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Ghozy S, El-Qushayri AE, Reda A, Oussama Kacimi SE, Kobeissi H, Mouffokes A, Awad DM, Kadirvel R, Kallmes DF. Off-Label Use of the 8-F Angio-Seal for Closure of Greater than 8-F Common Femoral Arterial Access: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2023; 34:1946-1954.e5. [PMID: 37468092 DOI: 10.1016/j.jvir.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE To evaluate the safety of >8-F access closures using 8-F Angio-Seal. MATERIALS AND METHODS An electronic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines using Web of Science, Embase, Scopus, and PubMed databases from inception until January 17, 2022. Actionable and nonactionable bleeding events were defined in conjugation with the Bleeding Academic Research Consortium definition. Prevalence rates with corresponding 95% CIs were calculated using R software version 4.2.2. Eight articles, with 422 patients, were included in the analysis. RESULTS The overall groin adverse event rate was 5.92% (95% CI, 3.01-11.34). The most commonly reported adverse events were any bleeding (5.74%; 95% CI, 3.23-10.00) (nonactionable bleeding, 0.96% [95% CI, 0.10-8.30]; actionable bleeding, 2.30% [95% CI, 0.89-5.84]), pseudoaneurysm (1.18%; 95% CI, 0.49-2.81), and groin hematoma (1.28%; 95% CI, 0.23-6.79). The least commonly reported adverse events were device failure and vessel occlusion/stenosis, with rates 0.29% (95% CI, 0.01-7.41) and 0.45% (95% CI, 0.02-7.74), respectively. No studies recorded events regarding the following adverse events: mortality, infection, deep venous thrombosis, and retroperitoneal hematoma. Moreover, the results showed significant differences, based on the sheath size used, in actionable bleeding (P = .04) and the rate of need for surgical repair (P < .01). CONCLUSIONS Common femoral artery access of >8-F can be effectively closed with the Angio-Seal with comparable outcomes to those of <8 F; however, larger access approaching 14 F is associated with a significant increase in morbidity. Further safety is needed, especially for the larger access sizes.
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Affiliation(s)
- Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (Evidence-Based Healthcare Program), Oxford University, Oxford, United Kingdom.
| | | | | | | | - Hassan Kobeissi
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan
| | | | | | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Farahat RA, Salamah HM, Mahmoud A, Hamouda E, Hashemy M, Hamouda H, Samir A, Chenfouh I, Marey A, Awad DM, Farag E, Abd-Elgawad M, Eldesouky E. The efficacy of oxytocin gel in postmenopausal women with vaginal atrophy: an updated systematic review and meta-analysis. BMC Womens Health 2023; 23:494. [PMID: 37716966 PMCID: PMC10505316 DOI: 10.1186/s12905-023-02645-0] [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] [Received: 02/12/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Genitourinary syndrome of menopause (GSM) is a common and disturbing issue in the postmenopausal period. Unlike vasomotor symptoms, it has a progressive trend. Our study aims to evaluate the efficacy and safety of oxytocin gel versus placebo gel in postmenopausal women with GSM. METHODS A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from Web of Science, SCOPUS, PubMed, and Cochrane Central Register of Controlled Trials databases on January 18, 2023. Keywords such as "oxytocin," "intravaginal," "vaginal," "atrophic," and "atrophy" were used. We used Review Manager (RevMan) version 5.4 in our analysis. We used the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes; both were presented with the corresponding 95% confidence interval (CI) and were calculated with the Mantel-Haenszel or inverse variance statistical method. Cochrane's Q test and the I2 statistic were used as measures of statistical inconsistency and heterogeneity. The Cochrane Risk of Bias Tool for RCTs was used for the quality assessment of the included studies. RESULTS Seven studies with 631 patients were included. Regarding the maturation index, there was a statistically insignificant increase in the oxytocin arm (MD = 12.34, 95% CI (-12.52-37.19), P = 0.33). Clinically assessed vaginal atrophy showed a statistically significant reduction in the oxytocin group (RR = 0.32, 95% CI (0.23 - 0.10), P < 0.00001). For dyspareunia, vaginal pH, and histological evaluation of vaginal atrophy, there was a statistically insignificant difference between the two groups (RR = 1.02, 95% CI (0.82-1.27), P = 0.84), (MD = -0.74, 95% CI (-1.58-0.10), P = 0.08), and (MD = -0.38, 95% CI (-0.82-0.06), P = 0.09), respectively. There was no significant difference in the safety profile between the two groups as measured by endometrial thickness (MD = 0.00, 95% CI (-0.23-0.23), P = 0.99). CONCLUSIONS Although oxytocin has been proposed as a viable alternative to estrogen in the treatment of GSM, our findings show the opposite. Larger, high-quality RCTs are needed to confirm or refute our results. TRIAL REGISTRATION PROSPERO registration number CRD42022334357.
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Affiliation(s)
| | | | | | - Esraa Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Heba Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ali Samir
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Imane Chenfouh
- Faculty of Medicine and Pharmacy, Oujda, Oujda-Angad, Morocco
| | - Ahmed Marey
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Dina M Awad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Elsayed Farag
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University, Cairo, Egypt
| | | | - Elsayed Eldesouky
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University, Cairo, Egypt
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Motawea KR, Elhalag RH, Aboelenein M, Ibrahim N, Swed S, Fathy H, Awad DM, Mohamed Belal M, Talaat NE, Rozan SS, Aiash H, Mostafa MR. Association of aortic valve calcification and high levels of lipoprotein (a): Systematic review and Meta-analysis. Curr Probl Cardiol 2023; 48:101746. [PMID: 37100357 DOI: 10.1016/j.cpcardiol.2023.101746] [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: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
AIM This study aimed to assess the association between aortic valve calcification and lipoprotein (a). METHODS We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any controlled clinical trials or observational studies that reported the level of Lipoprotein A in patients with aortic valve calcifications, excluding case reports, editorials and animal studies. RevMan software (5.4) was used to perform the meta-analysis. RESULTS After complete screening, 7 studies were included with a total number of 446179 patients included in the analysis. The pooled analysis showed a statistically significant association between the incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls (SMD = 1.71, 95% CI = 1.04 to 2.38, p-value < 0.00001). CONCLUSION This meta-analysis showed a statistically significant association between the incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls. Patients with high levels of lipoprotein (a) are at increased risk of developing aortic valve calcification. Medications targeting lipoprotein (a) in future clinical trials may be useful in primary prevention of aortic valve calcification in high risk patients.
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Affiliation(s)
| | | | | | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Hager Fathy
- Faculty of Medicine, Minia University, Egypt
| | - Dina M Awad
- Faculty of Medicine, Alexandria University, Egypt
| | | | | | | | - Hani Aiash
- Upstate Medical University, NY, USA, Cardiovascular perfusion Department
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4
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Motawea KR, Mostafa MR, Aboelenein M, Magdi M, Fathy H, Swed S, Belal MM, Awad DM, Elhalag RH, Talat NE, Rozan SS, Nashwan AJ, Battikh N, Sawaf B, Albuni MK, Battikh E, Mohamed GM, Farwati A, Aiash H. Anteriolateral versus anterior-posterior electrodes in external cardioversion of atrial fibrillation: A systematic review and meta-analysis of clinical trials. Clin Cardiol 2023; 46:359-375. [PMID: 36756856 PMCID: PMC10106664 DOI: 10.1002/clc.23987] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/15/2023] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
The efficacy of anteriolateral versus anterior-posterior electrode positions in the success of atrial fibrillation's (AF) electrical cardioversion is unclear. Our aim is to perform a meta-analysis to compare the success rate of both electrode positions. PUBMED, WOS, OVID, and SCOPUS were searched. Inclusion criteria were clinical trials that compared anterior-lateral with anterior-posterior electrodes in external cardioversion of AF. After the full-text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior-lateral electrode and increased cardioversion rate of AF (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.02-1.92, p = .04). Subgroup analysis revealed a statistically significant association between the anterior-lateral electrode and increased cardioversion rate of AF in subgroups of less than five shocks, patients with 60 years old or more and patients with left atrial (LA) diameter >45 mm (OR = 1.72, 95% CI = 1.17-2.54, p = .006), (OR = 1.73, 95% CI = 1.18-2.54, p = .005), and (OR = 1.86, 95% CI = 1.04-3.34, p = .04), respectively. Anteriolateral electrode is more effective than anterior-posterior electrode in external cardioversion of AF, particularly in patients who have received less than 5 shocks, are 60 years old or older and have a LA diameter greater than 45 mm.
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Affiliation(s)
- Karam R Motawea
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mostafa R Mostafa
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, New York, USA
| | | | - Mohamed Magdi
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, New York, USA
| | - Hager Fathy
- Faculty of Medicine, Minia University, Minya, Egypt
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Mohamed M Belal
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Dina M Awad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rowan H Elhalag
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nesreen E Talat
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samah S Rozan
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Naim Battikh
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mhd K Albuni
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Elias Battikh
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Gihan M Mohamed
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Amr Farwati
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hani Aiash
- Cardiovascular Perfusion Department, Upstate Medical University, Syracuse, New York, USA
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Motawea KR, Rabea RK, Elhalag RH, Goodloe J, Awad DM, Kaur M, Awad AK, Swed S, Varney J. Cosmetic operative care abroad leads to a multidrug-resistant Mycobacterium abscessus infection in a patient: a case report. J Med Case Rep 2022; 16:448. [PMID: 36447286 PMCID: PMC9710160 DOI: 10.1186/s13256-022-03678-z] [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: 01/06/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The Mycobacterium abscessus complex is a nontuberculous mycobacteria species that is pervasive in soil and water. Various medical equipment malfunctions, infected surfaces, and patient transmission are potential causes of Mycobacterium abscessus infection in the hospital environment. These cases have an annual prevalence that ranges from 1.4 to 6.6 per 100,000 infections, mainly increasing. CASE PRESENTATION We present the case of a 23-year-old American female patient who presented to the emergency room with significant abdominal pain between low pelvic sutures and the umbilicus. She reported abdominal pain, pruritus, and boils on her back preventing her from standing upright. The symptoms occurred in the liposuction area after cosmetic surgery in the Dominican Republic. The clinical, radiological, and cultural findings helped diagnose Mycobacterium abscessus infection. We conducted a mini literature review on the published reports of Mycobacterium abscessus. CONCLUSION Mycobacterium abscessus infection may occur due to surgical procedures abroad. Measures are required to combat Mycobacterium abscessus and reduce its prevalence in hospital settings.
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Affiliation(s)
- Karam R. Motawea
- grid.7155.60000 0001 2260 6941Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Randa K. Rabea
- grid.7269.a0000 0004 0621 1570Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rowan H. Elhalag
- grid.7155.60000 0001 2260 6941Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jason Goodloe
- grid.464520.10000 0004 0614 2595School of Medicine, American University of the Caribbean, Philipsburg, Sint Maarten
| | - Dina M. Awad
- grid.7155.60000 0001 2260 6941Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Manmeet Kaur
- grid.464520.10000 0004 0614 2595School of Medicine, American University of the Caribbean, Philipsburg, Sint Maarten
| | - Ahmed K. Awad
- grid.7269.a0000 0004 0621 1570Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sarya Swed
- grid.42269.3b0000 0001 1203 7853Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Joseph Varney
- grid.464520.10000 0004 0614 2595School of Medicine, American University of the Caribbean, Philipsburg, Sint Maarten
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Motawea KR, Kandil OA, Varney J, Aboelenein M, Ibrahim N, Shaheen A, Khairy LT, Bakkour A, Muwaili AHH, Muwaili DHH, Abdelmajid FAA, Ahmad EMS, Albuni MK, Battikh E, Sawaf B, Swed S, Ahmed SMA, Awad DM, Shah J, Aiash H. Association of familial Mediterranean fever and epicardial adipose tissue: A systematic review and meta‐analysis. Health Sci Rep 2022; 5:e693. [PMID: 35734339 PMCID: PMC9193962 DOI: 10.1002/hsr2.693] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/15/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Aim Some studies reported a positive link between familial Mediterranean fever (FMF) and epicardial adipose tissue. Our meta‐analysis aimed to evaluate whether there is a significant association between FMF and increased epicardial adipose tissue thickness. Methods We searched the following databases: PUBMED, WOS, OVID, SCOPUS, and EMBASE. Inclusion criteria were any original articles that reported epicardial adipose tissue in FMF patients with no age restriction, excluding reviews, case reports, editorials, animal studies, and non‐English studies. Thirty eligible studies were screened full text but only five studies were suitable. We used RevMan software (5.4) for the meta‐analysis. Results The total number of patients included in the meta‐analysis in the FMF patients group is 256 (mean age = 24.3), and the total number in the control group is 188 (mean age = 24.98). The pooled analysis between FMF patients and controls was [mean difference = 0.82 (95% CI = 0.25–1.39), p‐value = 0.005]. We observed heterogeneity that was not solved by random effects (p > 0.00001). We performed leave one out test by removing the Kozan et al. study, and the heterogeneity was solved (p = 0.07), and the results were (MD = 0.98, 95% CI = 0.52–1.43, p‐value < 0.0001). Conclusion FMF patients are at increased risk of developing epicardial adipose tissue compared to controls. More multicenter studies with higher sample sizes are needed to support our results.
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Affiliation(s)
| | | | - Joseph Varney
- School of Medicine American University of the Caribbean Cupecoy Sint Maarten
| | | | - Nancy Ibrahim
- Faculty of Medicine Alexandria University Alexandria Egypt
| | - Ahmed Shaheen
- Faculty of Medicine Alexandria University Alexandria Egypt
| | - Lina T. Khairy
- Faculty of Medicine The National Ribat University Al‐Ribat Sudan
| | | | - Ali H. H. Muwaili
- Faculty of Medicine Ivano‐Frankivsk National Medical University Ivano‐Frankivsk Ukraine
| | - Dhuha H. H. Muwaili
- Faculty of Medicine Ivano‐Frankivsk National Medical University Ivano‐Frankivsk Ukraine
| | | | - Eman M. S. Ahmad
- Departments of Obstetrics and Gynecology Nile Valley University Atbra Sudan
| | - Mhd K. Albuni
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Elias Battikh
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Bisher Sawaf
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Sarya Swed
- Faculty of Medicine Aleppo University Aleppo Syria
| | | | - Dina M. Awad
- Faculty of Medicine Alexandria University Alexandria Egypt
| | - Jaffer Shah
- Medical Research Center Kateb University Kabul Afghanistan
| | - Hani Aiash
- Cardiovascular perfusion Department Upstate Medical University Syracuse New York USA
- Family Medicine Department Suez Canal University Ismailia Governorate Egypt
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Kacimi SEO, Sukaina M, Elgenidy A, Farahat RA, Cheema HA, Benmelouka AY, Awad DM, Belaouni HA, Abdelli MK, Tidjane A, Mesli NS, Shah J, Setti MO, Afifi AM, Ghozy S, the Ramadan Diabetes Research Group (RDRG) Collaborators. Hypoglycemic Events in Diabetic Patients under Non-insulin Regimens During Ramadan: A Frequentist Network Meta-Analysis.. [DOI: 10.1101/2022.05.28.22275730] [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: 09/01/2023]
Abstract
AbstractBackgroundDiabetic Muslims who choose to fast during Ramadan encounter major risks such as hyperglycemia, hypoglycemia, diabetic ketoacidosis, and dehydration. Recently, newer antidiabetic agents have been found to be less likely to cause hypoglycemic emergencies. This meta-analysis aimed to present collective and conclusive results from major randomized controlled trials (RCTs) to determine the risk of hypoglycemia among patients taking oral antidiabetics during Ramadan.MethodsWe searched PubMed, Web of Science, and Google Scholar for RCTs. We performed a frequentist network meta-analysis using the “netmeta” package of R software version 4.1.1 to investigate the risk of developing hypoglycemia after taking oral antidiabetic drugs during Ramadan.ResultsNine RCTs with a total of 3464 patients were included in the final analysis. In the comparison of all antidiabetic drug classes with sulfonylureas, SGLT-2 inhibitors were associated with the lowest hypoglycemic risk (RR, 0.18; 95% CI, 0.04-0.78; P-score, 0.909), followed by GLP-1 agonists (RR, 0.31; 95% CI, 0.17-0.56; P-score, 0.799), and DDP-4 inhibitors (RR, 0.57; 95% CI, 0.43-0.75; P-score, 0.483). When comparing individual drugs, dapagliflozin was associated with the lowest hypoglycemic risk (RR, 0.18; 95% CI, 0.04-0.78; P-score, 0.874), followed by lixisenatide (RR, 0.25; 95% CI, 0.09-0.71; P-score, 0.813), liraglutide (RR, 0.34; 95% CI, 0.17-0.69; P-score, 0.715), and sitagliptin (RR. 0.51; 95% CI, 0.37-0.71; P-score, 0.515).ConclusionSGLT-2 inhibitors are associated with the least documented hypoglycemic events and adverse outcomes compared with other oral hypoglycemic drugs. These findings could have considerable public health and clinical implications when extrapolated to the global Muslim population with a similar clinical background.Abstract Figure
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Varney J, Motawea KR, Mostafa MR, AbdelQadir YH, Aboelenein M, Kandil OA, Ibrahim N, Hashim HT, Murry K, Jackson G, Shah J, Boury M, Awad AK, Patel P, Awad DM, Rozan SS, Talat NE. Efficacy of heads-up CPR compared to supine CPR positions: Systematic review and meta-analysis. Health Sci Rep 2022; 5:e644. [PMID: 35620549 PMCID: PMC9128396 DOI: 10.1002/hsr2.644] [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: 12/22/2021] [Revised: 03/03/2022] [Accepted: 04/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Aim Cardiopulmonary resuscitation (CPR) in full-coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads-up CPR versus supine CPR. Methods We searched PubMed Central, SCOPUS, Web of Science, and Cochrane databases from 1990 to February 2021. After the full-text screening of 40 eligible studies, only seven studies were eligible for our meta-analysis. We used the RevMan software (5.4) to perform the meta-analysis. Results In survival outcome, the pooled analysis between heads-up and supine CPR was (risk ratio = 0.98, 95% confidence interval [CI] = 0.17-5.68, p = 0.98). The pooled analyses between heads-up CPR and supine CPR in cerebral flow, cerebral perfusion pressure and coronary perfusion pressure outcomes, were (mean difference [MD] = 0.10, 95% CI = 0.03-0.17, p = 0.003), (MD = 12.28, 95% CI = 5.92-18.64], p = 0.0002), and (MD = 8.43, 95% CI = 2.71-14.14, p = 0.004), respectively. After doing a subgroup analysis, cerebral perfusion was found to increase during heads-up CPR compared with supine CPR at 6 min CPR duration and 18 to 20 min CPR duration as well. Conclusion Our study suggests that heads-up CPR is associated with better cerebral and coronary perfusion compared to the conventional supine technique in pigs' models. However, more research is warranted to investigate the safety and efficacy of the heads-up technique on human beings and to determine the best angle for optimization of the technique results.
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Affiliation(s)
- Joseph Varney
- School of Medicine American University of the Caribbean Philipsburg Sint Maarten (Dutch Part)
| | | | | | | | | | | | - Nancy Ibrahim
- Faculty of Medicine Alexandria University Alexandria Egypt
| | | | | | - Garrett Jackson
- School of Medicine American University of the Caribbean Philipsburg Sint Maarten (Dutch Part)
| | - Jaffer Shah
- Kateb University Medical Research Center Kateb University Kabul Afghanistan.,New York State Department of Health New York USA
| | - Maty Boury
- School of Medicine American University of the Caribbean Philipsburg Sint Maarten (Dutch Part)
| | - Ahmed K Awad
- Faculty of Medicine Ain-Shams University Cairo Egypt
| | - Priya Patel
- School of Medicine American University of the Caribbean Philipsburg Sint Maarten (Dutch Part)
| | - Dina M Awad
- Faculty of Medicine Alexandria University Alexandria Egypt
| | - Samah S Rozan
- Faculty of Medicine Alexandria University Alexandria Egypt
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9
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Varney J, Motawea KR, Kandil OA, Hashim HT, Murry K, Shah J, Shaheen A, Akwari J, Awad AK, Rivera A, Mostafa MR, Swed S, Awad DM. Prehospital administration of broad‐spectrum antibiotics for sepsis patients: A systematic review and meta‐analysis. Health Sci Rep 2022; 5:e582. [PMID: 35387313 PMCID: PMC8973268 DOI: 10.1002/hsr2.582] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/11/2022] [Accepted: 03/09/2022] [Indexed: 11/14/2022] Open
Abstract
Background and Aims Some studies have suggested that earlier initiation of antibiotics has shown positive outcomes in sepsis patients. We aimed to do a systematic review and meta‐analysis to evaluate the effect of prehospital administration of antibiotics on 28 days mortality and length of stay in hospital and intensive care unit for sepsis patients. Methods We formulated a search strategy and used it on search databases PubMed, Scopus, Web of Science, and Embase. We then screened the records for eligibility and included controlled studies, either clinical trials or cohort studies reporting prehospital antibiotic administration for sepsis patients. We excluded duplicates, books, conferences' abstracts, case reports, editorials, letters, author responses, not English studies, and studies with nonavailable full text. Animal and lab studies were also excluded. Results The total number of studies identified is 1811, 19 were eligible for systematic review and 4 for meta‐analysis (three cohort and one clinical trial). The total number of sepsis patients in the four included studies in the 28 days mortality outcome was 3523 (1779 took prehospital antibiotics and 1744 did not take prehospital antibiotics). Of 1779 who took the antibiotics, 190 died, and of 1744 who did not take antibiotics, 292 died (95% confidence interval 0.68–0.97, p = 0.02). Conclusion This meta‐analysis reveals that receiving prehospital antibiotics can significantly lower mortality in sepsis patients compared to patients who do not receive prehospital antibiotics. However, more clinical trials and multicenter prospective studies with high sample sizes are needed to get strong evidence supporting our findings.
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Affiliation(s)
- Joseph Varney
- School of Medicine American University of the Caribbean Cupecoy Sint Maarten
| | | | | | - Hashim T. Hashim
- College of Medicine University of Baghdad Nassiryah Dhi Qar Iraq
| | | | - Jaffer Shah
- Medical Research Center Kateb Univeristy Kabul Afghanistan
- New York State Department of Health New York USA
| | - Ahmed Shaheen
- Faculty of Medicine Alexandria University Alexandria Egypt
| | - Joy Akwari
- School of Medicine American University of the Caribbean Cupecoy Sint Maarten
| | - Ahmed K. Awad
- Faculty of Medicine Ain‐Shams University Cairo Egypt
| | - Amanda Rivera
- School of Medicine American University of the Caribbean Cupecoy Sint Maarten
| | | | - Sarya Swed
- Faculty of Medicine Aleppo university Aleppo Syria
| | - Dina M. Awad
- Faculty of Medicine Alexandria University Alexandria Egypt
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10
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Rabea EM, Abbas KS, Awad DM, Elgoweini NH, El-Sakka AA, Mahmoud NH, Abdelazeem B. Does ramadan fasting affect the therapeutic and clinical outcomes of warfarin? a systematic review and meta-analysis. Eur J Clin Pharmacol 2022; 78:755-763. [PMID: 35179616 DOI: 10.1007/s00228-022-03281-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/28/2021] [Accepted: 01/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Warfarin's therapeutic effect is affected by many factors, including diet modifications. The impact of Ramadan fasting on warfarin is controversial. The aim of this systematic review and meta-analysis was to investigate the effect of Ramadan fasting on patients taking warfarin. METHODS A literature search was done in PubMed, WOS, Scopus, and Embase from inception to May 24, 2021. All relevant studies measuring the international normalized ratio (INR), time in therapeutic range (TTR), or the number of patients within therapeutic range before, during, and after Ramadan were assessed by full-text screening for achieving all of the inclusion criteria. We used the Newcastle-Ottawa Scale for quality assessment and RevMan 5.4 software for meta-analysis. RESULTS A total of five studies with 446 patients were included in the meta-analysis. The patients served as their own control. Our pooled analyses showed no significant difference during Ramadan compared to pre-Ramadan (MD: 0.08; 95% CI: - 0.00, 0.15; P = 0.06) and post-Ramadan (MD: - 0.00; 95% CI: - 0.14, 0.14; P = 1.00, respectively). There was only a significant increase in the risk ratio of supratherapeutic INR when comparing post-Ramadan vs. pre-Ramadan (RR: 1.69; 95% CI: 1.22, 2.33; P = 0.001). However, there was no significant risk for supratherapeutic INR during Ramadan compared to pre-Ramadan or post-Ramadan; the number of patients within the therapeutic range of INR during Ramadan compared to pre-Ramadan; and TTR during Ramadan, pre-Ramadan, and post-Ramadan. CONCLUSION Ramadan fasting did not affect INR level, TTR, or the number of patients within the therapeutic range before, during, and after Ramadan. However, there was a possibility of achieving a supratherapeutic INR post-Ramadan compared to pre-Ramadan. Therefore, INR monitoring and warfarin dose adjustments accordingly are recommended after Ramadan.
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Affiliation(s)
| | | | - Dina M Awad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Nada H Mahmoud
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Basel Abdelazeem
- McLaren Health Care, Flint, MI, USA. .,Michigan State University, East Lansing, MI, USA.
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Fouda B, Tram HPB, Makram OM, Abdalla AS, Singh T, Hung IC, Raut A, Hemmeda L, Alahmar M, ElHawary AS, Awad DM, Huy NT. Identifying SARS-CoV2 transmission cluster category: An analysis of country government database. J Infect Public Health 2021; 14:461-467. [PMID: 33743366 PMCID: PMC7813483 DOI: 10.1016/j.jiph.2021.01.006] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/29/2020] [Accepted: 01/08/2021] [Indexed: 01/21/2023] Open
Abstract
Background As a result of the high contagiousness and transmissibility of SARS-CoV-2, studying the location of the case clusters that will follow, will help understand the risk factors related to the disease transmission. In this study, we aim to identify the transmission cluster category and settings that can guide decision-makers which areas to be opened again. Methods A thorough review of the literature and the media articles were performed. After data verification, we included cluster data from eight countries as of 16th May 2020. Clusters were further categorized into 10 categories and analysis was performed. The data was organized and presented in an easily accessible online sheet. Results Among the eight included countries, we have found 3905 clusters and a total number of 1,907,944 patients. Indoor settings (mass accommodation and residential facilities) comprised the highest number of both number of clusters (3315/3905) and infected patients (1,837,019/1,907,944), while the outdoor ones comprised 590 clusters and 70,925 patients. Mass accommodation was associated with the highest number of cases in 5 of the 7 countries with data available. Social events and residential settings were responsible for the highest number of cases in the two remaining countries. In the USA, workplace facilities have reported 165 clusters of infection including 122 food production facilities. Conclusions Lockdown could truly be a huge burden on a country’s economy. However, with the proper knowledge concerning the transmissibility and the behaviour of the disease, better decisions could be made to guide the appropriate removal of lockdown across the different fields and regions.
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Affiliation(s)
- Basem Fouda
- School of Medicine, Trinity College Dublin, Dublin, Ireland; Online Research Club, Nagasaki, Japan(2).
| | - Ha P B Tram
- Online Research Club, Nagasaki, Japan(2); VN-UK Institute for Research and Executive Education, The University of Danang, Danang, Vietnam.
| | - Omar M Makram
- Online Research Club, Nagasaki, Japan(2); Department of Cardiology, Faculty of Medicine, October 6 University, Giza, Egypt; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Abdelrahman S Abdalla
- Online Research Club, Nagasaki, Japan(2); Faculty of Medicine, Minia University, El-Minya, Egypt.
| | - Tushar Singh
- School of Medicine, Trinity College Dublin, Dublin, Ireland; Online Research Club, Nagasaki, Japan(2).
| | | | - Akshay Raut
- Online Research Club, Nagasaki, Japan(2); Rajarshee Chhatrapati Shahu Maharaj Government Medical College, Kolhapur 41002, Maharashtra, India.
| | - Lina Hemmeda
- Online Research Club, Nagasaki, Japan(2); Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
| | - Majd Alahmar
- Online Research Club, Nagasaki, Japan(2); Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed S ElHawary
- Online Research Club, Nagasaki, Japan(2); Faculty of Medicine, South Valley University, Qena City, Egypt.
| | - Dina M Awad
- Online Research Club, Nagasaki, Japan(2); Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Nguyen T Huy
- Institute of Research and Development, Duy Tan University, Da Nang 550000, Viet Nam; School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.
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