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Saleem M, Arshad V, Nabavizadeh P, Rajsheker S, Costea A. Subcutaneous Versus Transvenous Implantable Defibrillators: A Systematic Review and Meta-Analysis. Am J Cardiol 2024; 218:32-33. [PMID: 38395120 DOI: 10.1016/j.amjcard.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Maryam Saleem
- Division of Cardiovascular Health and Disease, Department of Cardiovascular Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio
| | - Verda Arshad
- Department of Internal Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio
| | - Pooneh Nabavizadeh
- Division of Cardiovascular Health and Disease, Department of Cardiovascular Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio
| | - Srinivas Rajsheker
- Division of Cardiovascular Health and Disease, Department of Cardiovascular Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio
| | - Alexandru Costea
- Division of Cardiovascular Health and Disease, Department of Cardiovascular Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio.
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Arshad V, Saleem M, Jilani MH, Harris DM. UNRUPTURED INTERVENTRICULAR SEPTAL PSEUDOANEURYSM - A RARE COMPLICATION OF BLUNT CARDIAC INJURY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04382-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Hindy JR, Quintero-Martinez JA, Lahr BD, Palraj R, Go JR, Fida M, Abu Saleh OM, Arshad V, Talha KM, DeSimone DC, Sohail MR, Baddour LM. Incidence of Monomicrobial Staphylococcus aureus Bacteremia: A Population-Based Study in Olmsted County, Minnesota – 2006 to 2020. Open Forum Infect Dis 2022; 9:ofac190. [PMID: 35794939 PMCID: PMC9251673 DOI: 10.1093/ofid/ofac190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Population-based studies of Staphylococcus aureus bacteremia (SAB) in the United States are limited. We provide a contemporary evaluation of SAB incidence in Olmsted County, Minnesota, from 2006 to 2020. Methods This was a retrospective population-based study of all adult patients with SAB residing in Olmsted County from 1 January 2006 through 31 December 2020. Initial episodes of SAB were identified using the microbiology laboratory databases at both Olmsted Medical Center and Mayo Clinic Rochester. Results Overall, 541 incident SAB cases were identified with a median age of 66.8 (interquartile range, 54.4–78.5) years, and 60.4% were male. Among these cases, 298 (56.2%) were due to methicillin-susceptible S aureus (MSSA) and 232 (43.8%) cases of methicillin-resistant S aureus (MRSA). The overall age- and sex-adjusted SAB incidence rate (IR) was 33.9 (95% confidence interval [CI], 31.0–36.8) cases/100 000 person-years (PY). Males had a higher age-adjusted IR of 46.0 (95% CI, 41.0–51.0) cases/100 000 PY compared to females (IR, 24.4 [95% CI, 21.1–27.7] cases/100 000 PY). Age- and sex-adjusted SAB IRs due to MSSA and MRSA were 18.7 and 14.6 cases/100 000 PY, respectively, and the percentage of incident SAB cases due to MRSA fluctuated across the study period. There was no apparent temporal trend in SAB incidence over the study period (P = .093). Conclusions Our investigation represents the only contemporary population-based study in the United States. Despite the impression that SAB incidence may have increased based on Centers for Disease Control and Prevention surveillance data, our finding of no change in SAB incidence was somewhat unanticipated.
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Affiliation(s)
- Joya-Rita Hindy
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Juan A. Quintero-Martinez
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Brian D. Lahr
- Division of Clinical Trials & Biostatistics, Department of Quantitative Health Sciences, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - John R. Go
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Madiha Fida
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Omar M. Abu Saleh
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Khawaja M. Talha
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Daniel C. DeSimone
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Cardiovascular Disease, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - M. Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Larry M. Baddour
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Cardiovascular Disease, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
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Abstract
INTRODUCTION The epidemiology of infective endocarditis (IE) in this millennium has changed with emergence of new risk factors and reemergence of others. This, coupled with modifications in national guidelines in the setting of a pandemic, prompted an address of the topic. AREAS COVERED Our goal is to provide a contemporary review of IE epidemiology considering changing incidence of rheumatic heart disease (RHD), cardiac device implantation, and injection drug use (IDU), with SARS-CoV-2 pandemic as the backdrop. METHODS PubMed and Google Scholar were used to identify studies of interest. EXPERT OPINION Our experience over the past two decades verifies the notion that there is not one 'textbook' profile of IE. Multiple factors have dramatically impacted IE epidemiology, and these factors differ, based, in part on geography. RHD has declined in many areas of the world, whereas implanted cardiovascular devices-related IE has grown exponentially. Perhaps the most influential, at least in areas of the United States, is injection drug use complicating the opioid epidemic. Healthy younger individuals contracting a potentially life-threatening infection has been tragic. In the past year, epidemiological changes due to the COVID-19 pandemic have also occurred. No doubt, changes will characterize IE in the future and serial review of the topic is warranted.
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Affiliation(s)
- Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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Arshad V, Inam M, Awan S, Ismail FW. Clinical spectrum of Celiac Disease in adults at a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci 2022; 38:445-449. [PMID: 35480550 PMCID: PMC9002428 DOI: 10.12669/pjms.38.3.4446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: Celiac Disease (CD) is a disorder that impacts physical, social and emotional health. Requiring life-long treatment, it poses a major economic burden on the healthcare system. Our objective was to study CD in patients from initial presentation to diagnosis and to ascertain the effect of a low resource setting on improvement in disease process. Methods: This is a retrospective cross-sectional study conducted at a Aga Khan University Hospital (AKUH), a tertiary care center in Karachi, Pakistan. Medical records of patients (≥ 18 years) from 2008 to 2018 with a diagnosis of CD were reviewed. Data on demographics, presenting complaints, investigations, endoscopy results and follow up visits was collected. Results: One hundred and twenty-six patients were included (61.6% females, mean age 35.5 years). The most common intestinal and extra-intestinal symptoms were abdominal pain (56.3%) and fatigue (24.6%) respectively. After microcytic anemia (36.5%), increased ALT (27.2%) was the most common laboratory derangement. On endoscopy, visible fissuring (29.4%) and atrophic mucosa (29.4%) were reported. Biopsy findings showed increased intraepithelial lymphocytes (92.9%) and villous atrophy (77.8%). Improvement in at least one of three parameters (symptoms, laboratory values or EGD) was reported by 42.0% of subjects, whereas 48.4% subjects were lost to follow-up. Conclusion: The most commonly reported symptoms by CD patients were abdominal pain, diarrhea and anemia. Thus, patients presenting with vague abdominal symptoms and anemia should be worked up for CD. A concerning majority of subjects was lost to follow up for reasons such as inability to afford advised GFD and a poor understanding of the disease process.
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Affiliation(s)
- Verda Arshad
- Dr. Verda Arshad, MBBS. Research Fellow, Department of Medicine, Mayo Clinic, MN, USA
| | - Maha Inam
- Ms. Maha Inam, MBBS. Medical Student, Medical College, Aga Khan University, Karachi, Pakistan
| | - Safia Awan
- Ms. Safia Awan, MSc Statistics, Senior Instructor, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Faisal Wasim Ismail
- Dr. Faisal Wasim Ismail, FCPS Gastroenterology, Associate Professor, Department of Medicine, Aga Khan University, Karachi, Pakistan
- Correspondence: Dr. Faisal Ismail, FCPS. Associate Professor, Department of Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan. E-mail:
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Talha KM, Dayer MJ, Thornhill MH, Tariq W, Arshad V, Tleyjeh IM, Bailey KR, Palraj R, Anavekar NS, Rizwan Sohail M, DeSimone DC, Baddour LM. Temporal Trends of Infective Endocarditis in North America From 2000 to 2017-A Systematic Review. Open Forum Infect Dis 2021; 8:ofab479. [PMID: 35224128 PMCID: PMC8864733 DOI: 10.1093/ofid/ofab479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/01/2021] [Accepted: 09/21/2021] [Indexed: 01/01/2023] Open
Abstract
Background The objective of this paper was to examine temporal changes of infective endocarditis (IE) incidence and epidemiology in North America. Methods A systematic review was conducted at Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science were searched for studies published between January 1, 2000, and May 31, 2020. Four referees independently reviewed all studies, and those that reported a population-based incidence of IE in patients aged 18 years and older in North America were included. Results Of 8588 articles screened, 14 were included. Overall, IE incidence remained largely unchanged throughout the study period, except for 2 studies that demonstrated a rise in incidence after 2014. Five studies reported temporal trends of injection drug use (IDU) prevalence among IE patients with a notable increase in prevalence observed. Staphylococcus aureus was the most common pathogen in 7 of 9 studies that included microbiologic findings. In-patient mortality ranged from 3.7% to 14.4%, while the percentage of patients who underwent surgery ranged from 6.4% to 16.0%. Conclusions The overall incidence of IE has remained stable among the 14 population-based investigations in North America identified in our systematic review. Standardization of study design for future population-based investigations has been highlighted for use in subsequent systematic reviews of IE.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, UK
| | - Martin H Thornhill
- Academic Unit of Oral & Maxillofacial Medicine Surgery & Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Division of Epidemiology, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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Talha KM, Baddour LM, Thornhill MH, Arshad V, Tariq W, Tleyjeh IM, Scott CG, Hyun MC, Bailey KR, Anavekar NS, Palraj R, Sohail MR, DeSimone DC, Dayer MJ. Escalating incidence of infective endocarditis in Europe in the 21st century. Open Heart 2021; 8:e001846. [PMID: 34670832 PMCID: PMC8529987 DOI: 10.1136/openhrt-2021-001846] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
AIM To provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe. METHODS A systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence. RESULTS Of 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%. CONCLUSION Based on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase. TRIAL REGISTERATION NUMBER CRD42020191196.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Martin H Thornhill
- School of Clinical Dentistry, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher G Scott
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Meredith C Hyun
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark J Dayer
- Taunton and Somerset NHS Foundation Trust, Taunton, UK
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Talha KM, Baddour LM, Ishaq H, Ramesh R, Arshad V, Tariq W, Fischer KM, Berbari EF, Sohail MR, Palraj R. Native Vertebral Osteomyelitis in Patients with Staphylococcus aureus Bacteremia. Am J Med Sci 2021; 363:140-146. [PMID: 34407419 DOI: 10.1016/j.amjms.2021.06.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/19/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the study was to assess the epidemiology, risk factors and outcomes of native vertebral osteomyelitis (NVO) in patients with Staphylococcus aureus bacteremia (SAB). METHODS A retrospective institutional review was conducted at Mayo Clinic, Minnesota. Patients aged ≥ 18 years with SAB who developed NVO from January 1, 2006 to December 31, 2020 were included and 3-month follow-up data were abstracted. Data pertaining to patient demographics, risk factors and outcomes were recorded using REDCap. A 1:2 nested case-control analysis was performed, and controls were matched according to age, sex and year of SAB diagnosis. RESULTS A total of 103 patients had NVO. A majority (60.2%) of patients was male, with a median age of 62.0 years. Thirty-one (30.1%) cases were caused by methicillin-resistant S. aureus (MRSA). The lumbar spine was most commonly (57.6%) and the most commonly reported comorbid conditions included diabetes mellitus (36.9%) and coronary artery disease (27.2%). Mortality at three-month follow-up was 18.6%. Nested case-control analysis revealed that injection drug use (IDU) and tobacco consumption were significant risk factors associated with NVO, while chronic hemodialysis and chronic liver disease (CLD) were associated with a decreased risk of NVO. CONCLUSIONS Atherosclerotic vascular disease was prominent in our contemporary cohort with NVO in the setting of SAB. Diabetes mellitus, tobacco consumption, older age and male sex likely contributed to this profile. Because IDU was associated with NVO, an increased number of cases should be anticipated among patients with IDU given the ongoing opioid epidemic in the United States.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA; Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Hassan Ishaq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Rommel Ramesh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Karen M Fischer
- Department of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Elie F Berbari
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - M Rizwan Sohail
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
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Arshad V, Baddour LM, Lahr BD, Khalil S, Tariq W, Talha KM, Cha YM, DeSimone DC, Sohail MR. Impact of delayed device re-implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis. Pacing Clin Electrophysiol 2021; 44:1303-1311. [PMID: 34132396 DOI: 10.1111/pace.14297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Optimal timing of cardiovascular implantable electronic device (CIED) re-implantation following device removal due to infection is undefined. Multinational guidelines reflect this and include no specific recommendation for this timing, while others have recommended waiting at least 14 days in cases of CIED related infective endocarditis (CIED-IE). The current work seeks to clarify this issue. METHODS We retrospectively reviewed institutional data at Mayo Clinic, Minnesota of patients aged ≥ 18 years who developed CIED-IE from January 1, 1991 to February 1, 2016. CIED-IE was defined as echocardiogram reported device lead or valvular vegetation. Regression analyses were used to relate the risk of clinical outcomes to the interval between CIED removal and re-implantation and the location of vegetations. RESULTS A total of 109 patients met study inclusion criteria. A majority (68.8%) of patients were men and the median age was 68.0 years. Transoesophageal echocardiogram (TEE) was performed in 95.4% of patients, with valve vegetations detected in 33.9% (n = 37). Survival analysis comparing patients in whom device re-implantation was < 14 days vs. ≥14 days, and further categorized by those with and without valve vegetation, showed a significant difference (P = 0.028); patients with valve vegetation and reimplantation interval < 14 days had the lowest (58.7%) 12-month survival. When adjusted for valve vegetation, longer time interval for reimplantation trended toward increased hospital length of stay (P = 0.079). CONCLUSION Our findings suggest that the recommended 14-day delay between CIED extraction and re-implantation in CIED-IE patients is associated with a survival benefit, but longer length of hospital stay following re-implantation.
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Affiliation(s)
- Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Brian D Lahr
- Department of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Sarwat Khalil
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical Center, Minnesota, USA
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Khawaja Muhammad Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Talha KM, Ishaq H, Ramesh R, Tariq W, Arshad V, Baddour LM, Sohail MR, Palraj R. Association between high vancomycin minimum inhibitory concentration and clinical outcomes in patients with methicillin-resistant Staphylococcus aureus bacteraemia - A retrospective cohort study. Eur J Clin Microbiol Infect Dis 2021; 40:1503-1510. [PMID: 33609261 DOI: 10.1007/s10096-021-04200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to determine the role of high (≥ 1.5 mg/L) vancomycin minimum inhibitory concentration (VMIC) in predicting clinical outcomes in patients with methicillin-resistant Staphylococcus aureus bacteraemia (MRSAB). A retrospective study was conducted at Mayo Clinic, Minnesota. Patients ≥ 18 years with a 3-month follow-up were included. Outcomes were defined as 30-day all-cause in-hospital mortality, median duration of bacteraemia, metastatic infectious complications, and relapse of MRSAB. A total of 475 patients with MRSAB were identified, and 93 (19.6%) of them had high VMIC isolates. Sixty-four percent of patients were male with a mean age of 69.0 years. Active solid organ malignancy and skin and soft tissue infection as source of MRSAB were associated with high VMIC, while septic arthritis as a complication was significantly associated with low VMIC on multivariate analysis. Eighty-one (17.1%) patients died within 30 days of hospitalization, with no significant difference in mortality rates between the two groups. In-hospital mortality, median duration of bacteraemia, and metastatic infectious complications were not significantly associated with high VMIC MRSAB.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Hassan Ishaq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rommel Ramesh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
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Arshad V, Samad Z, Das J, Almas A, Rashid N, Virani SS, Bloomfield GS, Jafar TH, Ahmed B. Prescribing Patterns of Antihypertensive Medications in Low- and Middle-Income Countries: A Systematic Review. Asia Pac J Public Health 2020; 33:14-22. [PMID: 33084371 DOI: 10.1177/1010539520965280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypertension is highly prevalent, but its pharmacological management has not been well evaluated in low- and middle-income countries (LMICs). This review examined the prescribing patterns of antihypertensives in LMICs. Data were extracted from a total of 26 studies spanning the time period 2000 to 2018. In 10 studies, calcium channel blockers (CCBs) were the most frequently prescribed medication for managing hypertension (range = 33% to 72%); in six studies, renin angiotensin system (RAS) blockers (range = 25% to 83%); in five studies, diuretics (range = 39% to 99%); and in five studies, β-blockers (BBs; range = 26% to 49%) were the most commonly prescribed antihypertensive medications. Prescribing sedatives and sublingual administration of captopril for controlling hypertension was also reported in 3 studies. Only 10 studies presented their findings in light of national or international guidelines. This review calls for further antihypertensive utilization and dispensation studies and a better understanding of clinician's perception and practice of hypertension management guidelines in LMICs.
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Affiliation(s)
| | | | - Jai Das
- The Aga Khan University, Karachi, Pakistan
| | | | | | - Salim S Virani
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
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Iqbal N, Irfan M, Siddiqui F, Arshad V, Zuabairi ABS. Effects of systemic steroids on patients with community-acquired pneumonia: Observational study from a tertiary care hospital of a developing country. Respir Investig 2020; 58:495-501. [PMID: 32665194 DOI: 10.1016/j.resinv.2020.05.004] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Steroid administration has been used as an adjunctive therapy in severe community-acquired pneumonia (SCAP), but there is limited evidence from developing countries to support their use. This study aimed to determine the effects of systemic steroids in patients with community-acquired pneumonia (CAP) in a tertiary care hospital in Pakistan. METHODS A retrospective observational study was performed among patients admitted with a primary diagnosis of CAP at the Aga Khan University Hospital in Karachi, Pakistan. We conducted binary logistic and negative binomial regression analyses to observe the effects of intravenous (IV) steroids on in-hospital mortality, length of hospital stay (LOS), and time to clinical stability (TCS). RESULTS A total of 1100 cases were reviewed, out of which 508 were included in our analysis; 173 (34.0%) patients received IV steroids. These patients had a higher proportion of comorbidities such as asthma (p = 0.002) and chronic obstructive pulmonary disease (COPD; p < 0.001), bilateral lung opacities/multilobar involvement (p < 0.001), and higher CURB-65 scores (p < 0.001) than the non-steroid group. Overall mortality was 10.8%. The adjusted estimates did not demonstrate any effect of systemic steroids on mortality (AOR: 0.85, 95% CI: 0.39-1.88). In fact, patients receiving IV steroid treatment showed a significantly longer duration of hospitalization (IRR: 1.51, 95% CI: 1.37-1.66) and had a longer TCS (IRR: 1.50, 95% CI: 1.13-1.33). CONCLUSION Our study does not demonstrate any mortality benefit with steroids in CAP. On the other hand, the patients showed a longer hospital stay and longer time to stability.
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Affiliation(s)
- Nousheen Iqbal
- Jinnah Medical and Dental College, 22-23 Shaheed-e-Millat Road, Karachi, Sindh, 75400, Pakistan; Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Stadium Road, Karachi, Sindh, 75300, Pakistan.
| | - Muhammad Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Stadium Road, Karachi, Sindh, 75300, Pakistan.
| | - Faraz Siddiqui
- Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, 75300, Pakistan.
| | - Verda Arshad
- Aga Khan University Hospital, Stadium Road, Karachi, Sindh, 75300, Pakistan.
| | - Ali Bin Sarwar Zuabairi
- Section Chief of Pulmonary and Critical Care Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, 75300, Pakistan.
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Iqbal N, Irfan M, Siddique F, Arshad V, Zubairi ABS. Factors predicting in-hospital mortality among patients admitted with community acquired pneumonia at a tertiary care hospital Karachi, Pakistan. Clin Respir J 2020; 14:328-334. [PMID: 31863551 DOI: 10.1111/crj.13137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/13/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Community Acquired Pneumonia (CAP) is associated with significant morbidity and mortality globally, but unfortunately there is limited data available from South East Asia. OBJECTIVE To determine the risk factors associated with in-hospital mortality in patients with CAP in a tertiary care hospital of Pakistan. METHODS A retrospective study was conducted on adult patients admitted with a diagnosis of CAP from January 2011 till December 2016. Their clinical records were reviewed and a multivariable analysis was done to determine the factors associated with in-hospital mortality. RESULTS A total of 1100 files were reviewed, of which 509 were included in the analysis. The mean age was 63.6 ± 16.5 years and 302 (52.16%) were males. The most Common isolated pathogen was Staphylococcus aureus (23%). Overall mortality was 10.8%. On univariate analysis factors associated with mortality were old age patients (P = 0.02); history of pneumonia in last 12 months (P = 0.008); CURB 65 score ≥ 3 (P < 0.001) and high dependency units as initial site of care (P < 0.001). On multivariable analysis CURB65 ≥ 3 score; high dependency unit as initial site of care; bedridden status; presence of bilateral infiltrates on chest X-ray and hemoglobin of 10.4 g/dL or less at the time of admission were key determinants of in-hospital mortality. CONCLUSION We found CURB65 ≥ 3 score; high dependency unit as initial site of care; bedridden status; bilateral infiltrates on chest X-ray and low hemoglobin (10.4 g/dL or less) at the time of admission as independent risk factors of in-hospital mortality. Staphylococcus aureus was the most common organism isolated in patients.
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Affiliation(s)
- Nousheen Iqbal
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.,Department of Medicine, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Muhammad Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Faraz Siddique
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Ali Bin Sarwar Zubairi
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Abstract
Pneumocystis pneumonia (PCP) is an opportunistic fungal infection that is usually seen in immunocompromised patients, especially those with HIV, malignancies, organ transplants and on drug therapies like chemotherapy and steroids. PCP has subacute presentation in patients with AIDS which if left untreated gets worse and is a significant cause of morbidity and mortality. Here we present a case of PCP went undiagnosed, partially due to the patient being unaware of his HIV positive status and partially because no organism could be found under the microscope.
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Affiliation(s)
- Verda Arshad
- Aga Khan Medical College, Aga Khan University, Karachi, Pakistan
| | - Nousheen Iqbal
- Section of Pulmonology and Critical Care, Department of Medicine, Aga Khan University and Hospital, Karachi, Pakistan
| | | | - Muhammad Irfan
- Section of Pulmonology and Critical Care, Department of Medicine, Aga Khan University and Hospital, Karachi, Pakistan
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