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Sama C, Fongwen NT, Chobufo MD, Ajibade A, Roberts M, Greathouse M, Ngonge AL, Adekolu A, Hamirani YS. Frequency of Cardiac Valvulopathies in Patients With Marfan Syndrome: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54141. [PMID: 38487153 PMCID: PMC10940034 DOI: 10.7759/cureus.54141] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 03/17/2024] Open
Abstract
Marfan syndrome (MFS) is a progressive connective tissue disease with a broad range of clinical manifestations. We sought to establish the spectrum of structural valvular abnormalities as cardiovascular involvement has been identified as the most life-threatening aspect of the syndrome. This was a systematic review with a meta-analysis of studies indexed in Medline from the inception of the database to November 7, 2022. Using the random-effects model, separate Forest and Galbraith plots were generated for each valvular abnormality assessed. Heterogeneity was assessed using the I2 statistics whilst funnel plots and Egger's test were used to assess for publication bias. From a total of 35 studies, a random-effects meta-analysis approximated the pooled summary estimates for the prevalence of cardiac valve abnormalities as mitral valve prolapse 65% (95% CI: 57%-73%); mitral valve regurgitation 40% (95% CI: 29%-51%); aortic valve regurgitation 40% (95% CI: 28%-53%); tricuspid valve prolapse 35% (95% CI: 15%-55%); and tricuspid valve regurgitation 43% (95% CI: 8%-78%). Only one study reported on the involvement of the pulmonary valve (pulmonary valve prolapse was estimated at 5.3% (95% CI: 1.9%-11.1%) in a cohort of 114 patients with MFS). We believe this study provides a description of the structural valvular disease spectrum and may help inform providers and patients in understanding the clinical history of MFS in the current treatment era with its increased life expectancy.
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Affiliation(s)
- Carlson Sama
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Noah T Fongwen
- Public Health Sciences, Africa Centre for Disease Control and Prevention (Africa CDC), Addis Ababa, ETH
| | | | - Ademola Ajibade
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Melissa Roberts
- Cardiology, West Virginia University School of Medicine, Morgantown, USA
| | - Mark Greathouse
- Cardiology, West Virginia University School of Medicine, Morgantown, USA
| | | | - Ayowumi Adekolu
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Yasmin S Hamirani
- Cardiology, West Virginia University School of Medicine, Morgantown, USA
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Sama C, Abdelhaleem A, Velu D, Ditah Chobufo M, Fongwen NT, Budoff MJ, Roberts M, Balla S, Mills JD, Njim TN, Greathouse M, Zeb I, Hamirani YS. Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: A systematic review and meta-analysis. J Cardiovasc Comput Tomogr 2024; 18:43-49. [PMID: 37821352 DOI: 10.1016/j.jcct.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND There is growing interest in understanding the coronary atherosclerotic burden in asymptomatic patients with zero coronary artery calcium score (CACS). In this population, we aimed to investigate the prevalence and severity of non-calcified coronary plaques (NCP) as detected by coronary CT angiography (CCTA), and to analyze the associated clinical predictors. METHODS This was a systematic review with meta-analysis of studies indexed in PubMed/Medline and Web of Science from inception of the database to March 31st, 2023. Using the random-effects model, separate Forest and Galbraith plots were generated for each effect size assessed. Heterogeneity was assessed using the I2 statistics whilst Funnel plots and Egger's test were used to assess for publication bias. RESULTS From a total of 14 studies comprising 37808 patients, we approximated the pooled summary estimates for the overall prevalence of NCP to be 10% (95%CI: 6%-13%). Similarly, the pooled prevalence of obstructive NCP was estimated at 1.1% (95%CI: 0.7%-1.5%) from a total of 10 studies involving 21531 patients. Hypertension [OR: 1.46 (95%CI:1.31-1.62)] and diabetes mellitus [OR: 1.69 (95%CI: 1.41-1.97)] were significantly associated with developing any NCP, with male gender being the strongest predictor [OR: 3.22 (95%CI: 2.17-4.27)]. CONCLUSION There is a low burden of NCP among asymptomatic subjects with zero CACS. In a subset of this population who have clinical predictors of NCP, the addition of CCTA has a potential to provide a better insight about occult coronary atherosclerosis, however, a risk-benefit approach must be factored in prior to CCTA use given the low prevalence of NCP.
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Affiliation(s)
- Carlson Sama
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Ahmed Abdelhaleem
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Dhivya Velu
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Muchi Ditah Chobufo
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Noah T Fongwen
- London School of Hygiene and Tropical Medicine & Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center and the Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Melissa Roberts
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Tsi N Njim
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mark Greathouse
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Irfan Zeb
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Yasmin S Hamirani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA.
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Fongwen NT, Nchafack A, Rohan H, Ong JJ, Tucker JD, Beckmann N, Hughes G, Peeling RW. Role and effectiveness of telephone hotlines in outbreak response in Africa: A systematic review and meta-analysis. PLoS One 2023; 18:e0292085. [PMID: 38019849 PMCID: PMC10686465 DOI: 10.1371/journal.pone.0292085] [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: 01/31/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND In Africa, little is known about the role of telephone hotlines in outbreak response. We systematically reviewed the role and effectiveness of hotlines on outbreak response in Africa. METHOD We used the Cochrane handbook and searched five databases. The protocol was registered on PROSPERO (CRD42021247141). Medline, Embase, PsycINFO, Global Health and Web of Science were searched from 30 June 2020 to August 2020 for studies on the use of telephone hotlines in outbreak response in Africa published between January 1995 and August 2020. The search was also repeated on 16 September 2022. Data on effectiveness (alerts generated, cases confirmed) were extracted from peer-reviewed studies. Meta-analysis of alerts generated, and proportion of cases confirmed was done using the random effects model. The quality of studies was assessed using the Joanna Briggs Institute (JBI) tools. The heterogeneity and publication bias were assessed using the Galbraith and funnel plots, respectively. RESULTS Our search yielded 1251 non-duplicate citations that were assessed. 41 full texts were identified, and 21 studies were included in the narrative synthesis, while 12 were included in the meta-analysis. The hotlines were local (seven studies) or national (three studies). A combination of a local and national hotline was used in one study. The hotlines were set up for unusual respiratory events (one study), polio (one study), Ebola (10 studies), COVID-19 (two studies), malaria (one study), influenza-like illnesses (ILI) (one study) and rift valley fever in livestock (one study). Hotlines were mainly used for outbreak surveillance at the local level. A total of 332,323 alerts were generated, and 67,658 met the case definition, corresponding to an overall pooled proportion of alerts generated(sensitivity) of 38% (95%CI: 24-52%). The sensitivity was 41% (95% CI: 24-59%) for local hotlines and 26%(95%CI:5-47%) for national hotlines. Hotlines were also used for surveillance of rift valley fever in livestock (one study) vaccination promotion (one study), death reporting (five studies), rumour tracking and fighting misinformation (two studies) and community engagement (five studies). The studies were of low to moderate quality with high publication bias and heterogeneity(I2 = 99%). The heterogeneity was not explained by the sample size. CONCLUSION These data suggest that telephone hotlines can be effective in outbreak disease surveillance in Africa. Further implementation research is needed to scale up telephone hotlines in rural areas.
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Affiliation(s)
- Noah T. Fongwen
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Division of Laboratory Systems and Networks, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Almighty Nchafack
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hana Rohan
- United Kingdom Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jason J. Ong
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Australia
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of North Carolina Institute of Global Health and Infectious Diseases, Chapel Hill, North Carolina, United States of America
| | - Nadine Beckmann
- United Kingdom Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gwenda Hughes
- United Kingdom Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosanna W. Peeling
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Sama C, Fongwen NT, Chobufo MD, Hamirani YS, Mills JD, Roberts M, Greathouse M, Zeb I, Kazienko B, Balla S. A systematic review and meta-analysis of the prevalence, incidence, and predictors of atrial fibrillation in cardiac sarcoidosis. Int J Cardiol 2023; 391:131285. [PMID: 37619882 DOI: 10.1016/j.ijcard.2023.131285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/06/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The occurrence of atrial arrhythmias, in particular, atrial fibrillation (AF) in patients with cardiac sarcoidosis (CS) are of growing interest in the field of infiltrative cardiomyopathies. Via a systematic review with meta-analysis, we sought to synthesize data on the prevalence, incidence, and predictors of atrial arrhythmias as well as outcomes in patients with CS. METHODS PubMed/Medline, Web of Science, and Scopus were systematically queried from inception until April 26th, 2023. Using the random-effects model, separate plots were generated for each effect size assessed. RESULTS From a total of 8 studies comprising 978 patients with CS, the pooled summary estimates for the prevalence of AF was 23% (95% CI: 13%-34%). Paroxysmal AF was the most common subtype of AF (83%; 95% CI: 77%-90%), followed by persistent AF (17%; 95% CI: 10%-23%). In 9 studies involving 545 patients with CS, the pooled incidence of AF was estimated at 5%, 13.1%, and 8.9% at <2 years, 2-4 years, and > 4 years of follow-up respectively, with an overall cumulative incidence of 10.6% (95% CI: 4.9%-17.8%) over a 6-year follow-up period. Increased left atrial size and atrial 18F-fluorodeoxyglucose uptake were identified as strong independent predictors for the development of atrial arrhythmias on qualitative synthesis. CONCLUSION The burden of AF and related arrhythmias in CS patients is considerable. This necessitates close follow-up and predictive risk-stratification tools to guide the initiation of appropriate strategies, including therapeutic interventions for prevention of AF-related embolic phenomenon, especially in those with known clinical predictors.
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Affiliation(s)
- Carlson Sama
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA.
| | - Noah T Fongwen
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Muchi Ditah Chobufo
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Yasmin S Hamirani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Melissa Roberts
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Mark Greathouse
- Department of Cardiology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Irfan Zeb
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Brian Kazienko
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
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Kadia BM, Dimala CA, Fongwen NT, Smith AD. Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis. AIDS Res Ther 2021; 18:85. [PMID: 34784918 PMCID: PMC8594459 DOI: 10.1186/s12981-021-00395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients' access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA. METHOD A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers. RESULTS Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level. CONCLUSIONS In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.
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Affiliation(s)
- Benjamin Momo Kadia
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Christian Akem Dimala
- Department of Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Noah T Fongwen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Africa Centres for Disease Control and Prevention (CDC) Innovation Hub, Africa CDC, Addis Ababa, Ethiopia
| | - Adrian D Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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