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Georges A, Chahal CAA. Pooled Genetic Screenings to Identify Likely Pathogenic Variants in Hypertrophic Cardiomyopathy. Circ Genom Precis Med 2024; 17:e004599. [PMID: 38497213 DOI: 10.1161/circgen.124.004599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Adrien Georges
- Université Paris Cité, Inserm, Paris Centre de Recherche Cardiovasculaire (PARCC), France (A.G.)
| | - Choudhary Anwar A Chahal
- Department of Cardiology, Center for Inherited Cardiovascular Diseases, WellSpan Health, York, PA (C.A.A.C.)
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (C.A.A.C.)
- William Harvey Research Institute, National Institute for Health and Care Research (NIHR) Barts Biomedical Centre, Queen Mary University London, United Kingdom (C.A.A.C.)
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Lopez-Medina AI, Campos-Staffico AM, A Chahal CA, Volkers I, Jacoby JP, Berenfeld O, Luzum JA. Genetic risk factors for drug-induced long QT syndrome: findings from a large real-world case-control study. Pharmacogenomics 2024; 25:117-131. [PMID: 38506312 DOI: 10.2217/pgs-2023-0229] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Aim: Drug-induced long QT syndrome (diLQTS), an adverse effect of many drugs, can lead to sudden cardiac death. Candidate genetic variants in cardiac ion channels have been associated with diLQTS, but several limitations of previous studies hamper clinical utility. Materials & methods: Thus, the purpose of this study was to assess the associations of KCNE1-D85N, KCNE2-I57T and SCN5A-G615E with diLQTS in a large observational case-control study (6,083 self-reported white patients treated with 27 different high-risk QT-prolonging medications; 12.0% with diLQTS). Results: KCNE1-D85N significantly associated with diLQTS (adjusted odds ratio: 2.24 [95% CI: 1.35-3.58]; p = 0.001). Given low minor allele frequencies, the study had insufficient power to analyze KCNE2-I57T and SCN5A-G615E. Conclusion: KCNE1-D85N is a risk factor for diLQTS that should be considered in future clinical practice guidelines.
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Grants
- F32 HL162231, K08 HL146990, R01-HL156961, R21-EB032661, R21-HL153694, T32 TR004371 CSR NIH HHS
- F32 HL162231, K08 HL146990, R01-HL156961, R21-EB032661, R21-HL153694, T32 TR004371 CSR NIH HHS
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Affiliation(s)
- Ana I Lopez-Medina
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Choudhary Anwar A Chahal
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Isabella Volkers
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Juliet P Jacoby
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Omer Berenfeld
- Center for Arrhythmia Research, Departments of Internal Medicine - Cardiology, Biomedical Engineering, & Applied Physics, University of Michigan, Ann Arbor, MI, USA
| | - Jasmine A Luzum
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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Lopez-Medina AI, Chahal CAA, Luzum JA. The genetics of drug-induced QT prolongation: evaluating the evidence for pharmacodynamic variants. Pharmacogenomics 2022; 23:543-557. [PMID: 35698903 DOI: 10.2217/pgs-2022-0027] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Drug-induced long QT syndrome (diLQTS) is an adverse effect of many commonly prescribed drugs, and it can increase the risk for lethal ventricular arrhythmias. Genetic variants in pharmacodynamic genes have been associated with diLQTS, but the strength of the evidence for each of those variants has not yet been evaluated. Therefore, the purpose of this review was to evaluate the strength of the evidence for pharmacodynamic genetic variants associated with diLQTS using a novel, semiquantitative scoring system modified from the approach used for congenital LQTS. KCNE1-D85N and KCNE2-T8A had definitive and strong evidence for diLQTS, respectively. The high level of evidence for these variants supports current consideration as risk factors for patients that will be prescribed a QT-prolonging drug.
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Affiliation(s)
- Ana I Lopez-Medina
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA
| | - Choudhary Anwar A Chahal
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.,Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.,WellSpan Health, Lancaster, PA 17607, USA
| | - Jasmine A Luzum
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA
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Siripanthong B, Hanff TC, Levin MG, Vidula MK, Khanji MY, Nazarian S, Chahal CAA. Coronavirus disease 2019 is delaying the diagnosis and management of chest pain, acute coronary syndromes, myocarditis and heart failure. Future Cardiol 2020; 17:3-6. [PMID: 32608242 PMCID: PMC7328666 DOI: 10.2217/fca-2020-0088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Thomas C Hanff
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA
| | - Michael G Levin
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA
| | - Mahesh K Vidula
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA
| | - Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital and Barts Heart Centre, Barts Health NHS Trust, London, E13 8SL, UK
| | - Saman Nazarian
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA
| | - Choudhary Anwar A Chahal
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA.,Mayo Clinic Rochester, MN 55905, United States.,Royal Papworth Hospital, NHS Trust, Cambridge, CB2 0AY, UK
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Abstract
Injury by contaminated sharp instruments and needles constitutes a major occupational hazard for healthcare workers. In a confidential survey at a district general hospital, 300 healthcare professionals were asked about their personal experience of needle-stick injury and their attitudes to reporting. 279 individuals responded, of whom 38% had experienced at least one needle-stick (mean 1.8) in the past year and 74% had sustained such an injury during their careers (mean 3.0). Although 80% of respondents were aware that such incidents should be notified, only 51% of those affected had reported all needle-stick injuries. Doctors were less likely to report than nurses, despite a higher liability to injury. This survey adds to evidence of a culture of silence pertaining to needle-stick injuries. The consequent risks to health, and the ethical and financial implications, remain uncertain.
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Affiliation(s)
- B Elmiyeh
- Department of Anatomy, University of Cambridge, Cambridge, UK
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Shahid F, Akhtar M, Khan F, Chahal CAA. Intra-aortic balloon pump counterpulsation: are we optimizing the management of cardiogenic shock? J R Soc Med 2013; 106:51-6. [PMID: 23401636 DOI: 10.1258/jrsm.2012.120083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Intra-aortic balloon pump counterpulsation (IABPC) has been used in various forms for decades. The change in physiology brought about by their use is conceptually appealing in managing cardiogenic shock and mechanical complications of myocardial infarction. A common myth is that this method of managing acute cardiological emergencies is to be limited to the realms of this specialist field. However, as medical physicians an appreciation and understanding of this novel therapy is essential not only as a lifesaving measure but also as a bridging therapy to more definitive management in the acute medical setting. IABPC is a safe and under-utilized technique despite featuring in all major international guidelines (ESC and ACC) for the management of cardiogenic shock secondary to acute coronary syndromes. Without awareness of this intervention we may be suboptimally managing patients in the first instance. To improve awareness we examine the evidence supporting the use of the IABPC therapy and the contraindications to their use. Complications and advances in technology are also addressed.
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Affiliation(s)
- F Shahid
- Department of Cardiology, London Chest Hospital NHS Trust, London E2 9JX, UK
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Abstract
Multiple clinical trials have shown that aspirin can reduce all cardiovascular events in primary and secondary prevention and yet there is a large population in whom aspirin fails. This review brings together the evidence and controversies surrounding the definition of ‘aspirin treatment failure’, its clinical significance and the possible approaches to managing such patients. Several different assays have been developed to measure the biochemical action of aspirin. At present there is no ‘gold standard’ and there is massive disparity between methods. Studies thus far have shown inconsistent results and to date the treatment of aspirin therapy failure is left to the discretion of the leading physician.
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Affiliation(s)
- F Shahid
- Department of Cardiology, Newham University Hospital NHS Trust , London E13 8SL , UK
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Dargan PI, Bishop CR, Chahal CAA, Jones AL, Wood DM. Can medical students identify recreational drugs by name? QJM 2008; 101:979-82. [PMID: 18786980 DOI: 10.1093/qjmed/hcn110] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recreational drug toxicity is a common reason for presentation to the Emergency Department. Knowledge of recreational drug names is important to allow targeted assessment of patients presenting with recreational drug toxicity. AIMS To assess final year medical student knowledge of proper and street names for recreational drugs. DESIGN Questionnaire survey of final year medical students attending a revision lecture. METHODS There were two questionnaires used in this study. The first contained either proper names of recreational drugs or names sounding similar to recreational drugs or licensed pharmaceutical products; students were asked to identify which of these were recreational drugs. The second contained street names of recreational drugs and the students were asked to identify which recreational drug the street name referred to. RESULTS One hundred and thirty-five students completed the questionnaire 1. The mean total score (+/-SD) of correct answers was 7.15 +/- 2.26 (range 2-13) out of a maximum of 15. One hundred and fifteen students completed questionnaire 2. The mean total score (+/-SD) of correctly identified street names was 11.0 +/- 2.6 (range 0-17) out of a maximum of 24. No individual student was able to correctly identify all the street names for the recreational drugs listed in the survey. CONCLUSION We have shown that final year medical students have variable knowledge of both the proper and street names of recreational drugs. There is a need for improved education of medical students in the names of recreational drugs and the sources of information available to assist them in identifying what drugs an individual has taken.
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Affiliation(s)
- P I Dargan
- Guy's and St Thomas' Poisons Unit, Guy's and St Thomas' NHS Foundation Trust, Avonley Road, London, SE14 5ER, UK
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Whitaker IS, Chahal CAA, Foo ITH. Aenictinae: the arthropodic suture. Br J Oral Maxillofac Surg 2005; 43:362. [PMID: 16106518 DOI: 10.1016/j.bjoms.2005.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Whitaker IS, Cheung CK, Chahal CAA, Karoo ROS, Gulati A, Foo ITH. By what mechanism do leeches help to salvage ischaemic tissues? A review. Br J Oral Maxillofac Surg 2005; 43:155-60. [PMID: 15749217 DOI: 10.1016/j.bjoms.2004.09.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2004] [Indexed: 11/19/2022]
Abstract
The therapeutic use of leeches in medicine dates back to 50 b.c. and was cited by ancient authors. The medicinal leech, Hirudo medicinalis, has been used with increasing frequency during the past few years by reconstructive surgeons to help salvage ischaemic tissues. We aim to summarise the anatomy, physiology, and pharmacological mechanisms of action of leeches to provide reconstructive surgeons with a theoretical basis for their use.
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Affiliation(s)
- I S Whitaker
- Department of Otolaryngology and Head and Neck Surgery, Leeds General Infirmary, Leeds, UK.
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Elmiyeh B, Whitaker IS, James MJ, Chahal CAA, Galea A, Alshafi K. Needle-stick injuries in the National Health Service: a culture of silence. J R Soc Med 2004. [PMID: 15229257 DOI: 10.1258/jrsm.97.7.326] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Injury by contaminated sharp instruments and needles constitutes a major occupational hazard for healthcare workers. In a confidential survey at a district general hospital, 300 healthcare professionals were asked about their personal experience of needle-stick injury and their attitudes to reporting. 279 individuals responded, of whom 38% had experienced at least one needle-stick (mean 1.8) in the past year and 74% had sustained such an injury during their careers (mean 3.0). Although 80% of respondents were aware that such incidents should be notified, only 51% of those affected had reported all needle-stick injuries. Doctors were less likely to report than nurses, despite a higher liability to injury. This survey adds to evidence of a culture of silence pertaining to needle-stick injuries. The consequent risks to health, and the ethical and financial implications, remain uncertain.
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Affiliation(s)
- B Elmiyeh
- Department of Anatomy, University of Cambridge, Cambridge, UK
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