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Motes A, Nugent K. Periodic generalized edema following COVID-19 infection. Am J Med Sci 2024; 367:61-66. [PMID: 37816456 DOI: 10.1016/j.amjms.2023.10.002] [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] [Received: 02/27/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/12/2023]
Abstract
The unprecedented impact and sequelae of COVID-19 infection are not yet fully understood, and better understanding of the pathophysiology of these infections is needed. Endothelial dysfunction might be common sequelae associated with COVID-19, and increased inflammatory responses, oxidative stress, proinflammatory cytokines, and impaired mitochondrial function also contribute to the pathophysiology of post COVID-19 medical disorders. Systemic capillary leak syndrome following COVID-19 infection, both new onset and exacerbation of a prior disorder, has been reported. The pathophysiology of SCLS is uncertain; it likely develops during transient vascular endothelial dysfunction or endotheliopathy and inflammation resulting from circulating humoral factors. Here, we report a case of adult patient with 2 episodes of systemic capillary leak syndrome following prior COVID-19 infection. This patient had a transient response to intravenous IgG.
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Affiliation(s)
- Arunee Motes
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX United States
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX United States.
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Motes A, Singh T, Vinan Vega N, Nugent K. A Focused Review of the Initial Management of Patients with Acute Respiratory Distress Syndrome. J Clin Med 2023; 12:4650. [PMID: 37510765 PMCID: PMC10380732 DOI: 10.3390/jcm12144650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/24/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
At present, the management of patients with acute respiratory distress syndrome (ARDS) largely focuses on ventilator settings to limit intrathoracic pressures by using low tidal volumes and on FiO2/PEEP relationships to maintain optimal gas exchange. Acute respiratory distress syndrome is a complex medical disorder that can develop in several primary acute disorders, has a rapid time course, and has several classifications that can reflect either the degree of hypoxemia, the extent of radiographic involvement, or the underlying pathogenesis. The identification of subtypes of patients with ARDS would potentially make precision medicine possible in these patients. This is a very difficult challenge given the heterogeneity in the clinical presentation, pathogenesis, and treatment responses in these patients. The analysis of large databases of patients with acute respiratory failure using statistical methods such as cluster analysis could identify phenotypes that have different outcomes or treatment strategies. However, clinical information available on presentation is unlikely to separate patients into groups that allow for secure treatment decisions or outcome predictions. In some patients, non-invasive positive pressure ventilation provides adequate support through episodes of acute respiratory failure, and the development of specialized units to manage patients with this support might lead to the better use of hospital resources. Patients with ARDS have capillary leak, which results in interstitial and alveolar edema. Early attention to fluid balance in these patients might improve gas exchange and alter the pathophysiology underlying the development of severe ARDS. Finally, more attention to the interaction of patients with ventilators through complex monitoring systems has the potential to identify ventilator dyssynchrony, leading to ventilator adjustments and potentially better outcomes. Recent studies with COVID-19 patients provide tentative answers to some of these questions. In addition, expert clinical investigators have analyzed the promise and difficulties associated with the development of precision medicine in patients with ARDS.
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Affiliation(s)
- Arunee Motes
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Tushi Singh
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Noella Vinan Vega
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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Rivas M, Motes A, Ismail A, Yang S, Sotello D, Arevalo M, Vutthikraivit W, Suchartlikitwong S, Carrasco C, Iwuji K, Pachariyanon P, Jaroudi S, Thavaraputta S, Nugent K. Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study. SAGE Open Med 2023; 11:20503121221146907. [PMID: 36632085 PMCID: PMC9827519 DOI: 10.1177/20503121221146907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Objectives The current guidelines for managing patients with sepsis include the early cultures, administration of antibiotics, and fluid resuscitation. Several clinical trials have tried to determine whether or not the administration of corticosteroids improves outcomes in these patients. This study analyzed the characteristics of a large group of critically ill patients who either had cortisol levels drawn during their intensive care unit management or had hydrocortisone administered during their management. Methods A list of patients who had cortisol levels measured or who had hydrocortisone administered empirically for the treatment of sepsis was identified by the medical record department at University Medical Center in Lubbock, Texas. The primary outcome was in-hospital mortality. Secondary outcomes included the need for mechanical ventilation, the need for renal replacement therapy, the need for vasopressors, length of stay, and the development of nosocomial infections. Results This study included 351 patients, including 194 women (55.3%). The mean age was 62.9 ± 16.1 years. The mean admission SOFA score was 9.3 ± 3.63, the mean APACHE 2 score was 18.15 ± 7.7, and the mean lactic acid level was 3.8 ± 4.0 mmol/L. One hundred sixty-two patients required intubation, 262 required vasopressors, 215 developed acute kidney injury, and 319 had cortisol levels measured. The mean length of stay was 11.5 ± 13.7 days; the mortality rate was 32.2%. Multiple variable analysis demonstrated that higher cortisol levels were associated with increased mortality (44.1% if cortisol ⩾20 µg/dL versus 17.5% if cortisol <20 µg/dL). One hundred forty-five patients received corticosteroids, and multivariable analysis demonstrated that these patients had increased mortality (40.0% versus 26.7%). Conclusion In this study, higher cortisol levels were associated with increased mortality. The administration of hydrocortisone was associated with increased mortality possibly reflecting the use of this medication in patients who had a higher likelihood of poor outcomes.
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Affiliation(s)
| | - Arunee Motes
- Division of Pulmonary/Critical Care,
Department of Internal Medicine, Texas Tech University Health Sciences Center,
Lubbock, TX, USA
| | - Amr Ismail
- Division of Pulmonary/Critical Care,
Department of Internal Medicine, Texas Tech University Health Sciences Center,
Lubbock, TX, USA
| | - Shengping Yang
- Department of Biostatistics, Pennington
Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Meily Arevalo
- Department of Internal Medicine,
University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Wasawat Vutthikraivit
- Division of Cardiovascular Medicine,
University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Sakolwan Suchartlikitwong
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine, University of Arizona College of
Medicine, Phoenix, AZ, USA
| | - Cynthia Carrasco
- Division of Pulmonary and Critical
Care, Department of Medicine, Indiana University School of Medicine, Indianapolis,
IN, USA
| | - Kenneth Iwuji
- Division of Pulmonary/Critical Care,
Department of Internal Medicine, Texas Tech University Health Sciences Center,
Lubbock, TX, USA
| | - Pavida Pachariyanon
- Division of Cardiology, Department of
Internal Medicine, Louisiana State University Health Sciences Center, Shreveport,
LA, USA
| | - Sarah Jaroudi
- Department of Internal Medicine, Baylor
College of Medicine, Houston, TX, USA
| | | | - Kenneth Nugent
- Division of Pulmonary/Critical Care,
Department of Internal Medicine, Texas Tech University Health Sciences Center,
Lubbock, TX, USA
- Kenneth Nugent, Division of
Pulmonary/Critical Care, Department of Internal Medicine, Texas Tech University
Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA.
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Kalaiselvan P, Yingchoncharoen P, Thongpiya J, Motes A, Nugent K. COVID-19 Infections and Inflammatory Markers in Patients Hospitalized During the First Year of the Pandemic. J Prim Care Community Health 2023; 14:21501319231206911. [PMID: 37864436 PMCID: PMC10590050 DOI: 10.1177/21501319231206911] [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] [Received: 08/04/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The clinical presentations in patients with SARS-CoV-2 (COVID-19) infections range from asymptomatic upper respiratory infections to acute respiratory failure with bilateral pulmonary infiltrates requiring mechanical ventilation. Clinicians often measured inflammatory markers in hospitalized patients to characterize the severity of the infection. Multiple studies published in 2020 reported information on the frequency of elevated inflammatory markers in hospitalized patients in various categories of disease severity. METHODS The PubMed database was searched using the terms "Inflammatory markers in COVID-19 patients" and "Clinical features of patients infected with COVID-19." Thirty-three publications were analyzed in detail to determine which inflammatory markers were increased and the frequency of these increases in various clinical classifications, including patients requiring hospitalization, patients with pneumonia, patients with severe infection, patients requiring intensive care unit admission, and patients who died. RESULTS C-reactive protein (CRP) was the most frequently elevated inflammatory marker in all categories. Ferritin, D-dimer, and erythrocyte sedimentation rate levels were also frequently elevated. In general, frequencies were higher in patients with more severe infections. For example, 24 out of 24 patients who died had an elevated CRP level. CONCLUSION This review provides concrete information about the frequency of various inflammatory markers in patients with COVID-19 infection who required hospitalization. It also provides us some insight into the approach clinicians took in the early phase of this pandemic in their efforts to characterize these patients and perhaps understand the disease process better. However, these results might suggest that clinicians and laboratory directors should develop protocols to optimize laboratory testing.
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Affiliation(s)
| | | | | | - Arunee Motes
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Nugent
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Parmar K, Mekraksakit P, Del Rio-Pertuz G, Sethi P, Motes A, Hughes M, Wischmeyer J, Carbajal L, Sosa EA. Myocarditis following COVID-19 mRNA vaccination. Proc AMIA Symp 2021; 35:209-213. [PMID: 35256821 PMCID: PMC8607537 DOI: 10.1080/08998280.2021.1990743] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Messenger RNA vaccines are the main COVID-19 vaccines authorized for use in the United States. Side effects are typically minor and transient. We report a case series of four subjects with an acute myocarditis-like illness following mRNA COVID-19 vaccination who were hospitalized at our hospital in Lubbock, Texas. Three patients were young men who presented with acute chest pain after the second dose of the mRNA-1273 vaccine. Another patient was a 53-year-old white woman who presented with acute left arm pain 3 days after the first dose of the mRNA-1273 vaccine. She was later found to have acute decompensated heart failure, and endomyocardial biopsy revealed eosinophilic injury–mediated myocarditis.
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Affiliation(s)
- Kanak Parmar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Poemlarp Mekraksakit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Gaspar Del Rio-Pertuz
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Pooja Sethi
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Arunee Motes
- Department of Pulmonary and Critical Care, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Megan Hughes
- Department of Pulmonary and Critical Care, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Jason Wischmeyer
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Luis Carbajal
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Erwin Argueta Sosa
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Motes A, Laoveeravat P, Thongtan T, Nugent K, Islam S, Islam E. Marijuana use-induced spontaneous pneumomediastinum. Proc (Bayl Univ Med Cent) 2020; 34:274-275. [PMID: 33678961 DOI: 10.1080/08998280.2020.1849485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The presence of air in the mediastinum is a rare finding called pneumomediastinum. Spontaneous pneumomediastinum is typically benign. Marijuana use has been rarely reported to cause pneumomediastinum. Our case series presents two young men with no significant past medical history who had a history of marijuana use and developed pneumomediastinum after multiple episodes of intractable vomiting. The pathophysiology of spontaneous pneumomediastinum in marijuana users includes cyclic vomiting or microperforation of the esophagus or barotrauma during breathing maneuvers. Most cases can be managed conservatively.
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Affiliation(s)
- Arunee Motes
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Passisd Laoveeravat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Thanita Thongtan
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Sameer Islam
- University Medical Center Southwest Gastroenterology, Lubbock, Texas
| | - Ebtesam Islam
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Motes A, Mallah H, Solis X, Brandi L, Islam E. PULMONARY AMYLOIDOSIS: AN UNCOMMON ETIOLOGY OF PULMONARY NODULE. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1723] [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: 10/23/2022] Open
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Motes A, Laoveeravat P, Ismail A, Test V. PNEUMOMEDIASTINUM IN PATIENTS WITH SUBSTANCE ABUSE: A CASE SERIES. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1098] [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: 11/30/2022] Open
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Motes A, Makram J, Solis X, Turnbow S. BILATERAL MULTIFOCAL LOCULATED EMPYEMA IN IMMUNOCOMPETENT PATIENT. Chest 2020. [DOI: 10.1016/j.chest.2020.08.431] [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: 11/24/2022] Open
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Ismail A, Arevalo M, Motes A, Makram J, Mallah H, Barcenas CC, Zitun M, Aviles DS, Hurtado AY, Nugent K. MULTIPLE PRIMARY LUNG CANCERS. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1293] [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: 11/30/2022] Open
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Laoveeravat P, Thavaraputta S, Suchartlikitwong S, Vutthikraivit W, Mingbunjerdsuk T, Motes A, Nugent K, Perisetti A, Tharian B, Islam S, Rakvit A. Optimal sequences of same-visit bidirectional endoscopy: Systematic review and meta-analysis. Dig Endosc 2020; 32:706-714. [PMID: 31368170 DOI: 10.1111/den.13503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/25/2019] [Accepted: 07/28/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Same-visit colonoscopy and esophagogastroduodenoscopy (EGD) have become common. Recent studies showed conflicting results regarding the performance, safety, and efficacy of different sequences. We conducted this meta-analysis to determine the most favorable performance and discomfort between an EGD followed by colonoscopy (E-C) and colonoscopy followed by EGD (C-E). METHODS The authors searched the databases of MEDLINE and EMBASE. Outcomes of interest were performance (including cecal intubation time, adenoma detection rate, and polyp detection rate), discomfort score (patients and endoscopists; Likert scale), and sedation uses. Pooled mean differences (MD) or odds ratios (OR) were calculated with 95% confidence intervals (CI). RESULTS Six randomized controlled trials were included in the meta-analysis. The authors found that there was significantly lower sedative use including fentanyl (14.70; 95% Cl: 8.20-21.20) and propofol (15.58; 95% Cl: 3.27-27.89) in the E-C group compared with the C-E group. There was a significantly better discomfort score in patients and endoscopists after both procedures in the E-C group than in the C-E group with pooled MD of 0.64 points (95% Cl: 0.09-1.20) and 0.47 (95% Cl: 0.05-0.90), respectively. There were no differences in cecal intubation time, adenoma detection rate, or polyp detection rate between the two groups. CONCLUSION The present study found that the discomfort score was better in the E-C group. However, there was no difference in polyp and adenoma detection. Therefore, the E-C group is the optimal sequence.
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Affiliation(s)
- Passisd Laoveeravat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA.,Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Subhanudh Thavaraputta
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Arunee Motes
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Abhilash Perisetti
- Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Benjamin Tharian
- Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Sameer Islam
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Ariwan Rakvit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA.,Division of Gastroenterology, Texas Tech University Health Sciences Center, Lubbock, USA
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Laoveeravat P, Thavaraputta S, Vutthikraivit W, Suchartlikitwong S, Mingbunjerdsuk T, Motes A, Nugent K, Rakvit A, Islam E, Islam S. Proton pump inhibitors and histamine-2 receptor antagonists on the risk of pancreatic cancer: a systematic review and meta-analysis. QJM 2020; 113:100-107. [PMID: 31503318 DOI: 10.1093/qjmed/hcz234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/06/2019] [Revised: 08/30/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) have been widely used for multiple purposes. Recent studies have suggested an association between these medications and the risk of pancreatic cancer. However, the results have been inconclusive. AIM We, therefore, conducted a study to assess the risk of developing pancreatic cancer in patients who used PPI and H2RA. DESIGN A systematic review and meta-analysis. METHODS A literature search was performed using MEDLINE and EMBASE databases from inception through February 2019. Studies that reported risk ratio comparing the risk of pancreatic cancer in patients who received PPI or H2RA versus those who did not receive treatments were included. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effect generic inverse variance method. Sensitivity analysis, excluding one study at a time, was performed. RESULTS After screening abstracts from the searching methods, seven studies (six case-control studies and one cohort study) were included in the analysis with total 546 199 participants. Compared to patients who did not take medications, the pooled RR of developing pancreatic cancer in patients receiving PPI and H2RA were 1.73 (95% CI: 1.16-2.57) and 1.26 (95% CI: 1.02-1.57), respectively. However, the sensitivity analysis of PPI changed the pooled RR to 1.87 (95% CI: 1.00-3.51) after a study was dropped out. Likewise, H2RA sensitivity analysis also resulted in non-significant pooled RR. CONCLUSIONS This meta-analysis did not find the strong evidence for the associations between the use of PPI and H2RA and pancreatic cancer.
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Affiliation(s)
- P Laoveeravat
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - S Thavaraputta
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - W Vutthikraivit
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - S Suchartlikitwong
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - T Mingbunjerdsuk
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - A Motes
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - K Nugent
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - A Rakvit
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Division of Gastroenterology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - E Islam
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - S Islam
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Vega MV, Mantilla B, Test V, Motes A, Makram J, Vutthikraivit W, Elmassry M. 36-YEAR-OLD MAN WITH ACUTE INFLUENZA AND SECONDARY BACTERIAL PNEUMONIA COMPLICATED BY HERPES VIRUS INFECTION. Chest 2019. [DOI: 10.1016/j.chest.2019.08.2099] [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: 10/25/2022] Open
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Motes A, Solis X, Test V, Mallah H, Makram J, Vega MV. EXERCISE-INDUCED PULMONARY HYPERTENSION IN A PATIENT WITH PREVIOUS PULMONARY EMBOLISM. Chest 2019. [DOI: 10.1016/j.chest.2019.08.708] [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: 11/24/2022] Open
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16
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Mallah H, Makram J, Paz P, Juarez RM, Elmassry M, Motes A, Orellana-Barrios M, Test V. TAKOSTSUBO CARDIOMYOPATHY AND CARDIOGENIC SHOCK INDUCED BY GI BLEEDING: A CASE REPORT. Chest 2019. [DOI: 10.1016/j.chest.2019.08.401] [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: 10/25/2022] Open
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Motes A, Möller B, Räbiger J. [Promoting competence in a model trial of a complementary course of study in health sciences/public health at the Berlin Technical University in cooperation with the Free University and other science and general practice institutions]. Gesundheitswesen 1993; 55 Suppl 2:106-9. [PMID: 8298206] [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: 01/29/2023]
Abstract
Since October 1992 (winter semester 92/93) graduates are being educated in Public Health at Berlin Technical University in cooperation with the Free University of Berlin as well as with the Humboldt University of Berlin and other institutions of science and practice in Berlin and Brandenburg. For the time being the course of studies is a pilot project for 4 years. The aim of the postgraduate studies is the creation of permanent structures and therefore institutionalisation. It is open to graduates and college graduates of public-health relevant subject areas of specialisation are "Health Promotion in the community and at the workplace" and "Planning and Management in Health Services". The course of studies takes 4 semesters and is divided into basic studies, studies of main points of emphasis and project studies. Social medicine and especially epidemiology are part of the basic disciplines, which are indispensable for finding the way of looking at problems concerning public health. The reason for the peculiarity with regard to establishing public health at other German universities are the main topics representing the interaction between the technical and ecological development of health. The graduate degree is "Magister of Public Health". During the time of the pilot project the course of studies is subjected to external and internal surveillance regarding quality assurance and quality optimisation of teaching and organisation of the studies. On the one hand this is done by an external advisory committee and on the other hand by internal and external evaluation.
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Affiliation(s)
- A Motes
- Gesundheitswissenschaften/Public Health, Technische Universität Berlin
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Motes A, Brost G, Rotgé J, Kim JJ. Temporal behavior of the intensity-dependent absorption in photorefractive BaTiO(3). Opt Lett 1988; 13:509-511. [PMID: 19745948 DOI: 10.1364/ol.13.000509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report measurements of response time for the intensity-dependent absorption in a single BaTiO(3) crystal under conditions in which no photorefractive effect can be observed. The speed of response is found to increase with increasing intensity but in a sublinear fashion similar to that observed for photorefractive decay. This experiment provides unambiguous evidence for the intensity-dependent absorption in BaTiO(3) crystals.
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Motes A, Kim JJ. Beam coupling in photorefractive BaTiO(3) crystals. Opt Lett 1987; 12:199-201. [PMID: 19738838 DOI: 10.1364/ol.12.000199] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Beam-coupling experiments are carried out with two BaTiO(3) crystals as a function of the intensity and wavelength. We demonstrate in these experiments that hole-electron competition is not the only mechanism responsible for the anomalous behavior of photorefractive BaTiO(3) crystals. We find that the intensity-dependent absorption coefficient plays a major role in beam-coupling experiments.
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