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Razzack AA, Lak HM, Erasani G, Rahman S, Hussain N, Ali BF, Eapi S, Yasmin F, Najeeb H, Mustafa A, Chawla S, Munir MB, Barakat AF, Saliba W, Wazni O, Hussein AA. Long-Term Efficacy and Safety of Left Atrial Appendage Occlusion (LAAO) vs Direct Oral Anticoagulation (DOAC) in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2023. [DOI: 10.31083/j.rcm2402044] [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: 02/05/2023] Open
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Reddy KT, Syeda H, Stenberg D, Bakhshaei S, Reddy S, Alkhero M, Razzack AA, Gounder S. Spontaneous Isolated Superior Mesenteric Artery Dissection With Thrombosis: A Case Report of a Rare Presentation of Acute Abdominal Pain. CJC Open 2022; 4:1090-1092. [PMID: 36562018 PMCID: PMC9764121 DOI: 10.1016/j.cjco.2022.08.007] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 08/12/2022] [Indexed: 02/01/2023] Open
Abstract
Spontaneous isolated superior mesenteric artery dissection is a very rare vascular disease that involves the superior mesenteric artery or its branches, with an incidence as low as 0.08%. The majority of cases occur in patients of Asian descent. Due to advances in imaging modalities, particularly abdominal computed tomography angiography, the diagnosis of this disease has been increasing. Herein, we present a rare case of spontaneous isolated superior mesenteric artery dissection with thrombosis in a young male patient with no past medical history. The importance of this disease as a differential diagnosis for acute abdominal pain is emphasized.
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Affiliation(s)
- Krishna Theja Reddy
- Cardiovascular Fellowship Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
| | - Humera Syeda
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
| | - Daniel Stenberg
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
| | - Sina Bakhshaei
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
- Corresponding author: Dr Sina Bakhshaei, Temecula Valley Hospital, 31700 Temecula Pkwy, Temecula, California 92592, USA. Tel.: +1-213-949-6412.
| | - Srivaibhav Reddy
- Internal Medicine Department, Karwar Institute of Medical Sciences, Karwar, India
| | - Mohammed Alkhero
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
| | - Aminah Abdul Razzack
- Internal Medicine Department, Dr N.T.R University of Health Sciences, Vijayawada, India
| | - Sivaraman Gounder
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
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Razzack AA, Lak HM, Pothuru S, Rahman S, Hassan SA, Hussain N, Najeeb H, Reddy KT, Syeda H, Yasmin F, Mustafa A, Chawla S, Munir MB, Barakat AF, Saliba W, Wazni O, Hussein AA. Efficacy and Safety of Catheter Ablation vs Antiarrhythmic Drugs as Initial Therapy for Management of Symptomatic Paroxysmal Atrial Fibrillation: A Meta-Analysis. Rev Cardiovasc Med 2022; 23:112. [PMID: 35345279 DOI: 10.31083/j.rcm2303112] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Catheter ablation is an effective treatment for atrial fibrillation (AF), primarily performed in patients who fail antiarrhythmic drugs. Whether early catheter ablation, as first-line therapy, is associated with improved clinical outcomes remains unclear. METHODS Electronic databases (PubMed, Scopus, Embase) were searched until March 28th, 2021. Randomized controlled trials (RCTs) compared catheter ablation vs antiarrhythmic drug therapy as first-line therapy were included. The primary outcome of interest was the first documented recurrence of any atrial tachyarrhythmia (symptomatic or asymptomatic; AF, atrial flutter, and atrial tachycardia). Secondary outcomes included symptomatic atrial tachyarrhythmia (AF, atrial flutter, and atrial tachycardia) and serious adverse events. Unadjusted risk ratios (RR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance considered if the confidence interval (CI) excludes one and p < 0.05. RESULTS A total of six RCTs with 1212 patients (Ablation n = 609; Antiarrhythmic n = 603) were included. Follow- up period ranged from 1-2 years. Patients who underwent ablation were less likely to experience any recurrent atrial tachyarrhythmia when compared to patients receiving antiarrhythmic drugs (RR 0.63; 95% CI 0.55-0.73; p < 0.00001). Symptomatic atrial tachyarrhythmia was also lower in the ablation arm (RR 0.53; 95% CI 0.32-0.87; p = 0.01). No statistically significant differences were noted for overall any type of adverse events (RR 0.93; 95% CI 0.68-1.27; p = 0.64) and cardiovascular adverse events (RR 0.90; 95% CI 0.56-1.44; p = 0.65) respectively. CONCLUSIONS Catheter ablation, as first-line therapy, was associated with a significantly lower rate of tachyarrhythmia recurrence compared to conventional antiarrhythmic drugs, with a similar adverse effect risk profile. These findings support a catheter ablation strategy as first-line therapy among patients with symptomatic paroxysmal atrial fibrillation.
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Affiliation(s)
- Aminah Abdul Razzack
- Department of Medicine, Dr. N.T.R University of Health Sciences, 520010 Vijayawada, India
| | - Hassan Mehmood Lak
- Section of Clinical Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Suveenkrishna Pothuru
- Department of Internal Medicine, Ascension via Christi Hospital, Manhattan, KS 66503, USA
| | - Sajedur Rahman
- Jalalabad Ragib-Rabeya Medical College and Hospital, Sylhet 3100, Bangladesh
| | - Syed Adeel Hassan
- Department of Internal Medicine, University of Louisville, Louisville, KY 40203, USA
| | - Nabeel Hussain
- Saba University School of Medicine, P.O. Box 1000 The Bottom, Saba, Dutch Caribbean
| | - Hala Najeeb
- Department of Medicine, Dow University of Health Sciences, 74400 Karachi, Pakistan
| | - Krishna Theja Reddy
- UHS Southern California Medical Education Consortium, Temecula, CA 92590, USA
| | - Humera Syeda
- UHS Southern California Medical Education Consortium, Temecula, CA 92590, USA
| | - Farah Yasmin
- Department of Medicine, Dow University of Health Sciences, 74400 Karachi, Pakistan
| | - Ahmad Mustafa
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10301, USA
| | - Sanchit Chawla
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Department of Cardiovascular Medicine, University of California, San Diego, CA 92101, USA
| | - Amr F Barakat
- Section of Electrophysiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Walid Saliba
- Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Oussama Wazni
- Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Sarfraz A, Sarfraz Z, Sarfraz M, Abdul Razzack A, Bano S, Singh Makkar S, Thevuthasan S, Paul T, Khawar Sana M, Azeem N, Felix M, Cherrez-Ojeda I. Industry 4.0 Technologies for the Manufacturing and Distribution of COVID-19 Vaccines. J Prim Care Community Health 2022; 13:21501319211068638. [PMID: 34984932 PMCID: PMC8753236 DOI: 10.1177/21501319211068638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The evolutionary stages of manufacturing have led us to conceptualize the use of Industry 4.0 for COVID-19 (coronavirus disease 2019), powered by Industry 4.0 technologies. Using applications of integrated process optimizations reliant on digitized data, we propose novel intelligent networks along the vaccine value chain. Vaccine 4.0 may enable maintenance processes, streamline logistics, and enable optimal production of COVID-19 vaccines. VACCINE 4.0 FRAMEWORK The challenge in applying Vaccine 4.0 includes the requirement of large-scale technologies for digitally transforming manufacturing, producing, rolling-out, and distributing vaccines. With our framework, Vaccine 4.0 analytics will target process performance, process development, process stability, compliance, quality assessment, and optimized maintenance. The benefits of digitization during and post the COVID-19 pandemic include first, the continual assurance of process control, and second, the efficacy of big-data analytics in streamlining set parameter limits. Digitization including big data-analytics may potentially improve the quality of large-scale vaccine production, profitability, and manufacturing processes. The path to Vaccine 4.0 will enhance vaccine quality, improve efficacy, and compliance with data-regulated requirements. DISCUSSION Fiscal and logistical barriers are prevalent across resource-limited countries worldwide. The Vaccine 4.0 framework accounts for expected barriers of manufacturing and equitably distributing COVID-19 vaccines. With amalgamating big data analytics and biometrics, we enable the identification of vulnerable populations who are at higher risk of disease transmission. Artificial intelligence powered sensors and robotics support thermostable vaccine distribution in limited capacity regions, globally. Biosensors isolate COVID-19 vaccinations with low or limited efficacy. Finally, Vaccine 4.0 blockchain systems address low- and middle-income countries with limited distribution capacities. CONCLUSION Vaccine 4.0 is a viable framework to optimize manufacturing of vaccines during and post the COVID-19 pandemic.
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Affiliation(s)
- Azza Sarfraz
- Larkin Community Hospital, South Miami, FL, USA,The Aga Khan University, Karachi, Pakistan
| | - Zouina Sarfraz
- Larkin Community Hospital, South Miami, FL, USA,Fatima Jinnah Medical University, Lahore, Pakistan,Zouina Sarfraz, Division of Research & Academic Affairs, Larkin Community Hospital, 7031 SW 62nd Avenue, South Miami, FL 100181, USA.
| | - Muzna Sarfraz
- Larkin Community Hospital, South Miami, FL, USA,King Edward Medical University, Lahore, Pakistan
| | | | - Shehar Bano
- Fatima Jinnah Medical University, Lahore, Pakistan
| | | | | | - Trissa Paul
- Larkin Community Hospital, South Miami, FL, USA
| | | | | | - Miguel Felix
- Universidad Espiritu Santo, Samborondon, Ecuador,Respiralab Research Group, Guayaquil, Ecuador
| | - Ivan Cherrez-Ojeda
- Universidad Espiritu Santo, Samborondon, Ecuador,Respiralab Research Group, Guayaquil, Ecuador
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Sattar Y, Abdul Razzack A, Kompella R, Alhajri N, Arshad J, Ullah W, Zghouzi M, Mir T, Power D, Qureshi WT, Aljaroudi W, Elgendy IY, Mamas MA, Alraies MC. Outcomes of intravascular ultrasound versus optical coherence tomography guided percutaneous coronary angiography: A meta regression-based analysis. Catheter Cardiovasc Interv 2021; 99:E1-E11. [PMID: 34668640 DOI: 10.1002/ccd.29976] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/18/2021] [Accepted: 09/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies comparing clinical outcomes with intravascular ultrasound (IVUS) versus optical coherence tomography (OCT) guidance for percutaneous coronary intervention (PCI) in patients presenting with coronary artery disease, including stable angina or acute coronary syndrome, are limited. METHODS We performed a detailed search of electronic databases (PubMed, Embase, and Cochrane) for randomized controlled trials and observational studies that compared cardiovascular outcomes of IVUS versus OCT. Data were aggregated for the primary outcome measure using the random-effects model as pooled risk ratio (RR). The primary outcome of interest was major adverse cardiac events (MACE), cardiac mortality, and all-cause mortality. Secondary outcomes included myocardial infarction (MI), stent thrombosis (ST), target lesion revascularization (TLR), and stroke. RESULTS A total of seven studies met the inclusion criteria, comprising 5917 patients (OCT n = 2075; IVUS n = 3842). OCT-PCI versus IVUS-guided PCI comparison yielded no statistically significant results for all the outcomes; MACE (RR 0.78; 95% confidence interval [CI], 0.57-1.09; p = 0.14), cardiac mortality (RR 0.97; 95% CI, 0.27-3.46; p = 0.96), all-cause mortality (RR 0.74; 95% CI, 0.39-1.39; p = 0.35), MI (RR 1.27; 95% CI, 0.52-3.07; p = 0.60), ST (RR 0.70; 95% CI, 0.13-3.61; p = 0.67), TLR (RR 1.09; 95% CI, 0.53-2.25; p = 0.81), and stroke (RR 2.32; 95% CI, 0.42-12.90; p = 0.34). Furthermore, there was no effect modification on meta-regression including demographics, comorbidities, lesion location, lesion length, and stent type. CONCLUSIONS In this meta-analysis, OCT-guided PCI was associated with no difference in clinical outcomes compared with IVUS-guided PCI.
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Affiliation(s)
- Yasar Sattar
- Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | | | - Ritika Kompella
- Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Noora Alhajri
- Public Health, Khalifa University College of Medicine and Health Science, Abu Dhabi, UAE
| | - Junaid Arshad
- Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Waqas Ullah
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Tanveer Mir
- Cardiology, Detroit Medical Center, Detroit, Michigan, USA
| | - David Power
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Waqas T Qureshi
- Cardiology, University of Massachusetts, Worcester, Massachusetts, USA
| | | | | | - Mamas A Mamas
- Cardiology, Keele University School of Medicine, Keele Cardiovascular Research Group, Stoke-on-Trent, UK
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Razzack AA, Hassan SA, Pasya SKR, Erasani G, Kumar S, Rocha-Castellanos DM, Lopez-Mendez A, Razzack SA. A Meta-Analysis of Association between Remdesivir and Mortality among Critically-Ill COVID-19 Patients. Infect Chemother 2021; 53:512-518. [PMID: 34508325 PMCID: PMC8511372 DOI: 10.3947/ic.2021.0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/04/2021] [Indexed: 12/24/2022] Open
Abstract
Background The World Health Organization guidelines did not make a recommendation on use of remdesivir based on disease severity. Little is known regarding effectiveness of remdesivir in critically ill coronavirus disease 2019 (COVID-19) patients. This has led to a state of dilemma for doctors leaving them skeptical of whether they should continue to recommend the drug or not. Materials and Methods A systematic search adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted from inception until February 20, 2020. Electronic bibliographic databases (PubMed, Cochrane database, Scopus, Embase) were included. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel Haenszel (M-H) using random-effects model. The primary outcome of interest was all-cause mortality in ventilated and non-ventilated patients. Results The Remdesivir arm was associated with similar rates of 28-day all-cause mortality (OR: 0.93, 95% confidence interval [CI]: 0.80 - 1.08; P = 0.33). Remdesivir was not found to be favorable for ventilated patients. Non ventilated COVID-19 patients showed a significant lower in-hospital mortality rate as compared with patients requiring mechanical ventilatory support (OR: 6.86, 95% CI: 5.39 - 268.74; P <0.0001) Conclusion Non-ventilated patients were associated with significant lower all-cause mortality rates. Prudent use of remdesivir is recommended in critically ill COVID-19 patients.
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Affiliation(s)
- Aminah Abdul Razzack
- Department of Internal Medicine, Dr. NTR University of Health Sciences, Vijayawada, India.
| | | | - Sai Kumar Reddy Pasya
- Department of Internal Medicine, Dr. NTR University of Health Sciences, Vijayawada, India
| | - Greeshma Erasani
- Department of Internal Medicine, Dr. NTR University of Health Sciences, Vijayawada, India
| | - Sham Kumar
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Alfonso Lopez-Mendez
- University Hospital, Dr. Jose Eleuterio Gonzalez, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Sarah Abdul Razzack
- Department of Internal Medicine, Dr. NTR University of Health Sciences, Vijayawada, India
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Razzack AA, Pothuru S, Mandava S, Hassan SA, Castellanos DMR, Reddy KT, Vicente JDDRS, Arshad J, Sattar Y. Revascularization vs. Conservative Management in Geriatric Population With Unstable Angina/Non-ST-Elevation Myocardial Infarction (UA/NSTEMI): A Systematic Review and Meta-Analysis. Cardiovascular Revascularization Medicine 2021. [DOI: 10.1016/j.carrev.2021.06.036] [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: 11/29/2022]
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Razzack AA, Ahmed F, Thompson A, Mandava S, Abraham VA, Panday P, Pacha F. SYNERGISTIC EFFECT OF EZETIMIBE AND STATIN ON LIPOPROTEINS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS-A SYSTEMATIC REVIEW AND META ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Yasmin F, Shujauddin SM, Naeem A, Jabeen A, Shah SMI, Ochani RK, Mohiuddin O, Khan AA, Jalees S, Razzack AA, Salman S, Khan SAK, Mustafa A, Lak HM. Exploring the impact of the COVID-19 pandemic on provision of cardiology services: a scoping review. Rev Cardiovasc Med 2021; 22:83-95. [PMID: 33792250 DOI: 10.31083/j.rcm.2021.01.241] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/30/2020] [Accepted: 01/03/2020] [Indexed: 11/06/2022] Open
Abstract
The coronavirus disease-19 (COVID-19) pandemic has forced hospitals to prioritize COVID-19 patients, restrict resources, and cancel all non-urgent elective cardiac procedures. Clinical visits have only been facilitated for emergency purposes. Fewer patients have been admitted to the hospital for both ST-segment elevation myocardial infarctions (STEMI) and non-ST segment elevation myocardial infarctions (NSTEMI) and a profound decrease in heart failure services has been reported. A similar reduction in the patient presentation is seen for ischemic heart disease, decompensated heart failure, and endocarditis. Cardiovascular services, including catheterization, primary percutaneous coronary intervention (PPCI), cardiac investigations such as electrocardiograms (ECGs), exercise tolerance test (ETT), dobutamine stress test, computed tomography (CT) angiography, transesophageal echocardiography (TOE) have been reported to have declined and performed on a priority basis. The long-term implications of this decline have been discussed with major concerns of severe cardiac complications and vulnerabilities in cardiac patients. The pandemic has also had psychological impacts on patients causing them to avoid seeking medical help. This review discusses the effects of the COVID-19 pandemic on the provision of various cardiology services and aims to provide strategies to restore cardiovascular services including structural changes in the hospital to make up for the reduced staff personnel, the use of personal protective equipment in healthcare workers, and provides alternatives for high-risk cardiac imaging, cardiac interventions, and procedures. Implementation of the triage system, risk assessment scores, and telemedicine services in patients and their adaptation to the cardiovascular department have been discussed.
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Affiliation(s)
- Farah Yasmin
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, 247000 Karachi, Pakistan
| | - Syed Muhammad Shujauddin
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, 247000 Karachi, Pakistan
| | - Aisha Naeem
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, 247000 Karachi, Pakistan
| | - Adina Jabeen
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, 247000 Karachi, Pakistan
| | | | - Rohan Kumar Ochani
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, 247000 Karachi, Pakistan
| | - Osama Mohiuddin
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, 247000 Karachi, Pakistan
| | - Anosh Aslam Khan
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, 247000 Karachi, Pakistan
| | - Sumeen Jalees
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, 247000 Karachi, Pakistan
| | | | - Shiza Salman
- Department of Internal Medicine, Dow International Medical College, 247000 Karachi, Pakistan
| | - Shuja Abdul Karim Khan
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, 247000 Karachi, Pakistan
| | - Ahmad Mustafa
- Department of Internal Medicine, Staten Island University Hospital, NY 10001, USA
| | - Hassan Mehmood Lak
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH 44111, USA
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Sarfraz A, Sarfraz Z, Razzack AA, Patel G, Sarfraz M. Venous Thromboembolism, Corticosteroids and COVID-19: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2021; 27:1076029621993573. [PMID: 33571009 PMCID: PMC7883150 DOI: 10.1177/1076029621993573] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) predisposes patients to venous thromboembolism (VTE) due to risk factors, severe infection, and severe inflammatory responses. The objective is to determine the risk of developing VTE after corticosteroid administration during COVID-19 treatment. Using PRISMA reporting guidelines, a review was conducted from inception until 20 September 2020 with MESH terms including “venous thromboembolism” and “covid-19,” using MEDLINE, Scopus, CINAHL Plus, and WHO Global Database. The inclusion criteria included studies with COVID-19 patients aged 18 years and older with VTE diagnosed by duplex ultrasonography or computed tomography pulmonary angiography (CTPA). Exclusion criteria were studies with non COVID-19 patients and non-VTE patients aged less than 18 years. Quality appraisal was conducted of included studies using the Newcastle-Ottawa Scale (NOS). A random-effect model using 95% confidence intervals, and significance of findings was assessed using Review Manager V5.4.We included 12 observational studies with 2801 patients (VTE n = 434; non-VTE; n = 2367). Patients had a higher risk of presenting with VTE when being administered corticosteroids during treatment of COVID-19 (RR = 1.39, 95% CI = 1.10 to 1.77, I2 = 0%). A positive effect size was found (SMD = 1.00, 95% CI = 0.67 to 1.32, I2 = 85%) for D-dimer laboratory values (µg/mL) in the VTE group. While critically ill COVID-19 patients are more likely to require corticosteroid treatment, it may be associated with increased risk of VTE, and poor clinical prognosis. Risk assessment is warranted to further evaluate patients as case-by-case in reducing VTE and worsening clinical outcomes.
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Affiliation(s)
- Azza Sarfraz
- Department of Pediatrics & Child Health, 9615Aga Khan University, Karachi, Pakistan
| | - Zouina Sarfraz
- Department of Research & Publication, 66873Fatima Jinnah Medical University, Lahore, Pakistan
| | | | - Gaurav Patel
- 213456Smt. NHL Municipal Medical College, Gujarat, India
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Sarfraz A, Sarfraz Z, Razzack AA, Hathaway III D, Thevuthasan S, Singh-Makkar S, Paul T, Patel G, Sana MK, Sarfraz M, Richter F, Gonzalez MAS. A Systematic Review and Meta-Analysis of an Emerging Therapy against COVID-19: Is Convalescent Plasma a Hidden Gem Not Yet Optimized? JPRI 2021. [DOI: 10.9734/jpri/2020/v32i4731113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: An unprecedented global effort in identifying potentially viable and emerging drugs for effective treatment of the novel coronavirus disease (2019) is being made. Of the most promising candidate therapies, convalescent plasma (CP), albeit controversial, is approved for emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA). The concept rests on passive immunity, achieved by administering plasma with high titers of neutralizing antibodies to reduce severity of SARS-CoV-2 infection and mortality. The aim of this paper is to assess the clinical improvement, patients’ discharge status and all-cause mortality in convalescent plasma versus standard of care COVID-19 patient groups.
Methods: Using PRISMA guidelines, a review was conducted from January, 2020, until October, 2020 employing keywords including “convalescent plasma”, “clinical improvement, “mortality”, “adverse events”, “viral load”, “dosing”, and survival.” Dichotomous data for all-cause mortality, patients’ discharge status, and clinical improvement at day 14 of treatment were meta-analyzed applying the Mantel-Haenszel (M-H) random effects model using Review Manager 5.4.
Results: A total of 627 (23.9%) patients in the CP group and 1997 (76.1%) patients in the control group were pooled. The studies were conducted in the United States, China, Netherlands, and Iran. The CP group had a lower association to all-cause mortality as compared to the control group [OR: 0.69; CI: 0.50 to 0.96; P=0.03]. Patients who received CP had higher probability of discharge during the study course [OR: 1.87; CI: 1.1 to 3.18; P=0.02]. Bias was expected in the analysis due to the stratified of study designs included.
Conclusion: Convalescent plasma therapy may be an effective and vital tool with promising historical, current, and expected clinical trial evidence of metrics such as increased safety and reduction of all-cause mortality.
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Sosa JP, Ferreira Caceres MM, Ross Comptis J, Quiros J, Príncipe-Meneses FS, Riva-Moscoso A, Belizaire MP, Malanyaon FQ, Agadi K, Jaffery SS, Sahajwani J, Arshia A, Senatus A, Verdecia G, Akano L, Razzack AA, Salam S, Gadamidi VK, Marian S. Effects of Interferon Beta in COVID-19 adult patients: Systematic Review. Infect Chemother 2021; 53:247-260. [PMID: 34216119 PMCID: PMC8258298 DOI: 10.3947/ic.2021.0028] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/31/2021] [Indexed: 12/11/2022] Open
Abstract
Background The high rate of transmission and infection of coronavirus disease 2019 (COVID-19) is a public health emergency of major epidemiological concern. No definitive treatments have been established, and vaccinations have only recently begun. We aim to review the efficacy and safety of Interferon Beta (IFN-β) in patients who have a confirmed COVID-19 diagnosis. Materials and Methods A search from PubMed, Science Direct, Cochrane, and Clinicaltrials.gov databases were conducted from December 2019 to December 2020 to review the efficacy and safety of IFN-β in adult patients with COVID-19 confirmed. We included randomized controlled trials, case reports, and experimental studies. Correspondences, letters, editorials, reviews, commentaries, case control, cross-sectional, and cohort studies that did not include any new clinical data were excluded. Results Of the 66 searched studies, 8 were included in our review. These studies demonstrated that although IFN-β did not reduce the time to clinical response, there was an increase in discharge rate at day 14 and a decrease in mortality at day 28. The time to negative reverse transcription polymerase chain reaction (RT-PCR) was shown to be significantly shortened in patients receiving IFN-β, along with a lower nasopharyngeal viral load. Further, patients receiving IFN-β had a less significant rise in IL-6. IFN-β was shown to decrease intensive care unit (ICU) admission rate, the requirement of invasive ventilation in severe cases, and improve the survival rate compared to control groups. There were no severe adverse events reported. Our review found that patients who received early treatment with IFN-β experienced significantly reduced length of hospitalization, mortality, ICU admission, and mechanical ventilation. A greater chance of clinical improvement and improved imaging studies was noted in patients who received IFN-β. There were no reported deaths associated with the addition of IFN-β. Further randomized trials involving more significant sample sizes are needed to better understand the effect of IFN-β on survival in COVID-19. Conclusion This review identified encouraging data and outcomes of incorporating IFN-β to treat COVID-19 patients. IFN-β has been shown to decrease hospital stay's overall length and decrease the severity of respiratory symptoms when added to the standard of care. Also, in some studies, it has been demonstrated to reduce the length of ICU stay, enhance survival rate, and decrease the need for invasive mechanical ventilation. There were minor side effects reported (neuropsychiatric symptoms and hypersensitivity reaction). However, randomized clinical trials with a large sample size are needed to assess IFN-β's benefit precisely.
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Affiliation(s)
- Juan Pablo Sosa
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | | | | | - Jorge Quiros
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Fortunato S Príncipe-Meneses
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA.,School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Adrian Riva-Moscoso
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA.,School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | | | - Freda Q Malanyaon
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Kuchalambal Agadi
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | | | - Juhi Sahajwani
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Asma Arshia
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Andrelle Senatus
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Graciela Verdecia
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Lordstrong Akano
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Aminah Abdul Razzack
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Sanna Salam
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Vinay Kumar Gadamidi
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
| | - Sheeba Marian
- Division of Research & Academic Affairs, Larkin Health System, South Miami, FL, USA
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Iqbal N, Taseer AR, Ahsan N, Kumari P, Portillo TP, Razzack AA, Khan F, Akhter S. Managing Patient With Coexisting Emphysematous Pyelonephritis And Cystitis. J Ayub Med Coll Abbottabad 2021; 33:162-164. [PMID: 33774976] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Emphysematous pyelonephritis (EPN) is a type of critical renal infection having dire consequences at times. It is said to be result of gases produced inside renal parenchymal tissue or pelvicalyceal system. Rarely coexistence of emphysematous pyelonephritis and emphysematous cystitis (EC) may lead to an intimidating condition in case it is not dealt with swiftly. The resent case report narrates the management of a 45-year-old female patient who suffered from EPN with concomitant EC. Right-sided emergency percutaneous nephrostomy was passed. Afterwards, Double J stent was passed under general anaesthesia. Although she had an initial improvement clinically but later on due to recurrent urinary tract infections and non-resolving right kidney abscess and fever right sided nephrectomy was done. This is a very rare presentation and has not previously reported much in literature.
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Affiliation(s)
- Nadeem Iqbal
- Department of Urology and Kidney Transplant, Pakistan Kidney and Liver Institute, Lahore, Pakistan
| | | | | | | | | | | | | | - Saeed Akhter
- Department of Urology and Kidney Transplant, Pakistan Kidney and Liver Institute, Lahore Pakistan
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14
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Pilla R, Palleti SK, Rayana R, Skss SR, Abdul Razzack A, Kalla S. Glycated Haemoglobin (HbA1c) Variations in Nondiabetics With Nutritional Anemia. Cureus 2020; 12:e11479. [PMID: 33329975 PMCID: PMC7735166 DOI: 10.7759/cureus.11479] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Diabetes is prevalent in the Indian population, to the extent that the diabetes burden matches that of nutritional anemia. We aimed to determine the effects of iron and vitamin B12 deficiency anemia on glycated haemoglobin (HbA1c) concentrations in individuals without diabetes. MATERIAL AND METHODS The study comprises 100 patients with iron deficiency anemia, 100 with vitamin B12 deficiency anemia, and 100 healthy volunteers as a control group. Each of the first two groups was subdivided into two groups depending on the severity of anemia based on Hb levels. We treated with iron replenishment in the iron deficiency group and B12 replenishment in the B12 deficiency group for three months. We noted HbA1c levels before and after the therapy. Data were entered into the SPSS package. For comparing pre and post-therapy levels, we used the Paired 't' test. RESULTS The mean HbA1c before treatment were 6.1% ± 0.23% and 5.5% ± 0.24%, and the values after treatment were 5.1% ± 0.14% and 4.6% ± 0.2% in severe iron deficiency anemia subgroup and mild to moderate subgroup, respectively. The mean HbA1c in the iron-deficiency anemia control group was 5.2% ± 0.2%. The mean HbA1c levels before treatment were 5.9% ± 0.3% and 5.6% ± 0.19%, and after treatment were 5.0% ± 0.15% and 4.9% ± 0.16% in severe and mild to moderate B12 deficiency anemia, respectively. The mean HbA1c in the vitamin B12 deficiency anemia control group was 5.1% ± 0.2%. CONCLUSION HbA1c in both types of anemia subjects showed a significant decrease with appropriate therapy. Physicians should consider rechecking patient haemoglobin values and correcting a patient's anemia before determining the patient's glycemic status using HbA1c to avoid misinterpretation of their diabetes status.
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Affiliation(s)
- Rakesh Pilla
- Internal Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, IND
| | | | - Renuka Rayana
- Internal Medicine, Andhra Medical College, Visakhapatnam, IND
| | - Satish Reddy Skss
- Internal Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, IND
| | | | - Sruti Kalla
- Internal Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, IND
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