥65 years old; p = 0.238). The prevalence of acquired idiopathic stiffness was significantly lower in males (1%, I = 85%) than females (3%, I = 95%) (p < 0.0001) as well as in patients with a BMI of <30 kg/m (2%, I = 94%) compared with those with a BMI of ≥30 kg/m (5%, I = 97%) (p = 0.027). CONCLUSIONS Contemporary literature supports the following definition for acquired idiopathic stiffness: a range of motion of <90° persisting for >12 weeks after pTKA in patients in the absence of complicating factors including preexisting stiffness. The mean prevalence of acquired idiopathic stiffness after pTKA was 4%; females and obese patients were at increased risk. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Meagan E. Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Afton K. Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Ahmed T. Ahmed
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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9
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Bhattacharyya S, Ahmed AT, Arnold M, Liu D, Luo C, Zhu H, Mahmoudiandehkordi S, Neavin D, Louie G, Dunlop BW, Frye MA, Wang L, Weinshilboum RM, Krishnan RR, Rush AJ, Kaddurah-Daouk R. Metabolomic signature of exposure and response to citalopram/escitalopram in depressed outpatients. Transl Psychiatry 2019; 9:173. [PMID: 31273200 PMCID: PMC6609722 DOI: 10.1038/s41398-019-0507-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/29/2019] [Accepted: 04/29/2019] [Indexed: 12/28/2022] Open
Abstract
Metabolomics provides valuable tools for the study of drug effects, unraveling the mechanism of action and variation in response due to treatment. In this study we used electrochemistry-based targeted metabolomics to gain insights into the mechanisms of action of escitalopram/citalopram focusing on a set of 31 metabolites from neurotransmitter-related pathways. Overall, 290 unipolar patients with major depressive disorder were profiled at baseline, after 4 and 8 weeks of drug treatment. The 17-item Hamilton Depression Rating Scale (HRSD17) scores gauged depressive symptom severity. More significant metabolic changes were found after 8 weeks than 4 weeks post baseline. Within the tryptophan pathway, we noted significant reductions in serotonin (5HT) and increases in indoles that are known to be influenced by human gut microbial cometabolism. 5HT, 5-hydroxyindoleacetate (5HIAA), and the ratio of 5HIAA/5HT showed significant correlations to temporal changes in HRSD17 scores. In the tyrosine pathway, changes were observed in the end products of the catecholamines, 3-methoxy-4-hydroxyphenylethyleneglycol and vinylmandelic acid. Furthermore, two phenolic acids, 4-hydroxyphenylacetic acid and 4-hydroxybenzoic acid, produced through noncanconical pathways, were increased with drug exposure. In the purine pathway, significant reductions in hypoxanthine and xanthine levels were observed. Examination of metabolite interactions through differential partial correlation networks revealed changes in guanosine-homogentisic acid and methionine-tyrosine interactions associated with HRSD17. Genetic association studies using the ratios of these interacting pairs of metabolites highlighted two genetic loci harboring genes previously linked to depression, neurotransmission, or neurodegeneration. Overall, exposure to escitalopram/citalopram results in shifts in metabolism through noncanonical pathways, which suggest possible roles for the gut microbiome, oxidative stress, and inflammation-related mechanisms.
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Affiliation(s)
- Sudeepa Bhattacharyya
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed T Ahmed
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Matthias Arnold
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC, USA
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Duan Liu
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Chunqiao Luo
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Siamak Mahmoudiandehkordi
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC, USA
| | - Drew Neavin
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Gregory Louie
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC, USA
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Liewei Wang
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Richard M Weinshilboum
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Ranga R Krishnan
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
| | - A John Rush
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC, USA
- Texas Tech University, Health Sciences Center, Permian Basin, Odessa, TX, USA
- Duke-National University of Singapore, Singapore, Singapore
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC, USA.
- Department of Medicine, Duke University, Durham, NC, USA.
- Duke Institute of Brain Sciences, Duke University, Durham, NC, USA.
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10
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Ahmed AT, Biernacka JM, Jenkins G, Rush AJ, Shinozaki G, Veldic M, Rung S, Bobo WV, Hall-Flavin DK, Weinshilboum RM, Wang L, Frye MA. Pharmacokinetic-Pharmacodynamic interaction associated with venlafaxine-XR remission in patients with major depressive disorder with history of citalopram / escitalopram treatment failure. J Affect Disord 2019; 246:62-68. [PMID: 30578947 PMCID: PMC6501809 DOI: 10.1016/j.jad.2018.12.021] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/08/2018] [Accepted: 12/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to identify specific pharmacokinetic (PK) and pharmacodynamics (PD) factors that affect the likelihood of treatment remission with a serotonin norepinephrine reuptake inhibitor (SNRI) in depressed patients whose initial selective serotonin reuptake inhibitor (SSRI) failed. METHODS Multiple logistic regression modeling of PK and PD variation hypothesized to contribute to SNRI (i.e. duloxetine or venlafaxine) treatment remission in prior SSRI (i.e. citalopram or escitalopram) failure was conducted on 139 subjects from the Pharmacogenomics Research Network (PGRN) and Sequenced Treatment Alternatives to Relieve Depression (STAR*D) studies. Depressive symptoms were assessed with the Quick Inventory of Depressive Symptomatology Clinician-rated (QIDS-C16). RESULTS Venlafaxine-XR remission was associated with a significant interaction between CYP2D6 ultra-rapid metabolizer (URM) phenotype and SLC6A4 5-HTTLPR L/L genotype. A similar significant interaction effect was observed between CYP2D6 URM and SLC6A2 G1287A GA genotype. Stratifying by transporter genotypes, venlafaxine-XR remission was associated with CYP2D6 URM in patients with SLC6A4 L/L (p = 0.001) and SLC6A2 G1287A GA genotypes. LIMITATIONS The primary limitation of this post hoc study was small sample size. CONCLUSION Our results suggest that CYP2D6 ultra-rapid metabolizer status contributes to venlafaxine-XR treatment remission in MDD patients; in particular, there is a PK-PD interaction with treatment remission associated with CYP2D6 URM phenotype and SLC6A4 5-HTTLPR L/L or SLC6A2 G1287A G/A genotype, respectively. These preliminary data are encouraging and support larger pharmacogenomics studies differentiating treatment response to mechanistically different antidepressants in addition to further PK-PD interactive analyses.
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Affiliation(s)
- Ahmed T. Ahmed
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| | - Joanna M. Biernacka
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Gregory Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - A John Rush
- Duke-National University of Singapore, Singapore,Department of Psychiatry, Duke Medical School, Durham, NC, United States,Texas Tech University-Health Sciences Center, Permian Basin, TX, United States
| | - Gen Shinozaki
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| | - Simon Rung
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| | - William V. Bobo
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa, United States,Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL, United States
| | | | - Richard M. Weinshilboum
- Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
| | - Liewei Wang
- Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
| | - Mark A. Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States,Corresponding author (M.A. Frye)
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Veldic M, Ahmed AT, Blacker CJ, Geske JR, Biernacka JM, Borreggine KL, Moore KM, Prieto ML, Vande Voort JL, Croarkin PE, Hoberg AA, Kung S, Alarcon RD, Keeth N, Singh B, Bobo WV, Frye MA. Cytochrome P450 2C19 Poor Metabolizer Phenotype in Treatment Resistant Depression: Treatment and Diagnostic Implications. Front Pharmacol 2019; 10:83. [PMID: 30837869 PMCID: PMC6389687 DOI: 10.3389/fphar.2019.00083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Pharmacogenomic testing, specifically for pharmacokinetic (PK) and pharmacodynamic (PD) genetic variation, may contribute to a better understanding of baseline genetic differences in patients seeking treatment for depression, which may further impact clinical antidepressant treatment recommendations. This study evaluated PK and PD genetic variation and the clinical use of such testing in treatment seeking patients with bipolar disorder (BP) and major depressive disorder (MDD) and history of multiple drug failures/treatment resistance. Methods: Consecutive depressed patients evaluated at the Mayo Clinic Depression Center over a 10-year study time frame (2003–2013) were included in this retrospective analysis. Diagnoses of BP or MDD were confirmed using a semi-structured diagnostic interview. Clinical rating scales included the Hamilton Rating Scale for Depression (HRSD24), Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Adverse Childhood Experiences (ACE) Questionnaire. Clinically selected patients underwent genotyping of cytochrome P450 CYP2D6/CYP2C19 and the serotonin transporter SLC6A4. PK and PD differences and whether clinicians incorporated test results in providing recommendations were compared between the two patient groups. Results: Of the 1795 patients, 167/523 (31.9%) with BP and 446/1272 (35.1%) with MDD were genotyped. Genotyped patients had significantly higher self-report measures of depression and anxiety compared to non-genotyped patients. There were significantly more CYP2C19 poor metabolizer (PM) phenotypes in BP (9.3%) vs. MDD patients (1.7%, p = 0.003); among participants with an S-allele, the rate of CYP2C19 PM phenotype was even higher in the BP (9.8%) vs. MDD (0.6%, p = 0.003). There was a significant difference in the distribution of SLC6A4 genotypes between BP (l/l = 28.1%, s/l = 59.3%, s/s = 12.6%) and MDD (l/l = 31.4%, s/l = 46.1%, s/s = 22.7%) patients (p < 0.01). Conclusion: There may be underlying pharmacogenomic differences in treatment seeking depressed patients that potentially have impact on serum levels of CYP2C19 metabolized antidepressants (i.e., citalopram / escitalopram) contributing to rates of efficacy vs. side effect burden with additional potential risk of antidepressant response vs. induced mania. The evidence for utilizing pharmacogenomics-guided therapy in MDD and BP is still developing with a much needed focus on drug safety, side effect burden, and treatment adherence.
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Affiliation(s)
- Marin Veldic
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Ahmed T Ahmed
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Caren J Blacker
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Jennifer R Geske
- Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Joanna M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States.,Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Kristin L Borreggine
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Katherine M Moore
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Miguel L Prieto
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de los Andes, Santiago, Chile.,Servicio de Salud Mental, Clínica Universidad de los Andes, Santiago, Chile
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Astrid A Hoberg
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Renato D Alarcon
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States.,Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nicola Keeth
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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12
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Ahmed AT, Frye MA, Rush AJ, Biernacka JM, Craighead WE, McDonald WM, Bobo WV, Riva-Posse P, Tye SJ, Mayberg HS, Flavin DH, Skime MK, Jenkins GD, Wang L, Krishnan RR, Weinshilboum RM, Kaddurah-Daouk R, Dunlop BW. Mapping depression rating scale phenotypes onto research domain criteria (RDoC) to inform biological research in mood disorders. J Affect Disord 2018; 238:1-7. [PMID: 29807322 PMCID: PMC6374030 DOI: 10.1016/j.jad.2018.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 01/05/2018] [Revised: 03/30/2018] [Accepted: 05/11/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Substantial research progress can be achieved if available clinical datasets can be mapped to the National Institute of Mental Health Research-Domain-Criteria (RDoC) constructs. This mapping would allow investigators to both explore more narrowly defined clinical phenotypes and the relationship of these phenotypes to biological markers and clinical outcomes approximating RDoC criteria. METHODS Using expert review and consensus, we defined four major depression phenotypes based on specific RDoC constructs. Having matched these constructs to individual items from the Hamilton Depression Rating Scale and Quick Inventory of Depressive Symptomatology, we identified subjects meeting criteria for each of these phenotypes from two large clinical trials of patients treated for major depression. In a post hoc analysis, we evaluated the overall treatment response based on the phenotypes: Core Depression (CD), Anxiety (ANX), and Neurovegetative Symptoms of Melancholia (NVSM) and Atypical Depression (NVSAD). RESULTS The phenotypes were prevalent (range 10.5-52.4%, 50% reduction range 51.9-82.9%) and tracked with overall treatment response. Although the CD phenotype was associated with lower rates of remission in both cohorts, this was mainly driven by baseline symptom severity. However, when controlling for baseline severity, patients with the ANX phenotype had a significantly lower rate of remission. LIMITATIONS The lack of replication between the studies of the phenotypes' treatment prediction value reflects important variability across studies that may limit generalizability. CONCLUSION Further work evaluating biological markers associated with these phenotypes is needed for further RDoC concept development.
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Affiliation(s)
- Ahmed T. Ahmed
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - A John Rush
- Department of Psychiatry, Duke University School of Medicine, Durham, Durham, NC,Texas Tech University, Health Sciences Center, Permian Basin, TX
| | | | - W. Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - William M. McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Susannah J. Tye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Helen S. Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | | | | | - Greg D. Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Liewei Wang
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | | | - Richard M. Weinshilboum
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | - Rima Kaddurah-Daouk
- Department of Psychiatry, Duke University School of Medicine, Durham, Durham, NC
| | - Boadie W. Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
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Ahmed AT, Mann H, Putta A, Agrawal R, Yim B, Gupta S. Safety, tolerability and outcomes of immunotherapy in minority underserved population. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15004] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ahmed T Ahmed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Hashim Mann
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Aakash Putta
- John H Stroger Jr. Hospital of Cook County, Chicago, IL
| | | | - Barbara Yim
- John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Shweta Gupta
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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14
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Pathak S, Thekkekara RJ, Ahmed AT, Yadav U, Mullane MR, Batra KK, Lad TE, Psutka SP. Upfront docetaxel for castration-sensitive metastatic prostate cancer in an ethnically diverse inner-city population. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e17038] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Surabhi Pathak
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Ahmed T Ahmed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Udit Yadav
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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15
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Thekkekara RJ, Pathak S, Yadav U, Ahmed AT, Mullane MR, Batra KK, Lad TE, Kato C, Psutka SP. Lean and fat-mass changes following upfront docetaxel compared to androgen deprivation monotherapy in metastatic castration-naïve prostate cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e17020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Surabhi Pathak
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Udit Yadav
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Ahmed T Ahmed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | | | | | - Caroline Kato
- John H Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Sarah P Psutka
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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16
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Singh SRK, Lu P, Malapati SJ, Ahmed AT, Mullane MR. Outcomes in left versus right metastatic colorectal cancer (mCRC) in patients presenting to an inner-city safety net hospital. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15542] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Pei Lu
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Ahmed T Ahmed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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17
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DeMarco CE, Lu P, Andrade Gonzalez XA, Lubelchek RJ, Angelov DF, Gupta S, Ahmed AT, Rubinstein PG. AIDS-associated Kaposi sarcoma: A subset analysis of the County Hospital AIDS Malignancy Project (CHAMP study) exploring epidemiology, staging, and prognostic factors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13587] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Pei Lu
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | | | | | - Shweta Gupta
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Ahmed T Ahmed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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18
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Mann H, Mushtaq MU, Andrade Gonzalez XA, Ahmed AT, Gupta S. Pre-therapy neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio do not predict survival in patients treated with immune checkpoint inhibitors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hashim Mann
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | | | - Ahmed T Ahmed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Shweta Gupta
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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19
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Alahdab F, Farah W, Almasri J, Barrionuevo P, Zaiem F, Benkhadra R, Asi N, Alsawas M, Pang Y, Ahmed AT, Rajjo T, Kanwar A, Benkhadra K, Razouki Z, Murad MH, Wang Z. Treatment Effect in Earlier Trials of Patients With Chronic Medical Conditions: A Meta-Epidemiologic Study. Mayo Clin Proc 2018; 93:278-283. [PMID: 29477781 DOI: 10.1016/j.mayocp.2017.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 08/14/2017] [Revised: 10/04/2017] [Accepted: 10/23/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether the early trials in chronic medical conditions demonstrate an effect size that is larger than that in subsequent trials. METHODS We identified randomized controlled trials (RCTs) evaluating a drug or device in patients with chronic medical conditions through meta-analyses (MAs) published between January 1, 2007, and June 23, 2015, in the 10 general medical journals with highest impact factor. We estimated the prevalence of having the largest effect size or heterogeneity in the first 2 published trials. We evaluated the association of the exaggerated early effect with several a priori hypothesized explanatory variables. RESULTS We included 70 MAs that had included a total of 930 trials (average of 13 [range, 5-48] RCTs per MA) with average follow-up of 24 (range, 1-168) months. The prevalence of the exaggerated early effect (ie, proportion of MAs with largest effect or heterogeneity in the first 2 trials) was 37%. These early trials had an effect size that was on average 2.67 times larger than the overall pooled effect size (ratio of relative effects, 2.67; 95% CI, 2.12-3.37). The presence of exaggerated effect was not significantly associated with trial size; number of events; length of follow-up; intervention duration; number of study sites; inpatient versus outpatient setting; funding source; stopping a trial early; adequacy of random sequence generation, allocation concealment, or blinding; loss to follow-up or the test for publication bias. CONCLUSION Trials evaluating treatments of chronic medical conditions published early in the chain of evidence commonly demonstrate an exaggerated treatment effect compared with subsequent trials. At the present time, this phenomenon remains unpredictable. Considering the increasing morbidity and mortality of chronic medical conditions, decision makers should act on early evidence with caution.
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Affiliation(s)
- Fares Alahdab
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.
| | - Wigdan Farah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Jehad Almasri
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Patricia Barrionuevo
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Feras Zaiem
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Raed Benkhadra
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Noor Asi
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Mouaz Alsawas
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Yifan Pang
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Ahmed T Ahmed
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Tamim Rajjo
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Amrit Kanwar
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Khalid Benkhadra
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Zayd Razouki
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - M Hassan Murad
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.
| | - Zhen Wang
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
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Pathak S, Thekkekara RJ, Ahmed AT, Yadav U, Mullane MR, Batra KK, Lad TE, Psutka SP. Real world outcomes of upfront docetaxel for hormone naïve metastatic prostate cancer in an ethnically diverse inner-city population. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.359] [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: 11/20/2022] Open
Abstract
359 Background: Upfront docetaxel (UD) in castration-sensitive metastatic prostate cancer (CSPC) has improved failure-free and overall survival in the CHAARTED, GETUG-AFU 15 and STAMPEDE trials, resulting in a paradigm shift in practice patterns. However, the impact of docetaxel-based chemotherapy regimens in minorities and in real-world practice remains to be described. The objective of this study is to evaluate tolerability and response to UD in an inner-city ethnically diverse CSPC cohort. Methods: We retrospectively reviewed clinical data for CSPC patients at Cook County Hospital. Patients treated with UD and androgen deprivation (UD, n = 49, 2013-17) were compared to those receiving androgen deprivation alone (ADT, n = 42, 2010-17) using descriptive statistics and Cox Proportional Hazards analysis. Results: Median age was 59 and 60 years in UD and ADT, respectively. African Americans, Hispanics and Caucasians formed 69%, 18%, and 10% in UD and 64%, 9.5% and 26% in ADT. Median PSA at diagnosis was: UD 536 [72-1110] ng/ml, ADT 229 [54-999] ng/ml (p = 0.3). Gleason score > 7 was present in 89.8% [UD] and 92.8% [ADT]. UD and ADT had similar frequency of bone (91% vs. 95%, p = 0.5), visceral (12.2% vs. 11.9%, p = 0.9) and retroperitoneal nodal metastases (55% vs. 45.2%, p = 0.3). UD was initiated a median of 8 weeks from diagnosis. 94% in UD received > 3 cycles of chemotherapy. CTCAE grade > 3 events included anemia (6%); neutropenia (6%); infection (4%); diarrhea (4%); peripheral neuropathy (6%), and fatigue (2%). Median PSA nadir was 3.2 [0.5-40.1] vs. 3.45 [0.1-36.4] ng/ml and time to nadir was 20 [13-27] vs. 41 [19-69] weeks in UD vs. ADT. Biochemical progression was observed in 34.7% [UD] vs. 40.5% [ADT]. Median time to castration-resistance was UD: 39 [31-67] vs. ADT: 65 [34-76] weeks [HR: 0.9; 95% CI 0.4-1.8; p = 0.7]. There were 12 deaths [UD: 4; ADT: 8] during a median follow-up of 46 [23-86, UD] and 111 [68-157, ADT] weeks. Conclusions: In a diverse underserved population with CSPC, UD was well tolerated but was not associated with improvement in time to castration compared to ADT. These results warrant validation and underscore the importance of ensuring accrual of minorities in clinical trials.
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Affiliation(s)
- Surabhi Pathak
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Ahmed T Ahmed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Udit Yadav
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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Ahmed AT, Weinshilboum R, Frye MA. Benefits of and Barriers to Pharmacogenomics-Guided Treatment for Major Depressive Disorder. Clin Pharmacol Ther 2018; 103:767-769. [PMID: 29388201 DOI: 10.1002/cpt.1009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/15/2017] [Accepted: 12/28/2017] [Indexed: 11/05/2022]
Abstract
Antidepressants have reduced the symptom burden for many Major Depressive Disorder (MDD) patients, but drug-related side effects and treatment resistance continue to present major challenges. Pharmacogenomics represents one approach to enhance antidepressant efficacy and avoid adverse reactions, but concerns remain with regard to the overall "value equation," and several barriers must be overcome to achieve the full potential of MDD pharmacogenomics.
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Affiliation(s)
- Ahmed T Ahmed
- Department of Psychiatry and Psychology and Mayo Clinic Depression Center, Rochester, Minnesota, USA
| | - Richard Weinshilboum
- Division of Clinical Pharmacology, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology and Mayo Clinic Depression Center, Rochester, Minnesota, USA
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22
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Ahmed AT, Mohammed K, Chehab M, Brinjikji W, Murad MH, Cloft H, Bjarnason H. Correction to: Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2018; 41:983. [PMID: 29374301 DOI: 10.1007/s00270-018-1881-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The original version of this paper contained an error.
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Affiliation(s)
- Ahmed T Ahmed
- Evidence-Based Practice Research Program, Mayo Clinic, 200 1st Street Southwest, Harwick Building 2-50, Rochester, MN, 55905, USA.
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN, 55905, USA.
| | - Khaled Mohammed
- Evidence-Based Practice Research Program, Mayo Clinic, 200 1st Street Southwest, Harwick Building 2-50, Rochester, MN, 55905, USA
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Monzer Chehab
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, 3601 W 13 Mile Road, Royal Oak, MI, 48073, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, 200 1st Street Southwest, Harwick Building 2-50, Rochester, MN, 55905, USA
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Harry Cloft
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Haraldur Bjarnason
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN, 55905, USA
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Chahal AA, Alhurani RE, Mohamed EA, Somers VK, Miller VM, Murad MH, Ahmed AT. Are there sex differences following treatment of left ventricular outflow tract obstruction in adults with hypertrophic cardiomyopathy? Eur Heart J Qual Care Clin Outcomes 2017; 3:249-250. [PMID: 28838090 PMCID: PMC5805115 DOI: 10.1093/ehjqcco/qcx005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anwar A Chahal
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Mayo Graduate School, 200 First Street SW, Rochester, MN 55905, USA.,Specialty Registrar, Cardiology and Internal Medicine, London Deanery, University College London Partners, UK
| | - Rabe E Alhurani
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Mayo Clinic Graduate School of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Essa A Mohamed
- Mayo Graduate School, 200 First Street SW, Rochester, MN 55905, USA
| | - Virend K Somers
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Virginia M Miller
- Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Mohammad Hassan Murad
- Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ahmed T Ahmed
- Mayo Clinic Graduate School of Medicine, 200 First Street SW, Rochester, MN 55905, USA.,Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, MN 55905, USA
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Mangla A, Mushtaq MU, Yadav U, Ahmed AT, Liu J, Go MT, Hassan AS, Bedrose S, Mann H, Mullane MR. Prognostic score to predict time to castration-resistance in underserved patients with metastatic prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e16518] [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: 11/20/2022] Open
Abstract
e16518 Background: This study aimed to identify predictors of time to castration-resistance prostate cancer (tCRPC) from initial diagnosis of metastatic prostate cancer (mPC) and develop a prognostic score in the underserved population of an inner-city tertiary care hospital. Methods: We retrospectively reviewed charts of 278 men diagnosed with mPC between 2001 and 2015, of which 155 patients were analyzed. Socio-demographic, clinical and pathologic factors were ascertained at the time of diagnosis. Kaplan-Meier and cox regression analyses were done to explore correlates tCRPC. Crude (HR) and adjusted (aHR) hazard ratios with 95% confidence intervals (CI) were obtained. Results: Over a median follow-up of 46 months (95% CI 23-69), 73.5% of men developed castration-resistance. Median tCRPC was 16 months (95% CI 12.5-19.5). All patients received medical or surgical castration at the time of diagnosis. Significant correlates of short tCRPC included: prostate specific antigen >20 ng/mL (HR 2.56, 95% CI 1.25-5.23, P=0.010), core involvement >50% (HR 2.11, 95% CI 1.43-3.11, P<0.001), bone metastases (HR 2.94, 95% CI 1.36-6.35, P=0.006), visceral metastases (HR 01.65, 95% CI 1.08-2.53, P=0.021), hemoglobin <10 g/dL (HR 2.02, 95% CI 1.26-3.23, P=0.003), alkaline phosphatase (ALP) >240 U/L (HR 2.42, 95% CI 1.62-3.61, P<0.001), lactate dehydrogenase (LDH) >200 U/L (HR 1.68, 95% CI 1.16-2.43, P=0.006) and neutrophil-lymphocyte ratio >2.4 (HR 1.50, 95% CI 1.03-2.20, P=0.035). In multivariate model, core involvement >50% (aHR 2.99, 95% CI 1.79-5.01, P<0.001), ALP >240 U/L (aHR 2.08, 95% CI 1.13-3.84, P=0.019) and LDH >200 U/L (aHR 1.71, 95% CI 1.02-2.86, P=0.043) independently predicted short tCRPC and each factor decreased tCRPC by almost 50%. Mean prognostic score (PS), based on 1 point for each independent predictor (scale 0-3), was 1.23 (SD 0.91) and significantly predicted short tCRPC (P<0.001). [Table] Conclusions: Our PS based on core involvement (>50%), high ALP (>240 U/L) and high LDH (>200 U/L) significantly predicts tCRPC in men with mPC. Prospective studies are warranted to further validate this score. [Table: see text]
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Affiliation(s)
- Ankit Mangla
- Division of Hematology and Oncology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Udit Yadav
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Ahmed T Ahmed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Jiaxiang Liu
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Ahmed S Hassan
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Sara Bedrose
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Hashim Mann
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Michael Russell Mullane
- Division of Hematology and Oncology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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Jasim S, Alahdab F, Ahmed AT, Tamhane SU, Sharma A, Donegan D, Nippoldt TB, Murad MH. The effect of growth hormone replacement in patients with hypopituitarism on pituitary tumor recurrence, secondary cancer, and stroke. Endocrine 2017; 56:267-278. [PMID: 27815769 DOI: 10.1007/s12020-016-1156-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Received: 07/18/2016] [Accepted: 10/18/2016] [Indexed: 12/29/2022]
Abstract
Growth hormone replacement therapy has benefits for patients with hypopituitarism. The safety profile in regard to tumor recurrence or progression, development of secondary malignancies, or cerebrovascular stroke is still an area of debate. A comprehensive search of multiple databases-MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was conducted through August 2015. Eligible studies that evaluated long-term adverse events in adult patients with hypopituitarism treated with growth hormone replacement therapy and reported development of pituitary tumor recurrence or progression, secondary malignancies, or cerebrovascular stroke were selected following a predefined protocol. Reviewers, independently and in duplicate, extracted data and assessed the risk of bias. Random-effects meta-analysis was used to pool relative risks and 95 % confidence intervals. We included 15 studies (published 1995-2015) that reported on 46,148 patients. Compared to non-replacement, growth hormone replacement therapy in adults with hypopituitarism was not associated with statistically significant change in pituitary tumor progression or recurrence (relative risk, 0.77; 95 % confidence interval, 0.53-1.13) or development of secondary malignancy (relative risk, 0.99; 95 % confidence interval, 0.70-1.39). In two retrospective studies, there was higher risk of stroke in patients who did not receive replacement (relative risk, 2.07; 95 % confidence interval, 1.51-2.83). The quality of evidence is low due to study limitations and imprecision. This systematic review and meta-analysis supports the overall safety of growth hormone therapeutic use in adults with hypopituitarism with no clear evidence of increased risk of pituitary tumor recurrence, malignancy, or stroke.
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Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Fares Alahdab
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Ahmed T Ahmed
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Shrikant U Tamhane
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Anu Sharma
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Diane Donegan
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Todd B Nippoldt
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, Rochester, MN, USA
| | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA.
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26
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Jasim S, Alahdab F, Ahmed AT, Tamhane S, Prokop LJ, Nippoldt TB, Murad MH. Mortality in adults with hypopituitarism: a systematic review and meta-analysis. Endocrine 2017; 56:33-42. [PMID: 27817141 DOI: 10.1007/s12020-016-1159-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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] [Received: 07/21/2016] [Accepted: 10/25/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Hypopituitarism is a rare disorder with significant morbidity. To study the evidence on the association of premature mortality and hypopituitarism. METHODS A comprehensive search of multiple databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was conducted through August, 2015. Eligible studies that evaluated patients with hypopituitarism and reported mortality estimates were selected following a predefined protocol. Reviewers, independently and in duplicate, extracted data and assessed the risk of bias. RESULTS We included 12 studies (published 1996-2015) that reported on 23,515 patients. Compared to the general population, hypopituitarism was associated with an overall excess mortality (weighted SMR of 1.55; 95 % CI 1.14-2.11), I 2 = 97.8 %, P = 0.000. Risk factors for increased mortality included younger age at diagnosis, female gender, diagnosis of craniopharyngioma, radiation therapy, transcranial surgery, diabetes insipidus and hypogonadism. CONCLUSION Hypopituitarism may be associated with premature mortality in adults. Risk is particularly higher in women and those diagnosed at a younger age.
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Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Fares Alahdab
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Ahmed T Ahmed
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA.
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27
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Ramar P, Ahmed AT, Wang Z, Chawla SS, Suarez MLG, Hickson LJ, Farrell A, Williams AW, Shah ND, Murad MH, Thorsteinsdottir B. Effects of Different Models of Dialysis Care on Patient-Important Outcomes: A Systematic Review and Meta-Analysis. Popul Health Manag 2017; 20:495-505. [PMID: 28332943 DOI: 10.1089/pop.2016.0157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ongoing payment reform in dialysis necessitates better patient outcomes and lower costs. Suggested improvements to processes of care for maintenance dialysis patients are abundant; however, their impact on patient-important outcomes is unclear. This systematic review included comparative randomized controlled trials or observational studies with no restriction on language, published from 2000 to 2014, involving at least 5 adult dialysis patients who received a minimum of 6 months of follow-up. The effect size was pooled and stratified by intervention strategy (multidisciplinary care [MDC], home dialysis, alternate dialysis settings, and electronic health record implementation). Heterogeneity (I2) was used to assess the variability in study effects related to study differences rather than chance. Of the 1988 articles screened, 25 international studies with 74,833 maintenance dialysis patients were included. Interventions with MDC or home dialysis were associated with a lower mortality (hazard ratio [HR] = 0.72, 95% confidence interval [CI] 0.61, 0.84, I2 = 41.6%; HR = 0.57, 95% CI 0.41, 0.81, I2 = 89.0%; respectively) and hospitalizations (incidence rate ratio [IRR] = 0.68, 95% CI 0.51, 0.91, I2 = NA; IRR = 0.88, 95% CI 0.64, 1.20, I2 = 79.6%; respectively). Alternate dialysis settings also were associated with a reduction in hospitalizations (IRR = 0.41, 95% CI 0.25, 0.69, I2 = 0.0%). This systematic review underscores the importance of multidisciplinary care, and also the value of telemedicine as a means to increase access to providers and enhance outcomes for those dialyzing at home or in alternate settings, including those with limited access to nephrology expertise because of travel distance.
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Affiliation(s)
- Priya Ramar
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota
| | - Ahmed T Ahmed
- 2 Division of Preventive, Occupational and Aerospace Medicine, Department of Medicine, Mayo Clinic , Rochester, Minnesota.,3 Division of Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic , Rochester, Minnesota
| | - Zhen Wang
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,4 Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
| | - Sagar S Chawla
- 5 Mayo Medical School, Mayo Clinic College of Medicine , Rochester, Minnesota.,6 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | | | - LaTonya J Hickson
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,7 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, Minnesota
| | - Ann Farrell
- 8 Mayo Clinic Libraries , Rochester, Minnesota
| | - Amy W Williams
- 7 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, Minnesota
| | - Nilay D Shah
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,4 Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
| | - M Hassan Murad
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,2 Division of Preventive, Occupational and Aerospace Medicine, Department of Medicine, Mayo Clinic , Rochester, Minnesota
| | - Bjorg Thorsteinsdottir
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,9 Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic , Rochester, Minnesota
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Kallmes KM, Brinjikji W, Ahmed AT, Kallmes DF. Difficulty in finding manuscript reviewers is not associated with manuscript acceptance rates: a study of the peer-review process at the journal Radiology. Scientometrics 2017. [DOI: 10.1007/s11192-017-2331-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Rajjo T, Mohammed K, Alsawas M, Ahmed AT, Farah W, Asi N, Almasri J, Prokop LJ, Murad MH. Treatment of Pediatric Obesity: An Umbrella Systematic Review. J Clin Endocrinol Metab 2017; 102:763-775. [PMID: 28359101 DOI: 10.1210/jc.2016-2574] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [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: 06/30/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Multiple interventions are available to reduce excess body weight in children. We appraised the quality of evidence supporting each intervention and assessed the effectiveness on different obesity-related outcomes. METHODS We conducted a systematic search for systematic reviews of randomized controlled trials evaluating pediatric obesity interventions applied for ≥6 months. We assessed the quality of evidence for each intervention using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. RESULTS From 16 systematic reviews, we identified 133 eligible randomized controlled trials. Physical activity interventions reduced systolic blood pressure and fasting glucose (low to moderate quality of evidence). Dietary interventions with low-carbohydrate diets had a similar effect to low-fat diets in terms of body mass index (BMI) reduction (moderate quality of evidence). Educational interventions reduced waist circumference, BMI, and diastolic blood pressure (low quality of evidence). Pharmacological interventions reduced BMI (metformin, sibutramine, orlistat) and waist circumference (sibutramine, orlistat) and increased high-density lipoprotein cholesterol (sibutramine) but also raised systolic and diastolic blood pressure (sibutramine). Surgical interventions (laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) resulted in the largest BMI reduction (moderate quality of evidence). Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education significantly reduced systolic and diastolic blood pressure, BMI, and triglycerides. Combined parent-child interventions and parent-only interventions had similar effects on BMI (low quality of evidence). CONCLUSIONS Several childhood obesity interventions are effective in improving metabolic and anthropometric measures. A comprehensive multicomponent intervention, however, appears to have the best overall outcomes.
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Affiliation(s)
- Tamim Rajjo
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Department of Family Medicine
| | - Khaled Mohammed
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Mouaz Alsawas
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Ahmed T Ahmed
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
| | - Wigdan Farah
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Noor Asi
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Jehad Almasri
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Larry J Prokop
- Library Public Services, Mayo Clinic, Rochester, Minnesota 55905
| | - Mohammad Hassan Murad
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
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Rajjo T, Almasri J, Al Nofal A, Farah W, Alsawas M, Ahmed AT, Mohammed K, Kanwar A, Asi N, Wang Z, Prokop LJ, Murad MH. The Association of Weight Loss and Cardiometabolic Outcomes in Obese Children: Systematic Review and Meta-regression. J Clin Endocrinol Metab 2017; 102:758-762. [PMID: 28359092 DOI: 10.1210/jc.2016-2575] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 06/30/2016] [Accepted: 08/31/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Excess body weight in children is associated with multiple immediate and long-term medical comorbidities. We aimed to identify the degree of reduction in excess body weight associated with cardiometabolic changes (lipid panel, liver function tests, systolic blood pressure (SBP), diastolic blood pressure, glycosylated hemoglobin, and fasting blood glucose) in overweight and obese children. METHODS We conducted a comprehensive search of MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus through February 12, 2015. We included randomized controlled trials and cohort studies that evaluated interventions to treat pediatric obesity (medication, surgery, lifestyle, and community-based interventions) with ≥ a 6-month follow-up. We used a random effects meta-regression approach to assess the association between body mass index (BMI)/weight and cardiometabolic changes. RESULTS We included 42 studies (37 randomized controlled trials and five cohorts) enrolling 3807 children (mean age, 12.2 years; weight, 74.7 kg; and BMI, 31.7 kg/m2). Studies had overall moderate to low risk of bias. A 1-mm Hg decrease in SBP was significantly associated with a decrease of 0.16 kg/m2 (P = .04) in BMI. A 1-mg/dL increase in HDL was significantly associated with a 0.74-kg decrease in weight (P = .02). A 1-mg/dL decrease in triglycerides was significantly associated with a 0.1-kg decrease in weight (P = .03). The remaining associations were not statistically significant. CONCLUSIONS Weight reduction in children is associated with significant changes in several cardiometabolic outcomes, particularly HDL, SBP, and triglycerides. The magnitude of improvement may help in setting expectations and may inform shared decision-making and counseling.
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Affiliation(s)
- Tamim Rajjo
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Jehad Almasri
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Alaa Al Nofal
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Wigdan Farah
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Mouaz Alsawas
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Ahmed T Ahmed
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Khaled Mohammed
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Amrit Kanwar
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Noor Asi
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Zhen Wang
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Larry J Prokop
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
| | - Mohammad Hassan Murad
- Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902
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Farah WH, Alsawas M, Mainou M, Alahdab F, Farah MH, Ahmed AT, Mohamed EA, Almasri J, Gionfriddo MR, Castaneda-Guarderas A, Mohammed K, Wang Z, Asi N, Sawchuk CN, Williams MD, Prokop LJ, Murad MH, LeBlanc A. Non-pharmacological treatment of depression: a systematic review and evidence map. ACTA ACUST UNITED AC 2016; 21:214-221. [DOI: 10.1136/ebmed-2016-110522] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Brown RS, McMahon BJ, Lok ASF, Wong JB, Ahmed AT, Mouchli MA, Wang Z, Prokop LJ, Murad MH, Mohammed K. Reply. Hepatology 2016; 64:1824-1825. [PMID: 27113389 DOI: 10.1002/hep.28617] [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] [Received: 04/19/2016] [Accepted: 04/22/2016] [Indexed: 12/07/2022]
Affiliation(s)
- Robert S Brown
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Brian J McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Anna S F Lok
- Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA
| | - Ahmed T Ahmed
- Evidence-based Practice Center Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic, Rochester, MN
| | | | - Zhen Wang
- Evidence-based Practice Center Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic, Rochester, MN
| | | | - Mohammad Hassan Murad
- Evidence-based Practice Center Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic, Rochester, MN
| | - Khaled Mohammed
- Evidence-based Practice Center Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic, Rochester, MN
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Elbaz AM, Ahmed AT, Mohamed AM, Oransa MA, Sayed KS, Eldeib AM. Motor imagery based brain computer interface using transform domain features. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2016:6421-6424. [PMID: 28269716 DOI: 10.1109/embc.2016.7592198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Brain Computer Interface (BCI) is a channel of communication between the human brain and an external device through brain electrical activity. In this paper, we extracted different features to boost the classification accuracy as well as the mutual information of BCI systems. The extracted features include the magnitude of the discrete Fourier transform and the wavelet coefficients for the EEG signals in addition to distance series values and invariant moments calculated for the reconstructed phase space of the EEG measurements. Different preprocessing, feature selection, and classification schemes were utilized to evaluate the performance of the proposed system for dataset III from BCI competition II. The maximum accuracy achieved was 90.7% while the maximum mutual information was 0.76 bit obtained using the distance series features.
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Lok ASF, McMahon BJ, Brown RS, Wong JB, Ahmed AT, Farah W, Almasri J, Alahdab F, Benkhadra K, Mouchli MA, Singh S, Mohamed EA, Abu Dabrh AM, Prokop LJ, Wang Z, Murad MH, Mohammed K. Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis. Hepatology 2016; 63:284-306. [PMID: 26566246 DOI: 10.1002/hep.28280] [Citation(s) in RCA: 366] [Impact Index Per Article: 45.8] [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: 08/18/2015] [Accepted: 09/23/2015] [Indexed: 01/10/2023]
Abstract
UNLABELLED Chronic hepatitis B viral (HBV) infection remains a significant global health problem. Evidence-based guidelines are needed to help providers determine when treatment should be initiated, which medication is most appropriate, and when treatment can safely be stopped. The American Association for the Study of Liver Diseases HBV guideline methodology and writing committees developed a protocol a priori for this systematic review. We searched multiple databases for randomized controlled trials and controlled observational studies that enrolled adults ≥18 years old diagnosed with chronic HBV infection who received antiviral therapy. Data extraction was done by pairs of independent reviewers. We included 73 studies, of which 59 (15 randomized controlled trials and 44 observational studies) reported clinical outcomes. Moderate-quality evidence supported the effectiveness of antiviral therapy in patients with immune active chronic HBV infection in reducing the risk of cirrhosis, decompensated liver disease, and hepatocellular carcinoma. In immune tolerant patients, moderate-quality evidence supports improved intermediate outcomes with antiviral therapy. Only very low-quality evidence informed the questions about discontinuing versus continuing antiviral therapy in hepatitis B e antigen-positive patients who seroconverted from hepatitis B e antigen to hepatitis B e antibody and about the safety of entecavir versus tenofovir. Noncomparative and indirect evidence was available for questions about stopping versus continuing antiviral therapy in hepatitis B e antigen-negative patients, monotherapy versus adding a second agent in patients with persistent viremia during treatment, and the effectiveness of antivirals in compensated cirrhosis with low-level viremia. CONCLUSION Most of the current literature focuses on the immune active phases of chronic HBV infection; decision-making in other commonly encountered and challenging clinical settings depends on indirect evidence.
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Affiliation(s)
- Anna S F Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Brian J McMahon
- Liver Diseases and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA
| | - Ahmed T Ahmed
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Wigdan Farah
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Jehad Almasri
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Fares Alahdab
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Khalid Benkhadra
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - Siddharth Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Essa A Mohamed
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | | | - Zhen Wang
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mohammad Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Khaled Mohammed
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN
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Jonas MM, Lok ASF, McMahon BJ, Brown RS, Wong JB, Ahmed AT, Farah W, Mouchli MA, Singh S, Prokop LJ, Murad MH, Mohammed K. Antiviral therapy in management of chronic hepatitis B viral infection in children: A systematic review and meta-analysis. Hepatology 2016; 63:307-18. [PMID: 26566163 DOI: 10.1002/hep.28278] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 08/25/2015] [Accepted: 10/04/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Most individuals with chronic hepatitis B viral (HBV) infection acquired the infection around the time of birth or during early childhood. We aimed to synthesize evidence regarding the effectiveness of antiviral therapy in the management of chronic HBV infection in children. We conducted a comprehensive search of multiple databases from 1988 to December 2, 2014, for studies that enrolled children (<18 years) with chronic HBV infection treated with antiviral therapy. We included observational studies and randomized controlled trials (RCTs). Two independent reviewers selected studies and extracted data. In the 14 included studies, two cohort studies showed no significant reduction in the already low risk of hepatocellular carcinoma or cirrhosis and 12 RCTs reported intermediate outcomes. In RCTs with posttreatment follow-up <12 months, antiviral therapy compared to placebo improved alanine aminotransferase normalization (risk ratio [RR] = 2.3, 95% confidence interval [CI] 1.7-3.2), hepatitis B e antigen (HBeAg) clearance/loss (RR = 2.1, 95% CI 1.5-3.1), HBV DNA suppression (RR = 2.9, 95% CI 1.8-4.6), HBeAg seroconversion (RR = 2.1, 95% CI 1.4-3.3), and hepatitis B surface antigen clearance (RR = 5.8, 95% CI 1.1-31.5). In RCTs with posttreatment follow-up ≥12 months, antiviral therapy improved cumulative HBeAg clearance/loss (RR = 1.9, 95% CI 1.7-3.1), HBeAg seroconversion (RR = 2.1, 95% CI 1.3-3.5), alanine aminotransferase normalization (RR = 1.4, 95% CI 1.1-1.7), and HBV DNA suppression (RR = 1.4, 95% CI 1.1-1.8) but not hepatitis B surface antigen clearance or seroconversion. CONCLUSION In children with chronic HBV infection, antivirals compared to no antiviral therapy improve HBV DNA suppression and frequency of alanine aminotransferase normalization and HBeAg seroconversion.
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Affiliation(s)
- Maureen M Jonas
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
| | - Anna S F Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Brian J McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | - John B Wong
- Department of Medicine, Tufts Medical Center, Boston, MA
| | - Ahmed T Ahmed
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Wigdan Farah
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - Siddharth Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Mohammad Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Khaled Mohammed
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN
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Brown RS, McMahon BJ, Lok ASF, Wong JB, Ahmed AT, Mouchli MA, Wang Z, Prokop LJ, Murad MH, Mohammed K. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis. Hepatology 2016; 63:319-33. [PMID: 26565396 DOI: 10.1002/hep.28302] [Citation(s) in RCA: 224] [Impact Index Per Article: 28.0] [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: 08/18/2015] [Accepted: 10/15/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Perinatal or mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains the major risk factor for chronic HBV infection worldwide. In addition to hepatitis B immune globulin and vaccination, oral antiviral therapies in highly viremic mothers can further decrease MTCT of HBV. We conducted a systematic review and meta-analysis to synthesize the evidence on the efficacy and maternal and fetal safety of antiviral therapy during pregnancy. A protocol was developed by the American Association for the Study of Liver Diseases guideline writing committee. We searched multiple databases for controlled studies that enrolled pregnant women with chronic HBV infection treated with antiviral therapy. Outcomes of interest were reduction of MTCT and adverse outcomes to mothers and newborns. Study selection and data extraction were done by pairs of independent reviewers. We included 26 studies that enrolled 3622 pregnant women. Antiviral therapy reduced MTCT, as defined by infant hepatitis B surface antigen seropositivity (risk ratio = 0.3, 95% confidence interval 0.2-0.4) or infant HBV DNA seropositivity (risk ratio = 0.3, 95% confidence interval 0.2-0.5) at 6-12 months. No significant differences were found in the congenital malformation rate, prematurity rate, and Apgar scores. Compared to control, lamivudine or telbivudine improved maternal HBV DNA suppression at delivery and during 4-8 weeks' postpartum follow-up. Tenofovir showed improvement in HBV DNA suppression at delivery. No significant differences were found in postpartum hemorrhage, cesarean section, and elevated creatinine kinase rates. CONCLUSIONS Antiviral therapy improves HBV suppression and reduces MTCT in women with chronic HBV infection with high viral load compared to the use of hepatitis B immunoglobulin and vaccination alone; the use of telbivudine, lamivudine, and tenofovir appears to be safe in pregnancy with no increased adverse maternal or fetal outcome.
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Affiliation(s)
- Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | - Brian J McMahon
- Liver Diseases and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Anna S F Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA
| | - Ahmed T Ahmed
- Evidence-Based Practice Research Program.,Center for the Science of Health Care Delivery
| | | | - Zhen Wang
- Evidence-Based Practice Research Program.,Center for the Science of Health Care Delivery
| | | | - Mohammad Hassan Murad
- Evidence-Based Practice Research Program.,Center for the Science of Health Care Delivery.,Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Khaled Mohammed
- Evidence-Based Practice Research Program.,Center for the Science of Health Care Delivery.,Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN
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Ahmed AT, Mohammed K, Chehab M, Brinjikji W, Hassan Murad M, Cloft H, Bjarnason H. Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2015; 39:652-667. [DOI: 10.1007/s00270-015-1250-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/31/2015] [Indexed: 11/27/2022]
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Ahmed AT, Rezek I, McDonald JS, Kallmes DF. 'Initial Clinical Experience' articles are poorly cited and negatively affect the impact factor of the publishing journal: a review. JRSM Short Rep 2013; 4:21. [PMID: 23560220 PMCID: PMC3616303 DOI: 10.1177/2042533313476694] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The phrase 'Initial Clinical Experience' in a manuscript's title implies that the described technique offers promise of future clinical relevance. We assessed, using rates of subsequent citations, the actual academic relevance of such articles in comparison to articles not containing the phrase. DESIGN We searched ISI database for articles that included the studied phrase in their titles between 1975 and 2009 and grouped the results by the related medical specialty. We excluded articles from journals with no available impact factor. For each identified article, we extracted number of included patients, citations/year, the average impact factor of the publishing journal over the last five years and the proportion of articles published in the same journal that garnered zero subsequent citations. SETTING Retrospective review of a scientific database. PARTICIPANTS None. MAIN OUTCOME MEASURES Citation rate. RESULTS Among a total of 982,127 articles published in 186 journals representing eight major publishing medical specialties, 531 (0.05%) were Initial Clinical Experience articles. Thirty percent of Initial Clinical Experience articles were never cited compared with 7% of the overall article volume (p < 0.0001). Citations/year for Initial Clinical Experience articles were significantly lower than the median impact factor (p < 0.0001). There was no correlation between citations and number of patients described in the Initial Clinical Experience articles (p = 0.61). CONCLUSIONS Initial Clinical Experience articles are cited less frequently than the average, especially in Cardiovascular, Radiology and Ophthalmology journals.
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Affiliation(s)
- Ahmed T Ahmed
- Department of Radiology , Mayo Clinic, Rochester, MN 55905 , USA
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Abstract
AIMS Our aim was to examine the associations of alcohol consumption with six diabetes self-care behaviours. METHODS We determined levels of alcohol consumption and examined associations between alcohol consumption and six self-care behaviours in 65 996 adults with diabetes who received care through Kaiser Permanente Northern California and who responded to a 1994-1997 survey. Adherence with recommendations for self monitoring of blood glucose, HbA1c testing, and diabetes medications were determined from electronic records; smoking and use of diet and exercise to treat diabetes were self reported. Multiple logistic regression models were used to determine the associations between alcohol consumption (average number of drinks/day in the past year) and the probability of adherence to each self-care behaviour. RESULTS Current alcohol consumption was reported by 50.8% of adults with diabetes. In adjusted models, we observed a gradient of increasing risk for poor adherence to diabetes self-care behaviours with increasing alcohol consumption, starting with those who consume even one drink a day. Former drinkers had the greatest compliance with each self-care behaviour, except for current smoking. CONCLUSIONS Alcohol consumption is a marker for poorer adherence to diabetes self-care behaviours. These findings highlight the importance of routine assessment of alcohol intake in people with diabetes, particularly as half of adults with diabetes consume alcohol. Given extant evidence that moderate alcohol intake may have cardiovascular benefits for patients with diabetes, examination of the trade-offs between cardiovascular benefits vs. potential risk of lower adherence with self-care behaviours deserves study.
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Affiliation(s)
- A T Ahmed
- Kaiser Permanente Division of Research, Oakland, CA 94612, USA.
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Abstract
AIMS Thiazolidinediones (TZD) have been associated with an expansion in plasma volume and the development of peripheral oedema. A recent study reported an association between the use of TZDs and development of congestive heart failure (CHF). The objective of this study was to determine if short-term use of pioglitazone, a TZD, is associated with increased risk of admission to hospital because of CHF in a well-characterized, community-based cohort of Type 2 diabetic patients without prevalent CHF. METHODS A cohort study of all patients in the Kaiser Permanente Medical Care Program with Type 2 diabetes (Kaiser Permanente Northern California Diabetes Registry) who initiated any diabetes pharmacotherapy (n = 23 440) between October 1999 and November 2001. Only patients initiating single new therapies ('new users') were included to reduce confounding and create mutually exclusive exposure groups. We constructed Cox proportional hazards models (with sulphonylureas initiators specified as the reference group) to evaluate the impact of initiating new diabetes therapies on time-to-incident admission to hospital because of CHF, defined by primary hospital discharge diagnosis. RESULTS Patients initiated pioglitazone (15.2%), sulphonylureas (25.3%), metformin (50.9%), and insulin (8.6%) alone, or as additions to pre-existing or maintained therapies. Three hundred and twenty admissions for CHF were observed during the follow-up (mean 10.2 months) after drug initiation. Relative to patients initiating sulphonylureas, there were no significant increases in the incidence of hospitalization for CHF in those initiating pioglitazone [hazard ratio (HR) = 1.28; 95% confidence interval (CI): 0.85-1.92] after adjusting for demographic, behavioural and clinical factors. There was a significantly higher incidence among those initiating insulin (HR = 1.56; 95% CI: 1.00-2.45) and lower incidence among those initiating metformin (HR = 0.70; 95% CI: 0.49-0.99). CONCLUSIONS This study of patients with Type 2 diabetes failed to find evidence that short-term pioglitazone use was associated with an elevated risk of hospitalization for CHF relative to the standard, first-line diabetes therapy.
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Affiliation(s)
- A J Karter
- Kaiser Permanente-Division of Research, Oakland, CA 94612, USA.
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Ahmed AT, Karter AJ. Tuberculosis in California dialysis patients. Int J Tuberc Lung Dis 2004; 8:341-5. [PMID: 15139473] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
SETTING Kaiser Permanente Northern California dialysis registry. OBJECTIVE To examine the incidence of tuberculosis disease (TB) in a large, insured population of dialysis patients and to describe the disease characteristics and outcomes of these cases. DESIGN Cohort study of all Kaiser patients who initiated dialysis between 1 January 1995 and 31 December 1999. TB incidence in our cohort between 1 January 1995 and 31 December 2000 was determined through electronic databases of out-patient diagnoses, laboratory results, and pharmacy records. The incidence of TB in the general population was determined from mandatory reporting of TB cases compiled by the California Department of Health Services. RESULTS During the 6-year period of observation, 13 cases of TB occurred among 2806 dialysis initiators. The incidence of TB in the dialysis cohort was 134 per 100,000 person-years, compared to an incidence of 11.9/100,000 in the California population, yielding a relative risk of 11.3. Extra-pulmonary disease occurred in eight of 11 patients for whom site of disease was recorded. Five of 13 patients died within 3 months of TB diagnosis. CONCLUSIONS The dialysis population is at high risk of TB. Physicians caring for dialysis patients must remain vigilant for signs of TB in this vulnerable population.
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Affiliation(s)
- A T Ahmed
- Division of Research, Kaiser Permanente, Oakland, California 94612, USA.
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