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Zeka N, Bejiqi R, Gerguri A, Zogaj L, Jashari H. A new variant of MYCN gene as a cause of Feingold syndrome. Clin Case Rep 2022; 10:e05886. [PMID: 35620261 PMCID: PMC9125397 DOI: 10.1002/ccr3.5886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Naim Zeka
- Pediatric Clinic Department of Neurology University Clinical Center of Kosovo Pristina Kosovo
| | - Ramush Bejiqi
- Pediatric Clinic Department of Cardiology University Clinical Center of Kosovo Pristina Kosovo
- Faculty of Medicine University of Gjakova Pristina Kosovo
| | - Abdurrahim Gerguri
- Pediatric Clinic Department of Neurology University Clinical Center of Kosovo Pristina Kosovo
| | - Leonore Zogaj
- Pediatric Clinic Department of Neurology University Clinical Center of Kosovo Pristina Kosovo
| | - Haki Jashari
- Pediatric Clinic Department of Neurology University Clinical Center of Kosovo Pristina Kosovo
- Pediatric Clinic University Children’s Hospital Skopje Republic of North Macedonia
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Bajraktari G, Bytyci I, Henein M, Alfonso F, Ahmed A, Jashari H, Bhatt D. Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: a meta-analysis of randomized controlled trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2560] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesion had a reduced risk of major adverse cardiac events (MACE: cardiovascular mortality, myocardial infarction, or ischemia-driven revascularization), but not of cardiovascular or total mortality.
Aim
To assess the efficacy of complete revascularization for cardiovascular or total mortality reduction by meta-analysis of all available randomized controlled trials (RCTs) including the COMPLETE trial.
Methods
PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n=3420) vs. only culprit lesion (n=3613) PCI for a median 28.7 months follow-up. Random effect risk ratios were used for efficacy and safety outcomes.
Results
Complete revascularization reduced the risk of MACE (10.4% vs. 16.6%; RR=0.59, 95% CI: 0.47 to 0.74, p<0.0001), CV mortality (2.87% vs. 3.72%; RR=0.73, 95% CI: 0.56 to 0.95, p=0.02), reinfarction (5.1% vs. 7.1%; RR=0.67, 95% CI: 0.52 to 0.86, p=0.002), urgent revascularization (7.92% vs. 17.4%; RR=0.47, 95% CI: 0.30 to 0.73, p<0.001), and CV hospitalization (8.68% vs. 11.4%; RR=0.65, 95% CI: 0.44to 0.96, p=0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy.
Conclusion
The findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Bajraktari
- University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of
| | - I Bytyci
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - M.Y Henein
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
| | - A Ahmed
- George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - H Jashari
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - D.L Bhatt
- Harvard Medical School, Boston, United States of America
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Bajraktari G, Bytyçi I, Henein MY, Alfonso F, Ahmed A, Jashari H, Bhatt DL. Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: A meta-analysis of randomized controlled trials. Int J Cardiol Heart Vasc 2020; 29:100549. [PMID: 32577495 PMCID: PMC7301199 DOI: 10.1016/j.ijcha.2020.100549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesions had a reduced risk of major adverse cardiac events (MACE), but not of cardiovascular or total mortality. The aim of this meta-analysis was to assess the efficacy of complete revascularization on cardiovascular or total mortality reduction using available randomized controlled trials (RCTs) including the COMPLETE trial, in hemodynamically stable STEMI patients with MVD. METHODS PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n = 3420) vs. only culprit lesion (n = 3613) PCI for a median 27.7 months follow-up. Random effect risk ratios were used to estimate for efficacy and safety outcomes. RESULTS Complete revascularization reduced the risk of MACE (10.4% vs.16.6%; RR = 0.59, 95% CI: 0.47 to 0.74, p < 0.0001), CV mortality (2.87% vs. 3.72%; RR = 0.73, 95% CI: 0.56 to 0.95, p = 0.02), reinfarction (5.1% vs. 7.1%; RR = 0.67, 95% CI: 0.52 to 0.86, p = 0.002), urgent revascularization (7.92% vs.17.4%; RR = 0.47, 95% CI: 0.30 to 0.73, p < 0.001), and CV hospitalization (8.68% vs.11.4%; RR = 0.65, 95% CI: 0.44to 0.96, p = 0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy. CONCLUSION The findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes.
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Affiliation(s)
- Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo
- University of Prishtina, Prishtina, Kosovo
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Fernando Alfonso
- Cardiac Department, La Princesa University Hospital, Institute of Health Research, IIS-IP, CIBER-CV University Autónoma of Madrid, Madrid, Spain
| | - Ali Ahmed
- Veterans Affairs Medical Center, George Washington University, and Georgetown University, Washington, DC, USA
| | - Haki Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
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Perçuku L, Bajraktari G, Jashari H, Bytyçi I, Ibrahimi P, Henein MY. Exaggerated systolic hypertensive response to exercise predicts cardiovascular events: a systematic review and meta-analysis. Pol Arch Intern Med 2019; 129:855-863. [PMID: 31577264 DOI: 10.20452/pamw.15007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/05/2023]
Abstract
INTRODUCTION The pathophysiology of exaggerated systolic hypertensive response to exercise (SHRE) is not fully understood, with contradictory data on its role in predicting cardiovascular (CV) events. OBJECTIVES The aim of this review and meta‑analysis was to assess the association of SHRE with CV clinical outcomes in healthy normotensive individuals. PATIENTS AND METHODS We searched PubMed (MEDLINE), Cochrane Library, RefWorks, and Google Scholar to identify clinical studies that reported data on CV event rates and outcomes for patients with SHRE on exercise stress testing. Sensitivity and specificity analysis for assessing the diagnostic accuracy of the SHRE cutoff associated with CV events was estimated using hierarchical summary receiver operating characteristic analysis. RESULTS We included 8 studies with 47 188 participants and a median follow‑up of 19.3 years. Exaggerated SHRE was found in patients with composite events (CV mortality and coronary artery disease; hazard ratio [HR], 1.363; 95% CI, 1.135-1.604; P <0.001), in those with coronary artery events (HR, 1.532; 95% CI, 1.240-1.893; P <0.001), and in those with CV mortality (HR, 1.286; 95% CI, 1.075-1.539; P =0.006), as compared with individuals with normal response. An exercise systolic blood pressure of 196 mm Hg predicted CV events with a sensitivity of 62% (54%-69%) and specificity of 75% (60%-86%), with a positive likelihood ratio of less than 3 and a strong correlation (r = -0.71). CONCLUSIONS Our study supports the clinical relevance of exaggerated SHRE as a predictor of composite and individual CV clinical outcome. These findings should be considered as thought‑provoking evidence for better stratification and, consequently, for optimal management of this high‑risk population.
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Affiliation(s)
- Luan Perçuku
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden; University of Prishtina, Medical Faculty, Prishtina, Kosovo.
| | - Haki Jashari
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden; Clinic of Pediatrics, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Ibadete Bytyçi
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Pranvera Ibrahimi
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden; Molecular and Clinical Sciences Research Institute, St George University London, United Kingdom; Brunel University, Middlesex, United Kingdom
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Ismaili HH, Jashari H, Merovci B, Hasbahta T, Kusari Z, Kerleshi D, Henein M. Infective Endocarditis on the Tricuspid Valve in a Neonate. ICFJ 2019. [DOI: 10.17987/icfj.v14i0.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A full-term female neonate with infective endocarditis was reviewed. Transthoracic echocardiography showed vegetations attached to the tricuspid valve. The baby had clinical signs of septicaemia and positive blood culture Pseudomonas aeruginosa. Thus, echocardiography remains an important tool in the diagnosis and follow-up of infective endocarditis.
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Abstract
Purpose: Prompt recognition and aggressive early treatment are the only effective measures against invasive meningococcal disease (IMD). Anti-inflammatory adjunctive treatment remains controversial and difficult to assess in patients with IMD. The purpose of this study was to evaluate the effect of dexamethasone (DXM) as adjunctive treatment in different clinical forms of IMD, and attempt to answer if DXM should be routinely used in the treatment of IMD. Methods: In this non-interventional clinical study (NIS), 39 patients with meningococcal septicaemia with or without of meningitis were included, and compared regarding the impact of dexamethasone (DXM), as an adjunctive treatment, on the outcome of IMD. SPSS statistics is used for statistical processing of data. Results: Thirty (76.9%) patients with IMD had sepsis and meningitis, and 9 (23.1%) of them had sepsis alone. Dexamethasone was used in 24 (61.5%) cases, in both clinical groups. The overall mortality rate was 10.3%. Pneumonia was diagnosed in 6 patients (15.4%), arthritis in 3 of them (7.7%), and subdural effusion in one patient (2.6%). The data showed a significant statistical difference on the length of hospitalization, and WBC normalization in groups of patients treated with DXM. Conclusion: The use of DXM as adjunctive therapy in invasive meningococcal disease has a degree of proven benefits and no harmful effects. In fighting this very dangerous and complex infection, even a limited benefit is sufficient to recommend the use of DXM as adjunctive treatment in invasive meningococcal disease.
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Affiliation(s)
- Ilir Tolaj
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Hamdi Ramadani
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Murat Mehmeti
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Hatixhe Gashi
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Arbana Kasumi
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Visar Gashi
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Haki Jashari
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
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Percuku L, Bajraktari G, Jashari H, Bytyci I, Ibrahimi P, Henein MY. 4330The exaggerated systolic hypertensive response to exercise predicts cardiovascular events: a systematic review and meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Percuku
- University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of
| | - G Bajraktari
- University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of
| | - H Jashari
- University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of
| | - I Bytyci
- University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of
| | - P Ibrahimi
- University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of
| | - M Y Henein
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Bajraktari G, Jashari H, Ibrahimi P, Alfonso F, Jashari F, Ndrepepa G, Elezi S, Henein MY. Complete revascularization for patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: a meta-analysis of randomized trials. Coron Artery Dis 2018; 29:204-215. [PMID: 29346126 DOI: 10.1097/mca.0000000000000602] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Despite the recent findings in randomized clinical trials (RCTs) with limited sample sizes and the updates in clinical guidelines, the current available data for the complete revascularization (CR) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) at the time of primary percutaneous coronary intervention (PCI) are still contradictory. AIM The aim of this meta-analysis of the existing RCTs was to assess the efficacy of the CR versus revascularization of infarct-related artery (IRA) only during primary PCI in patients with STEMI and multivessel disease (MVD). PATIENTS AND METHODS We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases aiming to find RCTs for patients with STEMI and MVD which compared CR with IRA-only. Random effect risk ratios (RRs) were calculated for efficacy and safety outcomes. RESULTS Ten RCTs with 3291 patients were included. The median follow-up duration was 17.5 months. Major adverse cardiac events (RR=0.57; 0.43-0.76; P<0.0001), cardiac mortality (RR=0.52; 0.31-0.87; P=0.014), and repeat revascularization (RR=0.50; 0.30-0.84; P=0.009) were lower in CR compared with IRA-only strategies. However, there was no significant difference in the risk of all-cause mortality, recurrent nonfatal myocardial infarction, stroke, major bleeding events, and contrast-induced nephropathy. CONCLUSION For patients with STEMI and MVD undergoing primary PCI, the current evidence suggests that the risk of major adverse cardiac events, repeat revascularization, and cardiac death is reduced by CR. However, the risk for all-cause mortality and PCI-related complications is not different from the isolated culprit lesion-only treatment. Although these findings support the cardiac mortality and safety benefit of CR in stable STEMI, further large trials are required to provide better guidance for optimum management of such patients.
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Affiliation(s)
- Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova
- Department of Internal Medicine, Medical Faculty, University of Prishtina, Prishtina, Republic of Kosovo
| | - Haki Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova
| | - Fernando Alfonso
- Cardiac Department, La Princesa University Hospital, Institute of Health Research, IIS-IP, University Autonoma of Madrid, Madrid, Spain
| | - Fisnik Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Internal Medicine, Medical Faculty, University of Prishtina, Prishtina, Republic of Kosovo
| | - Gjin Ndrepepa
- Department of Adult Cardiology, German Heart Centre Munich, Technical University of Munich, Germany
| | - Shpend Elezi
- Department of Internal Medicine, Medical Faculty, University of Prishtina, Prishtina, Republic of Kosovo
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- St George University, London, UK
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Spahiu L, Këpuska AB, Jaha VI, Merovci B, Jashari H. Aetiology, Diagnosis and Clinical Characteristics of Nephrocalcinosis. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/32270.11317] [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]
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Spahiu L, Merovci B, Ismaili Jaha V, Batalli Këpuska A, Jashari H. Case report of a novel mutation of the EYA1 gene in a patient with branchio-oto-renal syndrome. Balkan J Med Genet 2017; 19:91-94. [PMID: 28289595 PMCID: PMC5343337 DOI: 10.1515/bjmg-2016-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/01/2022] Open
Abstract
Branchio-oto-renal (BOR) syndrome is an autosomal dominant disorder characterized by the coexistence of branchial cysts or fistulae, external ear malformation with pre-auricular pits or tags, hearing impairment and renal malformations. However, the presence of the main features varies in affected families. Here, we present a 16-year-old boy admitted to the Department of Nephrology at the Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo because of severe renal insufficiency diagnosed 6 years ago, which progressed to end-stage renal failure. Clinical examination on readmission showed a pale, lethargic and edematous child, with auricular deformity, pre-auricular tags and pits as well as bilateral branchial fistulae. Laboratory tests revealed high blood urea nitrogen (BUN) 15.96 mmol/L and serum creatinine 633.0 µmol/L; low glomerular filtration rate (GFR) 12 mL/min./ 1.73 m2 and massive proteinuria 4+. Abdominal ultrasound showed bilateral kidney hypoplasia. A novel mutation of the EYA1 gene was confirmed. Daily hemodialysis is continuing until renal transplantation is done. This case is presented to increase awareness among general practitioners to consider BOR syndrome or other renal abnormalities in patients with branchial fistula and/ or external ear anomalies or similar findings in other family members.
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Affiliation(s)
- L Spahiu
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - B Merovci
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - V Ismaili Jaha
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - A Batalli Këpuska
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - H Jashari
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
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Jashari H, Lannering K, Mellander M, Ibrahimi P, Rydberg A, Henein MY. Coarctation repair normalizes left ventricular function and aorto-septal angle in neonates. CONGENIT HEART DIS 2016; 12:218-225. [DOI: 10.1111/chd.12430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Haki Jashari
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Katarina Lannering
- Department of Pediatric Cardiology; Queen Silvia Children's Hospital, Sahlgrenska University Hospital; Göteborg Sweden
| | - Mats Mellander
- Department of Pediatric Cardiology; Queen Silvia Children's Hospital, Sahlgrenska University Hospital; Göteborg Sweden
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Annika Rydberg
- Department of Clinical Sciences; Umeå University; Umeå Sweden
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
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Bajraktari G, Jashari H, Ibrahimi P, Alfonso F, Jashari F, Ndrepepa G, Elezi S, Henein MY. Comparison of drug-eluting balloon versus drug-eluting stent treatment of drug-eluting stent in-stent restenosis: A meta-analysis of available evidence. Int J Cardiol 2016; 218:126-135. [PMID: 27232924 DOI: 10.1016/j.ijcard.2016.05.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 04/15/2016] [Accepted: 05/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND In-stent restenosis (ISR) remains an important concern despite the recent advances in the drug-eluting stent (DES) technology. The introduction of drug-eluting balloons (DEB) offers a good solution to such problem. OBJECTIVES We performed a meta-analysis to assess the clinical efficiency and safety of DEB compared with DES in patients with DES-ISR. METHODS A systematic search was conducted and all randomized and observational studies which compared DEB with DES in patients with DES-ISR were included. The primary outcome measure-major adverse cardiovascular events (MACE)-as well as individual events as target lesion revascularization (TLR), stent thrombosis (ST), myocardial infarction (MI), cardiac death (CD) and all-cause mortality, were analyzed. RESULTS Three randomized and 4 observational studies were included with a total of 2052 patients. MACE (relative risk [RR]=1.00, 95% confidence interval (CI) 0.68 to 1.46, P=0.99), TLR (RR=1.15 [CI 0.79 to 1.68], P=0.44), ST (RR=0.37[0.10 to 1.34], P=0.13), MI (RR=0.97 [0.49 to 1.91], P=0.93) and CD (RR=0.73 [0.22 to 2.45], P=0.61) were not different between patients treated with DEB and with DES. However, all-cause mortality was lower in patients treated with DEB (RR=0.45 [0.23 to 0.87, P=0.019) and in particular when compared to only first generation DES (RR 0.33 [0.15-0.74], P=0.007). There was no statistical evidence for publication bias. CONCLUSIONS The results of this meta-analysis showed that DEB and DES have similar efficacy and safety for the treatment of DES-ISR.
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Affiliation(s)
- Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo.
| | - Haki Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo
| | - Fernando Alfonso
- Department of Cardiology, La Princesa University Hospital, Institute of Health Research, IIS-IP, University Autonoma of Madrid, Madrid, Spain
| | - Fisnik Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Shpend Elezi
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Jashari H, Lannering K, Ibrahimi P, Djekic D, Mellander M, Rydberg A, Henein MY. Persistent reduced myocardial deformation in neonates after CoA repair. Int J Cardiol 2016; 221:886-91. [PMID: 27434366 DOI: 10.1016/j.ijcard.2016.07.114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/31/2016] [Accepted: 07/08/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Surgical repair of coarctation of the aorta (CoA) is a safe procedure in children, however the condition is known for its potential recurrence and other related complications. The available evidence shows abnormal intrinsic properties of the aorta in CoA, thus suggesting additional effect, even after CoA repair, on left ventricular (LV) function. Accordingly, we sought to obtain a better understanding of LV myocardial mechanics in very early-corrected CoA using two-dimensional STE. METHODS AND RESULTS We retrospectively studied 21 patients with corrected CoA at a median age of 9 (2-53) days at three time points: 1) just before intervention, 2) at short-term follow-up and 3) at medium-term follow-up after intervention and compared them with normal values. Speckle tracking analysis was conducted via vendor independent software, Tomtec. After intervention, LV function significantly improved (from -12.8±3.9 to -16.7±1.7; p<0.001), however normal values were not reached even at medium term follow-up (-18.3±1.7 vs. -20±1.6; p=0.002). Medium term longitudinal strain correlated with pre intervention EF (r=0.58, p=0.006). Moreover, medium term subnormal values were more frequently associated with bicuspid aortic valve (33.3% vs. 66.6%; p<0.05). CONCLUSION LV myocardial function in neonates with CoA can be feasibly evaluated and followed up by speckle tracking echocardiography. LV subendocardial dysfunction however, remains in early infancy coarctation long after repair. Long-term follow-up through adulthood using myocardial deformation measurements should shed light on the natural history and consequences of this anomaly.
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Affiliation(s)
- Haki Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Katarina Lannering
- Department of Pediatric Cardiology, Queen Silvia Children's Hospital at the Sahlgrenska University Hospital, Götenborg, Sweden
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Demir Djekic
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Mats Mellander
- Department of Pediatric Cardiology, Queen Silvia Children's Hospital at the Sahlgrenska University Hospital, Götenborg, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Umeå University, Sweden
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Sweden.
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Abstract
Introduction: Identification of the NPHS1 gene, which encodes nephrin, was followed by many studies demonstrating its mutation as a frequent cause of congenital nephrotic syndrome (CNS). While this gene is found in 98% of Finnish children with this syndrome, non-Finnish cases have lower level of incidence ranging from 39 to 80%. Case report: This report describes the clinical presentation of a two-week-old neonate who presented with periorbital and lower extremities edema, abdominal distention, heavy proteinuria, serum hypoproteinemia and failure to thrive. Genetic analysis revealed NHPS1 gene mutation leading to CNS-Finnish type diagnosis. Conclusion: Through this case we want to create awareness about diagnosis and treatment challenges in developing countries for rare congenital diseases.
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Affiliation(s)
- Lidvana Spahiu
- Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo
| | - Besart Merovci
- Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo
| | - Haki Jashari
- Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo; Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | | | - Blerta Elezi Rugova
- Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo
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Spahiu L, Jashari H, Mulliqi-Kotori V, Elezi-Rugova B, Merovci B. Hashimoto Thyroiditis and Nephrocalcinosis in a Child with Down Syndrome. Acta Inform Med 2016; 24:143-5. [PMID: 27147809 PMCID: PMC4851541 DOI: 10.5455/aim.2016.24.143-145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 01/23/2016] [Accepted: 03/16/2016] [Indexed: 11/07/2022] Open
Abstract
Introduction: Hypothyroidism has been reported to affect renal function and structure. However, the association of hypothyroidism with distal renal tubular acidosis (dRTA) is rarely reported in children. Case Presentation: We present a 6-year-boy with Down syndrome admitted in our department due to vomiting, weakness, polyuria, polydipsia, irritability and weight loss in the last few weeks. Investigations revealed features of hypokalemia, metabolic acidosis and alkaline urine consistent with dTRA. Abdominal ultrasound found nephrocalcinosis. In addition, Antithyroid peroxidase antibodies were positive, suggesting an autoimmune background for the pathogenesis of the tubular dysfunction. Treatment for dRTA and hypothyroidism was started and symptomatic improve was noticed. Conclusion: dRTA should be excluded in children with autoimmune disorders who develop weakness, polyuria, polydipsia or growth failure. Early diagnosis would reduce long-term complications.
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Affiliation(s)
- Lidvana Spahiu
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Haki Jashari
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo; Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Vjosa Mulliqi-Kotori
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Blerta Elezi-Rugova
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Besart Merovci
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
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Jashari H, Rydberg A, Ibrahimi P, Bajraktari G, Kryeziu L, Jashari F, Henein MY. Normal ranges of left ventricular strain in children: a meta-analysis. Cardiovasc Ultrasound 2015; 13:37. [PMID: 26250696 PMCID: PMC4528396 DOI: 10.1186/s12947-015-0029-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [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: 06/15/2015] [Accepted: 07/20/2015] [Indexed: 02/08/2023] Open
Abstract
AIMS The definition of normal values of two-dimensional speckle-tracking echocardiography derived left ventricular (LV) deformation parameters, is of critical importance for the routine application of this modality in children. The objectives of this study were to perform a meta-analysis of normal ranges for longitudinal, circumferential and radial strain/strain rate values and to identify confounders that may contribute to differences in reported measures. METHODS AND RESULTS A systematic search was conducted. Studies describing normal healthy subjects and observational studies that used control groups as a comparison were included. Data were combined using a random-effect model. Effects of demographic, clinical and equipment variables were assessed through meta-regression. The search identified 1,192 subjects form 28 articles. Longitudinal strain (LS) normal mean values varied from -12.9 to -26.5 (mean, -20.5; 95% CI, -20.0 to -21.0). Normal mean values of circumferential strain (CS) varied from -10.5 to -27.0 (mean, -22.06; 95% CI, -21.5 to -22.5). Radial strain (RS) normal mean values varied from 24.9 to 62.1 (mean, 45.4; 95% CI, 43.0 to 47.8). Meta-regression showed LV end diastolic diameter as a significant determinant of variation for LS. Longitudinal systolic strain rate (LSRs) was significantly determined by the age and RS by the type of vendor used. CONCLUSION Variations among different normal ranges were dependent on the vendor used, LV end-diastolic diameter and age. Vendor-independent software for analyzing myocardial deformation in children, using images from different vendors would be the ideal solution for strain measurements or else using the same system for patient's follow up.
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Affiliation(s)
- Haki Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lindita Kryeziu
- Department of Neonatology, Gynecology Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Fisnik Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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Jashari H, Rydberg A, Ibrahimi P, Bajraktari G, Henein MY. Left ventricular response to pressure afterload in children: aortic stenosis and coarctation: a systematic review of the current evidence. Int J Cardiol 2015; 178:203-9. [PMID: 25464254 DOI: 10.1016/j.ijcard.2014.10.089] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 07/26/2014] [Revised: 10/10/2014] [Accepted: 10/18/2014] [Indexed: 02/05/2023]
Abstract
Congenital aortic stenosis (CAS) and Coarctation of Aorta (CoA) represent two forms of pressure afterload that affect the left ventricle (LV), hence require regular echocardiographic monitoring. Subclinical dysfunction of the LV exists even in asymptomatic patients with preserved left ventricular ejection fraction (EF), implying low sensitivity of EF in predicting optimum time for intervention. In this article we review patterns of LV myocardial deformation before and after correction of CAS and CoA in infants, children and adolescents, showing their important role in monitoring the course of LV dysfunction. A systematic search using PubMed was performed and suitable studies are presented on a narrative form. Normal EF and/or fractional shortening (FS), with subclinical myocardial dysfunction are reported in all studies before intervention. The short-term results, after intervention, were related to the type of procedure, with no improvement or further deterioration related to surgery but immediate improvement after balloon intervention. Long term follow-up showed further improvement but still subnormal function. Thus correction of CAS and CoA before irreversible LV dysfunction is vital, and requires longitudinal studies in order to identify the most accurate parameter for function prognostication. Until then, conventional echocardiographic parameters together with myocardial velocities and deformation parameters should continue to provide follow-up reproducible measures of ventricular function.
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Affiliation(s)
- Haki Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Umeå University, Sweden
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Sweden.
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