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Rizk Y, Saad N, Arnaout W, Chalah MA, Farah S. Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management. J Clin Med 2023; 12:6321. [PMID: 37834965 PMCID: PMC10573864 DOI: 10.3390/jcm12196321] [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: 08/15/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is a common endocrine disorder among older adults. The aim of this review is to shed light on PHPT, particularly in this age group, in terms of prevalence, clinical manifestations, medical and surgical management, and post-operative complications. METHODS Eligible studies were those considering PHPT exclusively in the older population (main databases: PubMed, Medline, Google Scholar and the University Online database). Articles published in the last 10 years (2013-2023) were considered. Eligibility criteria followed the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. The methodological quality of the studies was assessed using the Joanna Briggs Institute critical appraisal tool. A total of 29 studies (mainly observational) matched the inclusion criteria. RESULTS The prevalence of PHPT is approximately 1 per 100 in the elderly, and it is more common in females. The clinical presentation varies by age and can include osteoporosis, fractures, and neuropsychiatric symptoms. Conservative management can be an option whenever surgery is not indicated or feasible. However, parathyroidectomy (PTX) remains a safe and effective modality in aging populations with improvement to symptoms, bone mineral density, fracture risk, frailty, quality of life, and metabolic derangements. Complication rates are similar in elderly people compared to younger ones, except for mildly longer length of hospital stay and reoperation for those with higher frailty. CONCLUSION PHPT is a common yet overlooked and underdiagnosed condition among the older population. The safety and efficacy of PTX in the older population on different levels is now well demonstrated in the literature.
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Affiliation(s)
- Youssef Rizk
- Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon; (Y.R.); (N.S.); (W.A.)
| | - Nour Saad
- Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon; (Y.R.); (N.S.); (W.A.)
| | - Wassim Arnaout
- Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon; (Y.R.); (N.S.); (W.A.)
| | - Moussa A. Chalah
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 13-5053, Lebanon
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), 75116 Paris, France
| | - Stephanie Farah
- Endocrinology, Diabetes and Metabolism, Private Practice, Haddade Street, Batroun P.O. Box 1400, Lebanon
- Division of Research, LAU Medical Center-Rizk Hospital, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 13-5053, Lebanon
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Rodriguez-Morales AJ, Lopez-Echeverri MC, Perez-Raga MF, Quintero-Romero V, Valencia-Gallego V, Galindo-Herrera N, López-Alzate S, Sánchez-Vinasco JD, Gutiérrez-Vargas JJ, Mayta-Tristan P, Husni R, Moghnieh R, Stephan J, Faour W, Tawil S, Barakat H, Chaaban T, Megarbane A, Rizk Y, Sakr R, Escalera-Antezana JP, Alvarado-Arnez LE, Bonilla-Aldana DK, Camacho-Moreno G, Mendoza H, Rodriguez-Sabogal IA, Millán-Oñate J, Lopardo G, Barbosa AN, Cimerman S, Chaves TDSS, Orduna T, Lloveras S, Rodriguez-Morales AG, Thormann M, Zambrano PG, Perez C, Sandoval N, Zambrano L, Alvarez-Moreno CA, Chacon-Cruz E, Villamil-Gomez WE, Benites-Zapata V, Savio-Larriera E, Cardona-Ospina JA, Risquez A, Forero-Peña DA, Henao-Martínez AF, Sah R, Barboza JJ, León-Figueroa DA, Acosta-España JD, Carrero-Gonzalez CM, Al-Tawfiq JA, Rabaan AA, Leblebicioglu H, Gonzales-Zamora JA, Ulloa-Gutiérrez R. The global challenges of the long COVID-19 in adults and children. Travel Med Infect Dis 2023; 54:102606. [PMID: 37295581 PMCID: PMC10247301 DOI: 10.1016/j.tmaid.2023.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas-Institución Universitaria Visión de las Américas, Pereira, 660003, Risaralda, Colombia; Faculty of Health Sciences, Universidad Científica del Sur, Lima, 15067, Peru; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon.
| | - María Camila Lopez-Echeverri
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Maria Fernanda Perez-Raga
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Valentina Quintero-Romero
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Valentina Valencia-Gallego
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Nicolas Galindo-Herrera
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Santiago López-Alzate
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Juan Diego Sánchez-Vinasco
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Juan José Gutiérrez-Vargas
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Percy Mayta-Tristan
- Faculty of Health Sciences, Universidad Científica del Sur, Lima, 15067, Peru
| | - Rola Husni
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Rima Moghnieh
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Joseph Stephan
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Wissam Faour
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Samah Tawil
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Hanane Barakat
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Toufic Chaaban
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Andre Megarbane
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Youssef Rizk
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Rania Sakr
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Juan Pablo Escalera-Antezana
- Direction of First Level, Municipal Secretary of Health, Municipal Autonomous Government of Cochabamba, Cochabamba, Bolivia
| | | | | | - German Camacho-Moreno
- Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, DC, Colombia; Division of Infectious Diseases, HOMI, Hospital Pediátrico La Misericordia, Bogotá, DC, Colombia; Fundación Hospital Infantil Universitario de San José, Bogotá, DC, Colombia
| | - Henry Mendoza
- Hemera Unidad de Infectología IPS SAS, Bogota, Colombia
| | | | - Jose Millán-Oñate
- Clinica Imbanaco Grupo Quironsalud, Cali, Colombia; Universidad Santiago de Cali, Cali, Colombia; Clinica de Occidente, Cali, Colombia; Clinica Sebastián de Belalcazar, Valle del Cauca, Colombia
| | - Gustavo Lopardo
- Cátedra de Enfermedades Infecciosas, University of Buenos Aires, Buenos Aires, Argentina
| | - Alexandre Naime Barbosa
- Infectious Diseases Department, Botucatu Medical School, UNESP, Brazilian Society for Infectious Diseases, São Paulo, SP, Brazil
| | - Sergio Cimerman
- Institute of Infectious Diseases Emilio Ribas, São Paulo, Brazil
| | - Tânia do Socorro Souza Chaves
- Evandro Chagas Institute, Health of Ministry of Brazil, Belém, Pará, Brazil; Faculdade de Medicina da Universidade Federal do Pará, Brazil
| | - Tomas Orduna
- Cátedra de Enfermedades Infecciosas, University of Buenos Aires, Buenos Aires, Argentina; Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
| | - Susana Lloveras
- Cátedra de Enfermedades Infecciosas, University of Buenos Aires, Buenos Aires, Argentina; Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
| | - Andrea G Rodriguez-Morales
- Unidad Procedimientos, Policlínico Neurología, Centro de Referencia de Salud Dr. Salvador Allende Gossens, Santiago de Chile, Chile
| | - Monica Thormann
- Hospital Salvador Bienvenido Gautier, Santo Domingo, Dominican Republic
| | | | - Clevy Perez
- Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - Lysien Zambrano
- Institute for Research in Medical Sciences and Right to Health (ICIMEDES), National Autonomous University of Honduras (UNAH), Tegucigalpa, Honduras
| | - Carlos A Alvarez-Moreno
- National Clinical Coordinator COVID-19-WHO Studies, Colombia; Clinica Universitaria Colombia, Clinica Colsanitas and Facultad de Medicina, Universidad Nacional de Colombia, Colombia
| | | | - Wilmer E Villamil-Gomez
- Centro de Investigación en Ciencias de la Vida, Universidad Simón Bolívar, Barranquilla, Colombia; Grupo de Expertos Clínicos Secretaria de Salud de Barranquilla, Barranquilla, Colombia
| | - Vicente Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Jaime A Cardona-Ospina
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, 94704, USA
| | - Alejandro Risquez
- Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - David A Forero-Peña
- Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela; Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Andrés F Henao-Martínez
- Division of Infectious Diseases, School of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Ranjit Sah
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal; Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Maharashtra, India
| | | | | | - Jaime David Acosta-España
- Institute of Microbiology, Friedrich Schiller University Jena, Beutenbergstraße 13, 07745, Jena, Germany; Postgraduate Program in Infectious Diseases, School of Medicine, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | | | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, 34465, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 47405, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia; Department of Public Health and Nutrition, The University of Haripur, Haripur, 22610, Pakistan
| | - Hakan Leblebicioglu
- Department of Infectious Diseases, VM Medicalpark Samsun Hospital, Samsun, Turkey
| | - Jose A Gonzales-Zamora
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Rolando Ulloa-Gutiérrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica; Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica; Cátedra de Pediatría, Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
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Rizk Y, Hoteit R, Khater B, Naous J. Psychosocial wellbeing and risky health behaviors among Syrian adolescent refugees in South Beirut: a study using the HEEADSSS interviewing framework. Front Psychol 2023; 14:1019269. [PMID: 37205080 PMCID: PMC10187139 DOI: 10.3389/fpsyg.2023.1019269] [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] [Received: 09/01/2022] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose Adolescent refugees are at risk of mental health disorders and underdiagnosed risky behaviors. Limited research exists in the Middle East and North Africa. This study aims to assess psychosocial wellbeing and risk-taking behaviors among adolescent refugees displaced to South Beirut following a standardized framework. Methods A cross-sectional study using face-to-face confidential HEEADSSS (Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Safety and Suicide/Depression) interviews was conducted among 52 Syrian adolescent refugees, between the ages of 14 and 21, in a health center in South Beirut. Results The mean age of the interviewees was 17.04 ± 1.77 years, with a male predominance 34 (65.4%). Five (9.6%) were married, 38 (73.1%) were not attending school 27 (52.9%) lived in a place with a crowding index ≥3.5 and 21 (40.4%) were working. Risky health concerns or behaviors detected included no activities or exercise 38 (73.1%), eating one to two meals per day 39 (75%) and smoking 22 (42.3%). Eleven (21.2%) have been ever offered drugs and 22 (42.3%) believed they should carry a weapon for protection. Twenty one out of 32 (65.7%) had major depressive disorders and 33 (63.5%) screened positive for behavioral problems. Exposure to home verbal or physical violence, male gender, smoking, and employment were associated with high scoring in behavioral problems. Smoking and ever been touched in an unwanted way were found to be associated with depression. Conclusion and practical implications Implementing the HEEADSSS interviewing assessment within medical encounters with refugee adolescents is one efficient way to detect risky health behaviors and mental health problems. Interventions need to be implemented as early as possible in the refugees' journey to help them cope and gain resilience. Training health care providers to conduct the questionnaire and delivering brief counseling when required is recommended. Establishing a network of referrals to provide multidisciplinary care to adolescents can be helpful. Obtaining a fund to distribute safety helmets for adolescent motorbike drivers can be a way to reduce injuries. More research among adolescent refugees in multiple settings, including teenagers in the host country, is needed to serve this population better.
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Affiliation(s)
- Youssef Rizk
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Lebanese American University Medical Center Rizk Hospital, Beirut, Lebanon
| | - Reem Hoteit
- Faculty of Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Beatrice Khater
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jihane Naous
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
- *Correspondence: Jihane Naous,
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4
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Affiliation(s)
- John G Rizk
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, School of Pharmacy, 220 Arch Street, 12th Floor, Room 01-409-E, Baltimore, MD, 21201, USA.
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Brandon M Henry
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Donald N Forthal
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Molecular Biology and Biochemistry, University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Youssef Rizk
- Division of Family Medicine, Department of Internal Medicine, Lebanese American University School of Medicine, Beirut, Lebanon
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Abstract
Human monkeypox is a zoonotic orthopoxvirus with presentation similar to smallpox. Monkeypox is transmitted incidentally to humans when they encounter infected animals. Reports have shown that the virus can also be transmitted through direct contact (sexual or skin-to-skin), respiratory droplets, and via fomites such as towels and bedding. Multiple medical countermeasures are stockpiled for orthopoxviruses such as monkeypox. Two vaccines are currently available, JYNNEOSTM (live, replication incompetent vaccinia virus) and ACAM2000® (live, replication competent vaccinia virus). While most cases of monkeypox will have mild and self-limited disease, with supportive care being typically sufficient, antivirals (e.g. tecovirimat, brincidofovir, cidofovir) and vaccinia immune globulin intravenous (VIGIV) are available as treatments. Antivirals can be considered in severe disease, immunocompromised patients, pediatrics, pregnant and breastfeeding women, complicated lesions, and when lesions appear near the mouth, eyes, and genitals. The purpose of this short review is to describe each of these countermeasures.
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Affiliation(s)
- John G Rizk
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, School of Pharmacy, 220 Arch Street, 12th Floor, Room 01-409-E, Baltimore, MD, 21201, USA.
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Brandon M Henry
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Donald N Forthal
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, School of Medicine, Irvine, CA, USA
- Department of Molecular Biology and Biochemistry, University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Youssef Rizk
- Division of Family Medicine, Department of Internal Medicine, Lebanese American University School of Medicine, Beirut, Lebanon
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Rizk JG, Lazo JG, Quan D, Gabardi S, Rizk Y, Streja E, Kovesdy CP, Kalantar-Zadeh K. Mechanisms and management of drug-induced hyperkalemia in kidney transplant patients. Rev Endocr Metab Disord 2021; 22:1157-1170. [PMID: 34292479 DOI: 10.1007/s11154-021-09677-7] [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] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Hyperkalemia is a common and potentially life-threatening complication following kidney transplantation that can be caused by a composite of factors such as medications, delayed graft function, and possibly potassium intake. Managing hyperkalemia after kidney transplantation is associated with increased morbidity and healthcare costs, and can be a cause of multiple hospital admissions and barriers to patient discharge. Medications used routinely after kidney transplantation are considered the most frequent culprit for post-transplant hyperkalemia in recipients with a well-functioning graft. These include calcineurin inhibitors (CNIs), pneumocystis pneumonia (PCP) prophylactic agents, and antihypertensives (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers). CNIs can cause hyperkalemic renal tubular acidosis. When hyperkalemia develops following transplantation, the potential offending medication may be discontinued, switched to another agent, or dose-reduced. Belatacept and mTOR inhibitors offer an alternative to calcineurin inhibitors in the event of hyperkalemia, however should be prescribed in the appropriate patient. While trimethoprim/sulfamethoxazole (TMP/SMX) remains the gold standard for prevention of PCP, alternative agents (e.g. dapsone, atovaquone) have been studied and can be recommend in place of TMP/SMX. Antihypertensives that act on the Renin-Angiotensin-Aldosterone System are generally avoided early after transplant but may be indicated later in the transplant course for patients with comorbidities. In cases of mild to moderate hyperkalemia, medical management can be used to normalize serum potassium levels and allow the transplant team additional time to evaluate the function of the graft. In the immediate post-operative setting following kidney transplantation, a rapidly rising potassium refractory to medical therapy can be an indication for dialysis. Patiromer and sodium zirconium cyclosilicate (ZS-9) may play an important role in the management of chronic hyperkalemia in kidney transplant patients, although additional long-term studies are necessary to confirm these effects.
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Affiliation(s)
- John G Rizk
- Arizona State University, Edson College, Phoenix, AZ, USA.
| | - Jose G Lazo
- UCSF Medical Center, University of California San Francisco, San Francisco, CA, USA
| | - David Quan
- UCSF Medical Center, University of California San Francisco, San Francisco, CA, USA
| | - Steven Gabardi
- Department of Transplant Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Youssef Rizk
- Department of Internal Medicine, Division of Family Medicine, Lebanese American University Medical Center - St. John's Hospital, Beirut, Lebanon
| | - Elani Streja
- Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, School of Medicine, University of California, CA, Irvine, Orange, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, School of Medicine, University of California, CA, Irvine, Orange, USA
- Department of Epidemiology, University of California, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Affiliation(s)
- John G Rizk
- Edson College, Arizona State University, Phoenix, AZ, USA -
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Youssef Rizk
- Division of Family Medicine, Department of Internal Medicine, Lebanese American University Medical Center - St. John's Hospital, Beirut, Lebanon
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Rizk JG, Barr CE, Rizk Y, Lewin JC. The next frontier in vaccine safety and VAERS: Lessons from COVID-19 and ten recommendations for action. Vaccine 2021; 39:6017-6018. [PMID: 34400020 PMCID: PMC8352656 DOI: 10.1016/j.vaccine.2021.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022]
Affiliation(s)
- John G Rizk
- Arizona State University, Edson College, Phoenix, AZ, United States.
| | - Charles E Barr
- Pivotal Strategic Consulting, LLC, Danville, CA, United States; Diya Health, Oakland, CA, United States
| | - Youssef Rizk
- Department of Internal Medicine, Division of Family Medicine, Lebanese American University Medical Center - St. John's Hospital, Lebanon
| | - John C Lewin
- National Coalition on Health Care, Washington, DC, United States
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Abstract
PURPOSE OF REVIEW Medications used frequently after kidney transplantation, including calcineurin inhibitors, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers and antimicrobials, are considered the leading culprit for posttransplant hyperkalaemia in recipients with a well functioning allograft. Other risk factors include comorbidities such as diabetes, hypertension and heart failure; and consumption of a potassium-enriched diet. We review the mechanisms for hyperkalaemia following kidney transplantation that are addressed using nonpharmacological and pharmacological interventions. We also discuss emerging therapeutic approaches for the management of recurrent hyperkalaemia in solid organ transplantation, including newer potassium binding therapies. RECENT FINDINGS Patiromer and sodium zirconium cyclosilicate are emerging potassium binders approved for the treatment of hyperkalaemia. Patiromer is a polymer that exchanges potassium for calcium ions. In contrast, sodium zirconium cyclosilicate is a nonpolymer compound that exchanges potassium for sodium and hydrogen ions. Both agents are efficacious in the treatment of chronic or recurrent hyperkalaemia and may result in fewer gastrointestinal side effects than older potassium binders such as sodium polystyrene sulfonate and calcium polystyrene sulfonate. Large-scale clinical studies have not been performed in kidney transplant patients. Patiromer may increase serum concentrations of tacrolimus, but not cyclosporine. Sodium zirconium cyclosilicate does not appear to compromise tacrolimus pharmacokinetics, although it may have a higher sodium burden. SUMMARY Patiromer and sodium zirconium cyclosilicate may be well tolerated options to treat asymptomatic hyperkalaemia and have the potential to ease potassium dietary restrictions in kidney transplant patients by maintaining a plant-dominant, heart-healthy diet. Their efficacy, better tolerability and comparable cost with respect to previously available potassium binders make them an attractive therapeutic option in chronic hyperkalaemia following kidney transplantation.
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Affiliation(s)
- John Rizk
- Arizona State University, Edson College, Phoenix, Arizona
| | - David Quan
- UCSF Medical Center, University of California San Francisco, San Francisco, California
| | - Steven Gabardi
- Department of Transplant Surgery, Brigham and Women's Hospital
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Youssef Rizk
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange
- Department of Epidemiology, University of California, Los Angeles, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Rizk JG, Forthal DN, Kalantar-Zadeh K, Mehra MR, Lavie CJ, Rizk Y, Pfeiffer JP, Lewin JC. Expanded Access Programs, compassionate drug use, and Emergency Use Authorizations during the COVID-19 pandemic. Drug Discov Today 2020; 26:593-603. [PMID: 33253920 PMCID: PMC7694556 DOI: 10.1016/j.drudis.2020.11.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 10/05/2020] [Revised: 11/08/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
The US Food and Drug Administration (FDA) Expanded Access (EA) Program, which allows for compassionate uses of unapproved therapeutics and diagnostics outside of clinical trials, has gained significant traction during the Coronavirus 2019 (COVID-19) pandemic. While development of vaccines has been the major focus, uncertainties around new vaccine safety and effectiveness have spawned interest in other pharmacological options. Experimental drugs can also be approved under the FDA Emergency Use Authorization (EUA) program, designed to combat infectious disease and other threats. Here, we review the US experience in 2020 with pharmacological EA and EUA approvals during the pandemic. We also provide a description of, and clinical rationale for, each of the EA- or EUA-approved drugs (e.g. remdesivir, convalescent plasma, propofol 2%, hydroxychloroquine, ruxolitinib, bamlanivimab, baricitinib, casirivimab plus imdevimab) during the pandemic and concluding reflections on the EA program and its potential future uses.
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Affiliation(s)
- John G Rizk
- Edson College, Arizona State University, Phoenix, AZ, USA.
| | - Donald N Forthal
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, School of Medicine, Irvine, CA, USA; Department of Molecular Biology and Biochemistry, University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Irvine, School of Medicine, Irvine, CA, USA; Department of Epidemiology, University of California, Los Angeles, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Youssef Rizk
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - John C Lewin
- National Coalition on Health Care, Washington, DC, USA
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Rizk JG, Kalantar-Zadeh K, Mehra MR, Lavie CJ, Rizk Y, Forthal DN. Authors' Reply to Vrachatis et al. "Pharmaco-Immunomodulatory Therapy I COVID-19". Drugs 2020; 80:1501-1503. [PMID: 32880806 PMCID: PMC7471515 DOI: 10.1007/s40265-020-01396-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- John G Rizk
- Edson College, Arizona State University, Phoenix, AZ, USA.
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Epidemiology, University of California, Los Angeles, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Tibor Rubin VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Youssef Rizk
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Donald N Forthal
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Molecular Biology and Biochemistry, University of California, Irvine, School of Medicine, Irvine, CA, USA
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Abstract
The severe acute respiratory syndrome coronavirus 2 associated coronavirus disease 2019 (COVID-19) illness is a syndrome of viral replication in concert with a host inflammatory response. The cytokine storm and viral evasion of cellular immune responses may play an equally important role in the pathogenesis, clinical manifestation, and outcomes of COVID-19. Systemic proinflammatory cytokines and biomarkers are elevated as the disease progresses towards its advanced stages, and correlate with worse chances of survival. Immune modulators have the potential to inhibit cytokines and treat the cytokine storm. A literature search using PubMed, Google Scholar, and ClinicalTrials.gov was conducted through 8 July 2020 using the search terms ‘coronavirus’, ‘immunology’, ‘cytokine storm’, ‘immunomodulators’, ‘pharmacology’, ‘severe acute respiratory syndrome 2’, ‘SARS-CoV-2’, and ‘COVID-19’. Specific immune modulators include anti-cytokines such as interleukin (IL)-1 and IL-6 receptor antagonists (e.g. anakinra, tocilizumab, sarilumab, siltuximab), Janus kinase (JAK) inhibitors (e.g. baricitinib, ruxolitinib), anti-tumor necrosis factor-α (e.g. adalimumab, infliximab), granulocyte–macrophage colony-stimulating factors (e.g. gimsilumab, lenzilumab, namilumab), and convalescent plasma, with promising to negative trials and other data. Non-specific immune modulators include human immunoglobulin, corticosteroids such as dexamethasone, interferons, statins, angiotensin pathway modulators, macrolides (e.g. azithromycin, clarithromycin), hydroxychloroquine and chloroquine, colchicine, and prostaglandin D2 modulators such as ramatroban. Dexamethasone 6 mg once daily (either by mouth or by intravenous injection) for 10 days may result in a reduction in mortality in COVID-19 patients by one-third for patients on ventilators, and by one-fifth for those receiving oxygen. Research efforts should focus not only on the most relevant immunomodulatory strategies but also on the optimal timing of such interventions to maximize therapeutic outcomes. In this review, we discuss the potential role and safety of these agents in the management of severe COVID-19, and their impact on survival and clinical symptoms.
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Affiliation(s)
- John G Rizk
- Edson College, Arizona State University, Phoenix, AZ, USA.
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Epidemiology, University of California, Los Angeles, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Tibor Rubin VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Youssef Rizk
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Donald N Forthal
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Molecular Biology and Biochemistry, University of California, Irvine, School of Medicine, Irvine, CA, USA
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13
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Abuoghaba A, Rizk Y, Ismail I, Awadien N. Impact of hen treatment with bee pollen and thermal manipulation
during early egg incubation period on the hatchability
and embryonic development of chicks. J Anim Feed Sci 2018. [DOI: 10.22358/jafs/100622/2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Catanescu I, Long G, Bove P, Khoury M, Brown O, Rimar S, Rizk Y, Uzieblo M, Hans S. Rupture of Abdominal Aortic Aneurysm in Patients with and without Antecedent Endovascular Repair. Ann Vasc Surg 2016; 39:99-104. [PMID: 27522971 DOI: 10.1016/j.avsg.2016.05.104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/07/2016] [Accepted: 05/18/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Reported results of ruptured abdominal aortic aneurysm (rAAA) in patients with antecedent endovascular aneurysm repair (EVAR) to those presenting with de novo rupture show a similar or slightly improved outcome. The aim of this study was to compare differences in the presentation and outcomes of rAAA with and without prior EVAR. METHODS A retrospective review of 121 patients with rAAA, ruptured identified 2 groups. Group A included 17 patients (rAAA n = 17) with antecedent EVAR and group B consisted of 104 patients (rAAA n = 104) with de novo ruptures, from January 2001 to March 2015 in 3 teaching hospitals. Patient characteristics and perioperative variables were compared; Fisher's exact test was used for categorical variables. For continuous variables, Student's t-test and Mann-Whitney U test were used. RESULTS Both groups were similar in age, gender, the incidence of hypertension, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, and nicotine abuse. Mean time of presentation from EVAR to rupture in group A was 42 ± 22 months. Mean preoperative transverse or anteroposterior diameter of AAA was 6.6 cm in group A and 7.1 cm in group B. Three patients of 17 (17.6%) in group A were hemodynamically unstable as compared to 47 of 104 patients (45.1%) in group B (P = 0.03). Mean red blood cells, fresh frozen plasma, and platelet transfusion were similar in both groups. Thirty-day mortality was 8 of 17 (44.7%) in group A and 44 of 104 (42.3%) in group B (P = 1.0). Postoperative complications were also similar in both groups except the incidence of postoperative respiratory failure was higher in group B (38%) as compared with 11.1% in group A (P = 0.001). CONCLUSIONS Patients presenting with rAAA with antecedent EVAR are hemodynamically more stable as compared with patients with de novo rupture of AAA. Postoperative respiratory failure is more common in patients with de novo rupture. rAAA carry high mortality with and without prior EVAR.
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Affiliation(s)
| | | | - Paul Bove
- William Beaumont Hospital, Royal Oak, MI
| | - Michael Khoury
- Henry Ford-Macomb Hospital, Clinton Township, MI; St. John Macomb Hospital, Warren, MI
| | - Otto Brown
- William Beaumont Hospital, Royal Oak, MI
| | | | - Youssef Rizk
- Henry Ford-Macomb Hospital, Clinton Township, MI; St. John Macomb Hospital, Warren, MI
| | | | - Sachinder Hans
- Henry Ford-Macomb Hospital, Clinton Township, MI; St. John Macomb Hospital, Warren, MI.
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Criado FJ, Barnatan MF, Rizk Y, Clark NS, Wang CF. Technical Strategies to Expand Stent-Graft Applicability in the Aortic Arch and Proximal Descending Thoracic Aorta. J Endovasc Ther 2016. [DOI: 10.1177/15266028020090s206] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The endovascular repair of thoracic aortic pathology is on an evolutionary threshold, as advancing technologies and techniques combine to offer the interventionist expanded treatment opportunities. A variety of maneuvers are recommended to address the landing zone limitations to thoracic endografting imposed by the arch vessels: transostial bare stent placement, intentional occlusion of the arch vessel origin, vessel transposition, and bypass grafting. These adjunctive techniques can help us extend the option of a minimally invasive treatment to a greater number of patients with severe thoracic aortic lesions and comorbidities that place them at high risk for standard surgical intervention.
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Affiliation(s)
- Frank J. Criado
- Center for Vascular Intervention, Union Memorial Hospital/MedStar Health, Baltimore, Maryland, USA
| | - Marcos F. Barnatan
- Center for Vascular Intervention, Union Memorial Hospital/MedStar Health, Baltimore, Maryland, USA
| | - Youssef Rizk
- Center for Vascular Intervention, Union Memorial Hospital/MedStar Health, Baltimore, Maryland, USA
| | - Nancy S. Clark
- Center for Vascular Intervention, Union Memorial Hospital/MedStar Health, Baltimore, Maryland, USA
| | - Cecilia F. Wang
- Center for Vascular Intervention, Union Memorial Hospital/MedStar Health, Baltimore, Maryland, USA
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Hans SS, Sachwani G, Khoury MD, Mitsuya M, King T, Rizk Y, Sayed L. Results of Iliac Stenting for Iliac Artery Occlusions. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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17
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Criado FJ, Barnatan MF, Rizk Y, Clark NS, Wang CF. Technical strategies to expand stent-graft applicability in the aortic arch and proximal descending thoracic aorta. J Endovasc Ther 2002; 9 Suppl 2:II32-8. [PMID: 12166839] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The endovascular repair of thoracic aortic pathology is on an evolutionary threshold, as advancing technologies and techniques combine to offer the interventionist expanded treatment opportunities. A variety of maneuvers are recommended to address the landing zone limitations to thoracic endografting imposed by the arch vessels: transostial bare stent placement, intentional occlusion of the arch vessel origin, vessel transposition, and bypass grafting. These adjunctive techniques can help us extend the option of a minimally invasive treatment to a greater number of patients with severe thoracic aortic lesions and comorbidities that place them at high risk for standard surgical intervention.
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Affiliation(s)
- Frank J Criado
- Center for Vascular Intervention, Union Memorial Hospital/MedStar Health, Baltimore, Maryland, USA.
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Criado FJ, Barnatan MF, Rizk Y, Clark NS, Wang CF. Technical Strategies to Expand Stent-Graft Applicability in the Aortic Arch and Proximal Descending Thoracic Aorta. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550-9.sp3.32] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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