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Vidula MK, Rajewska-Tabor J, Cao JJ, Kang Y, Craft J, Mei W, Chandrasekaran PS, Clark DE, Poenar AM, Gorecka M, Malahfji M, Cowan E, Kwan JM, Reinhardt SW, Al-Tabatabaee S, Doeblin P, Villa ADM, Karagodin I, Alvi N, Christia P, Spetko N, Cassar MP, Park C, Nambiar L, Turgut A, Azad MR, Lambers M, Wong TC, Salerno M, Kim J, Elliott M, Raman B, Neubauer S, Tsao CW, LaRocca G, Patel AR, Chiribiri A, Kelle S, Baldassarre LA, Shah DJ, Hughes SG, Tong MS, Pyda M, Simonetti OP, Plein S, Han Y. Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement. JACC Cardiovasc Imaging 2022; 16:609-624. [PMID: 36752429 PMCID: PMC9833283 DOI: 10.1016/j.jcmg.2022.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/05/2022] [Accepted: 10/13/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood. OBJECTIVES The purpose of this study was to characterize myocardial injury in a multicenter cohort of patients with COVID-19 and suspected cardiac involvement referred for cardiac magnetic resonance (CMR). METHODS This retrospective study consisted of 1,047 patients from 18 international sites with polymerase chain reaction-confirmed COVID-19 infection who underwent CMR. Myocardial injury was characterized as acute myocarditis, nonacute/nonischemic, acute ischemic, and nonacute/ischemic patterns on CMR. RESULTS In this cohort, 20.9% of patients had nonischemic injury patterns (acute myocarditis: 7.9%; nonacute/nonischemic: 13.0%), and 6.7% of patients had ischemic injury patterns (acute ischemic: 1.9%; nonacute/ischemic: 4.8%). In a univariate analysis, variables associated with acute myocarditis patterns included chest discomfort (OR: 2.00; 95% CI: 1.17-3.40, P = 0.01), abnormal electrocardiogram (ECG) (OR: 1.90; 95% CI: 1.12-3.23; P = 0.02), natriuretic peptide elevation (OR: 2.99; 95% CI: 1.60-5.58; P = 0.0006), and troponin elevation (OR: 4.21; 95% CI: 2.41-7.36; P < 0.0001). Variables associated with acute ischemic patterns included chest discomfort (OR: 3.14; 95% CI: 1.04-9.49; P = 0.04), abnormal ECG (OR: 4.06; 95% CI: 1.10-14.92; P = 0.04), known coronary disease (OR: 33.30; 95% CI: 4.04-274.53; P = 0.001), hospitalization (OR: 4.98; 95% CI: 1.55-16.05; P = 0.007), natriuretic peptide elevation (OR: 4.19; 95% CI: 1.30-13.51; P = 0.02), and troponin elevation (OR: 25.27; 95% CI: 5.55-115.03; P < 0.0001). In a multivariate analysis, troponin elevation was strongly associated with acute myocarditis patterns (OR: 4.98; 95% CI: 1.76-14.05; P = 0.003). CONCLUSIONS In this multicenter study of patients with COVID-19 with clinical suspicion for cardiac involvement referred for CMR, nonischemic and ischemic patterns were frequent when cardiac symptoms, ECG abnormalities, and cardiac biomarker elevations were present.
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Affiliation(s)
- Mahesh K Vidula
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justyna Rajewska-Tabor
- Department of Magnetic Resonance, I Clinic of Cardiology, University of Medical Sciences, Poznan, Poland
| | - J Jane Cao
- St. Francis Hospital, Roslyn, New York, USA
| | - Yu Kang
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Daniel E Clark
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ana-Maria Poenar
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Miroslawa Gorecka
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Maan Malahfji
- Houston Methodist Heart and Vascular Center, Houston, Texas, USA
| | - Eilidh Cowan
- Houston Methodist Heart and Vascular Center, Houston, Texas, USA
| | - Jennifer M Kwan
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Samuel W Reinhardt
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah Al-Tabatabaee
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Ilya Karagodin
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nazia Alvi
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Nicholas Spetko
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mark Philip Cassar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Christine Park
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lakshmi Nambiar
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Alper Turgut
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mahan Roosta Azad
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre Elisabeth-Krankenhaus, Essen, Germany
| | - Moritz Lambers
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre Elisabeth-Krankenhaus, Essen, Germany
| | - Timothy C Wong
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Salerno
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Michael Elliott
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gina LaRocca
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amit R Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Lauren A Baldassarre
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dipan J Shah
- Houston Methodist Heart and Vascular Center, Houston, Texas, USA
| | - Sean G Hughes
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew S Tong
- Division of Cardiology, The Ohio State University, Columbus, Ohio, USA
| | - Malgorzata Pyda
- Department of Magnetic Resonance, I Clinic of Cardiology, University of Medical Sciences, Poznan, Poland
| | | | - Sven Plein
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Yuchi Han
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Cardiology, The Ohio State University, Columbus, Ohio, USA.
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2
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D'Ambruoso L, Price J, Cowan E, Goosen G, Fottrell E, Herbst K, van der Merwe M, Sigudla J, Davies J, Kahn K. Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making. Glob Health Action 2021; 14:2000091. [PMID: 35377291 PMCID: PMC8986216 DOI: 10.1080/16549716.2021.2000091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Recognising that the causes of over half the world's deaths pass unrecorded, the World Health Organization (WHO) leads development of Verbal Autopsy (VA): a method to understand causes of death in otherwise unregistered populations. Recently, VA has been developed for use outside research environments, supporting countries and communities to recognise and act on their own health priorities. We developed the Circumstances of Mortality Categories (COMCATs) system within VA to provide complementary circumstantial categorisations of deaths. OBJECTIVES Refine the COMCAT system to (a) support large-scale population assessment and (b) inform public health decision-making. METHODS We analysed VA data for 7,980 deaths from two South African Health and Socio-Demographic Surveillance Systems (HDSS) from 2012 to 2019: the Agincourt HDSS in Mpumalanga and the Africa Health Research Institute HDSS in KwaZulu-Natal. We assessed the COMCAT system's reliability (consistency over time and similar conditions), validity (the extent to which COMCATs capture a sufficient range of key circumstances and events at and around time of death) and relevance (for public health decision-making). RESULTS Plausible results were reliably produced, with 'emergencies', 'recognition, 'accessing care' and 'perceived quality' characterising the majority of avoidable deaths. We identified gaps and developed an additional COMCAT 'referral', which accounted for a significant proportion of deaths in sub-group analysis. To support decision-making, data that establish an impetus for action, that can be operationalised into interventions and that capture deaths outside facilities are important. CONCLUSIONS COMCAT is a pragmatic, scalable approach enhancing functionality of VA providing basic information, not available from other sources, on care seeking and utilisation at and around time of death. Continued development with stakeholders in health systems, civil registration, community and research environments will further strengthen the tool to capture social and health systems drivers of avoidable deaths and promote use in practice settings.
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Affiliation(s)
- Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Public Healtlh, National Health Service (NHS), Scotland
| | - Jessica Price
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eilidh Cowan
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland.,School of Geosciences, College of Science and Engineering, University of Edinburgh, Scotland
| | | | | | - Kobus Herbst
- Africa Health Research Institute, Durban, South Africa.,DSI-MRC South African Population Research Infrastructure Network (SAPRIN), South Africa
| | - Maria van der Merwe
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Independent Consultant, South Africa
| | | | - Justine Davies
- Institute for Applied Health Research, University of Birmingham, UK
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,International Network for the Demographic Evaluation of Populations and Their Health (Indepth), Accra, Ghana
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Shastry S, Lin M, Villars M, Cowan E. 359 Emergency Department Buprenorphine Initiation: A Qualitative Study of Attending Physician Attitudes, Beliefs and Practices. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.374] [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: 11/25/2022]
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ED INNOVATION Research Group, Hawk K, Taylor A, Phadke M, Li F, Dziura J, Perrone J, McCormack R, Herring A, Cowan E, Fiellin D, D'Onofrio G. 221 Changes in Emergency Department Visits for Opioid-Related Diagnosis, Opioid Overdose and Buprenorphine Use Across 14 US Emergency Departments During the SARS-CoV-2 Pandemic. Ann Emerg Med 2021. [PMCID: PMC8536288 DOI: 10.1016/j.annemergmed.2021.09.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
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Vishnu N, Hamilton A, Bagge A, Wernersson A, Cowan E, Barnard H, Sancak Y, Kamer KJ, Spégel P, Fex M, Tengholm A, Mootha VK, Nicholls DG, Mulder H. Mitochondrial clearance of calcium facilitated by MICU2 controls insulin secretion. Mol Metab 2021; 51:101239. [PMID: 33932586 PMCID: PMC8163986 DOI: 10.1016/j.molmet.2021.101239] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Transport of Ca2+ into pancreatic β cell mitochondria facilitates nutrient-mediated insulin secretion. However, the underlying mechanism is unclear. Recent establishment of the molecular identity of the mitochondrial Ca2+ uniporter (MCU) and associated proteins allows modification of mitochondrial Ca2+ transport in intact cells. We examined the consequences of deficiency of the accessory protein MICU2 in rat and human insulin-secreting cells and mouse islets. METHODS siRNA silencing of Micu2 in the INS-1 832/13 and EndoC-βH1 cell lines was performed; Micu2-/- mice were also studied. Insulin secretion and mechanistic analyses utilizing live confocal imaging to assess mitochondrial function and intracellular Ca2+ dynamics were performed. RESULTS Silencing of Micu2 abrogated GSIS in the INS-1 832/13 and EndoC-βH1 cells. The Micu2-/- mice also displayed attenuated GSIS. Mitochondrial Ca2+ uptake declined in MICU2-deficient INS-1 832/13 and EndoC-βH1 cells in response to high glucose and high K+. MICU2 silencing in INS-1 832/13 cells, presumably through its effects on mitochondrial Ca2+ uptake, perturbed mitochondrial function illustrated by absent mitochondrial membrane hyperpolarization and lowering of the ATP/ADP ratio in response to elevated glucose. Despite the loss of mitochondrial Ca2+ uptake, cytosolic Ca2+ was lower in siMICU2-treated INS-1 832/13 cells in response to high K+. It was hypothesized that Ca2+ accumulated in the submembrane compartment in MICU2-deficient cells, resulting in desensitization of voltage-dependent Ca2+ channels, lowering total cytosolic Ca2+. Upon high K+ stimulation, MICU2-silenced cells showed higher and prolonged increases in submembrane Ca2+ levels. CONCLUSIONS MICU2 plays a critical role in β cell mitochondrial Ca2+ uptake. β cell mitochondria sequestered Ca2+ from the submembrane compartment, preventing desensitization of voltage-dependent Ca2+ channels and facilitating GSIS.
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Affiliation(s)
- N Vishnu
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden
| | - A Hamilton
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden
| | - A Bagge
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden
| | - A Wernersson
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden
| | - E Cowan
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden
| | - H Barnard
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden
| | - Y Sancak
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - K J Kamer
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - P Spégel
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden
| | - M Fex
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden
| | - A Tengholm
- Department of Medical Cell Biology, Uppsala University, Uppsala SE-751 23, Sweden
| | - V K Mootha
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - D G Nicholls
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden; Buck Institute for Research on Aging, Novato, CA 94945, USA
| | - H Mulder
- Unit of Molecular Metabolism, Lund University Diabetes Center, Lund University, Malmö SE-205 02, Sweden.
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Cowan E, D'Ambruoso L, van der Merwe M, Witter S, Byass P, Ameh S, Wagner RG, Twine R. Understanding non-communicable diseases: combining health surveillance with local knowledge to improve rural primary health care in South Africa. Glob Health Action 2021; 14:1852781. [PMID: 33357074 PMCID: PMC7782313 DOI: 10.1080/16549716.2020.1852781] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries. Objective: The aims were:develop methods to provide integrated biosocial accounts of NCD mortality; and explore the practical utility of extended mortality data for the primary health care system. Methods: We drew on data from research programmes in the study area. Data were analysed in three steps: [a]analysis of levels, causes and circumstances of NCD mortality [n = 4,166] from routine census updates including Verbal Autopsy and of qualitative data on lived experiences of NCDs in rural villages from participatory research; [b] identifying areas of convergence and divergence between the analyses; and [c]exploration of the practical relevance of the data drawing on engagements with health systems stakeholders. Results: NCDs constituted a significant proportion of mortality in this setting [36%]. VA data revealed multiple barriers to access in end-of-life care. Many deaths were attributed to problems with resources and health systems [21%;19% respectively]. The qualitative research provided rich complementary detail on the processes through which risk originates, accumulates and is expressed in access to end-of-life care, related to chronic poverty and perceptions of poor quality care in clinics. The exploration of practical relevance revealed chronic under-funding for NCD services, and an acute need for robust, timely data on the NCD burden. Conclusions: VA data allowed a significant burden of NCD mortality to be quantified and revealed barriers to access at and around the time of death. Qualitative research contextualised these barriers, providing explanations of how and why they exist and persist. Health systems analysis revealed shortages of resources allocated to NCDs and a need for robust research to provide locally relevant evidence to organise and deliver care. Pragmatic interdisciplinary and mixed method analysis provides relevant renditions of complex problems to inform more effective responses.
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Affiliation(s)
- Eilidh Cowan
- School of Geosciences, University of Edinburgh , Edinburgh, UK
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, University of Aberdeen , Aberdeen, UK.,Umeå Centre for Global Health Research, Department of Epidemiology and Global Health, Umeå University , Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit [Agincourt], School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa.,National Health Service , Grampian, UK
| | - Maria van der Merwe
- Independent Public Health and Nutrition Consultant , Nelspruit, South Africa
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University Edinburgh , Musselburgh, UK
| | - Peter Byass
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, University of Aberdeen , Aberdeen, UK.,Umeå Centre for Global Health Research, Department of Epidemiology and Global Health, Umeå University , Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit [Agincourt], School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa
| | - Soter Ameh
- Department of Community Medicine, College of Medical Sciences, University of Calabar , Calabar, Nigeria.,Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University , Boston, MA, USA
| | - Ryan G Wagner
- Umeå Centre for Global Health Research, Department of Epidemiology and Global Health, Umeå University , Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit [Agincourt], School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa.,Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) - INDEPTH Network , Accra, Ghana
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit [Agincourt], School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa
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Lim C, Julie O, Cowan E, Eiting E, Imikomobong I, Barnett B, Calderon Y. 191 Outcomes and Cost: A Retrospective Analysis of Admissions to a Pediatric Observation Unit Versus Inpatient Hospitalization. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.196] [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: 10/28/2022]
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8
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Naheed S, Cowan E, Higginson A, Beable R, Elms M, Archer C, O'Callaghan A. P-131 Percutaneous transhepatic cholangiographic drainage for malignanct biliary obstruction: single centre - 5 year experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.131] [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: 11/14/2022] Open
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9
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Nandivada P, Cowan E, Carlson SJ, Chang M, Gura KM, Puder M. Mechanisms for the effects of fish oil lipid emulsions in the management of parenteral nutrition-associated liver disease. Prostaglandins Leukot Essent Fatty Acids 2013; 89:153-8. [PMID: 23602846 DOI: 10.1016/j.plefa.2013.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 02/04/2013] [Accepted: 02/22/2013] [Indexed: 12/12/2022]
Abstract
Parenteral nutrition (PN) can be life saving for infants unable to adequately absorb enteral nutrients due to intestinal failure from inadequate bowel length or function. However, long-term PN carries significant morbidity and mortality, with 30 to 60% of patients developing progressive liver dysfunction. The etiology of PN-associated liver disease (PNALD) is poorly understood, however the involvement of lipid emulsions in its pathogenesis has been clearly established, with new emphasis emerging on the role of omega-6 polyunsaturated fatty acids and omega-3 polyunsaturated fatty acids. Recent studies evaluating the use of parenteral fish oil lipid emulsions instead of soybean oil lipid emulsions have demonstrated marked improvements in cholestasis, morbidity, and mortality in patients with PNALD treated with fish oil. This review provides an overview of the role of lipid emulsions in the pathogenesis of PNALD and the proposed mechanisms by which parenteral fish oil lipid emulsions may be exerting their beneficial effects.
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Affiliation(s)
- P Nandivada
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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10
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Chakravarty PD, McLaughlin E, Whittaker D, Byrne E, Cowan E, Xu K, Bruce DM, Ford JA. Comparison of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures; a systematic review of the randomised controlled trials. Surgeon 2012; 10:172-82. [PMID: 22405735 DOI: 10.1016/j.surge.2012.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bariatric surgery can provide efficient weight loss and improvement in obesity-related co-morbidities in adults. Laparoscopic adjustable gastric banding (LAGB) comprised 30.3% of all bariatric procedures between 2009 and 2010 in the UK. This review evaluates the level 1 evidence for change in co-morbidities, quality of life (QoL) and weight provided by LAGB compared with other bariatric procedures. METHOD Systematic literature search of MEDLINE, EMBASE and CENTRAL (1988 to May 2011) was performed. Only randomised controlled trials (RCTs) were included. Studies with non-surgical comparators, open gastric banding procedures or adolescent participants were excluded. Primary outcome was change in co-morbidities. Secondary outcomes included QoL, weight loss, complications, operation time and length of stay. RESULTS Five RCTs met the inclusion criteria. Vertical banded gastroplasty, sleeve gastrectomy and gastric bypass were compared to LAGB. Co-morbidities were reported in two studies and QoL in one. LAGB was comparable to other procedures for both of these outcomes. All five trials showed LABG to be effective in weight loss, however all comparative procedures resulted in greater weight loss. Operative time and length of hospital stay were significantly shorter with LAGB. Short-term complications were found to be consistently lower in the LAGB group. Evidence was divided with respect to long-term complications. CONCLUSION Co-morbidities and QoL are poorly reported and showed no difference between LAGB and other bariatric procedures. Evidence suggests that LAGB is not the most effective surgical procedure to reduce weight. LAGB is associated with lower early complications and shorter operative time and length of stay, and therefore may be preferable to patients.
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Affiliation(s)
- P D Chakravarty
- University of Aberdeen, Section of Population Health, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
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11
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Calderon Y, Cowan E, Fettig J, Hannon M, Leider J. 54: Characteristics and Risk Factors of Patients Who Refuse Routine HIV Testing in an Urban Emergency Department. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.075] [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: 11/16/2022]
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Abstract
Pseudo-ainhum is an auto-amputation of the digits. Although extremely rare, it is a traumatic and painful experience that can be alleviated with early recognition and intervention. The scientific literature is filled with reports of this interesting but unfortunate phenomenon. To date, a firm causative aetiology has not yet been established. Although reports on this phenomenon have attempted to further our understanding of pseudo-ainhum, a clear understanding has been complicated by the interchangeable use of terms describing this auto-amputation. In this review, we discuss the current understanding, diagnostic criteria, and management of pseudo-ainhum. Furthermore, the nomenclature of pseudo-ainhum is clarified. Ideally, this will allow for more efficient exploration of pseudo-ainhum, its causes, and therapeutic approaches.
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Affiliation(s)
- R M Rashid
- Loyola Stritch School of Medicine, Maywood, IL 60153, USA.
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Cowan E, Patenaud D, Lindner J, Calderon Y. 135: Measured and Perceived Adult Health Literacy in an Urban Emergency Department. Ann Emerg Med 2007. [DOI: 10.1016/j.annemergmed.2007.06.168] [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: 11/16/2022]
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Hou ST, Cowan E, Walker T, Ohan N, Dove M, Rasqinha I, MacManus JP. The transcription factor E2F1 promotes dopamine-evoked neuronal apoptosis by a mechanism independent of transcriptional activation. J Neurochem 2001; 78:287-97. [PMID: 11461964 DOI: 10.1046/j.1471-4159.2001.00402.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The E2F1 transcription factor plays an important role in promoting neuronal apoptosis; however, it is not clear how E2F1 does this. Here we show that E2F1 is involved in dopamine (DA)-evoked apoptosis in cerebellar granule neurons (CGNs). E2F1 -/- CGNs and CGNs expressing an antisense E2F1 cDNA were significantly protected from DA-toxicity relative to controls. The neuronal protection was accompanied by significantly reduced caspase 3 activity. E2F1-mediated neuronal apoptosis did not require activation of gene transcription because: (1) ectopic expression of E2F1 or its mutants lacking the transactivation domain induced neuronal apoptosis, whereas an E2F1 mutant lacking the DNA-binding domain did not; (2) under all of these conditions, known E2F1 target genes including cyclin A, cdc2 and p19(ARF) were not induced; and (3) DA-evoked neuronal apoptosis was associated with up-regulated E2F1, but not transcription of its target genes. Finally, E2F1-mediated neuronal apoptosis was associated with reduced nuclear factor (NF)-kappaB DNA-binding activity. Taken together, these data suggest that E2F1 promotes DA-evoked caspase 3-dependent neuronal apoptosis by a mechanism independent of gene transactivation, and this may possibly occur through inhibition of anti-apoptotic genes including NF-kappaB.
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Affiliation(s)
- S T Hou
- Institute for Biological Sciences, National Research Council Canada, Ottawa, Ontario, Canada.
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Hou ST, Cowan E, Dostanic S, Rasquinha I, Comas T, Morley P, MacManus JP. Increased expression of the transcription factor E2F1 during dopamine-evoked, caspase-3-mediated apoptosis in rat cortical neurons. Neurosci Lett 2001; 306:153-6. [PMID: 11406318 DOI: 10.1016/s0304-3940(01)01909-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The transcription factor E2F1 mRNA and protein levels increased in rat cortical neurons in response to dopamine (DA)- or 6-hydroxydopamine (OHDA)-evoked apoptosis. Increased E2F1 protein was detected in the nucleus of neurons by double fluorescent immunocytochemistry using antibodies to E2F1 and NeuN. DA and 6-OHDA induced caspase-3-mediated apoptosis of cortical neurons which was attenuated by the addition of antioxidants or caspase-3 inhibitors to the cultures. Antioxidants prevented DA-evoked neuronal apoptosis, and also attenuated the increase in E2F1 expression. These findings suggest that increased expression of the transcription factor E2F1 may serve as a death signal during DA-evoked neuronal apoptosis.
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Affiliation(s)
- S T Hou
- Institute for Biological Sciences, National Research Council Canada, Building M-54, 1500 Montreal Road, Ottawa, Ontario, K1A 0R6, Canada.
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Kwarciany G, Cowan E, Gosselin T, Gubanc D, Webb R. How are you sure that a patient's advance directives are known and being followed? ONS News 1996; 11:4. [PMID: 8945346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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17
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Reid A, Fish D, Cowan E. The role of preventive dentistry in Canadian dental education. Clin Prev Dent 1979; 1:10-5. [PMID: 317453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Willis WT, Cowan E. Survey of therapeutic x-ray installations in Alabama. Radiol Health Data Rep 1968; 9:13-5. [PMID: 5636435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Willis WT, Cowan E. Radium survey in Alabama. Radiol Health Data Rep 1968; 9:16-8. [PMID: 5636436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Willis WT, Cowan E. Radium survey in Alabama. J Med Assoc State Ala 1966; 35:860-6. [PMID: 5906325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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