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Radmanesh F, Izzy S, Rotem RS, Tahir Z, Rademaker QJ, Yahya T, Mashlah A, Taylor HA, Weisskopf MG, Zafonte RD, Baggish AL, Grashow R. Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension. Neurotrauma Rep 2024; 5:462-466. [PMID: 38666008 PMCID: PMC11044850 DOI: 10.1089/neur.2024.0015] [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] [Indexed: 04/28/2024] Open
Abstract
Traumatic brain injury (TBI) is independently associated with hypertension and ischemic stroke. The goal of this study was to determine the interplay between TBI and incident hypertension in the occurrence of post-TBI stroke. This prospective study used a hospital-based registry to identify patients without pre-existing comorbidities. TBI patients (n = 3664) were frequency matched on age, sex, and race to non-TBI patients (n = 1848). Follow-up started 6 months post-TBI or study entry and extended up to 10 years. To examine hypertension's role in post-TBI stroke, we used logistic regression models to calculate the effect estimates for stroke in four exposure categories that included TBI or hypertension in isolation and in combination. Second, we calculated the conditional direct effect (CDE) of TBI in models that considered hypertension as intermediary. Third, we examined whether TBI effect was modified by antihypertensive medication use. The 10-year cumulative incidence of stroke was higher in the TBI group (4.7%) than the non-TBI group (1.3%; p < 0.001). TBI patients who developed hypertension had the highest risk of stroke (odds ratio [OR] = 4.83, 95% confidence interval [CI] = 2.53-9.23, p < 0.001). The combined effect estimates were less than additive, suggesting an overlapping biological pathway. The total effect of TBI (OR = 3.16, 95% CI = 1.94-5.16, p < 0.001) was higher than the CDE that accounted for hypertension (OR = 2.45, 95% CI = 0.93-6.47, p = 0.06). Antihypertensives attenuated the TBI effect, suggesting that the TBI effect on stroke is partially mediated through hypertension. TBI is an independent risk factor for long-term stroke, and the underlying biological pathway may partly operate through TBI-precipitated hypertension. These findings suggest that screening for hypertension may mitigate stroke risk in TBI.
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Affiliation(s)
- Farid Radmanesh
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Neurocritical Care, Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Saef Izzy
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Boston, Massachusetts, USA
| | - Ran S. Rotem
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Zabreen Tahir
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
| | - Quinn J. Rademaker
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Taha Yahya
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ahmad Mashlah
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Boston, Massachusetts, USA
- Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard University, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ross D. Zafonte
- Football Players Health Study at Harvard University, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Aaron L. Baggish
- Football Players Health Study at Harvard University, Boston, Massachusetts, USA
- Institute for Sport Science and Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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2
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Izzy S, Chen PM, Tahir Z, Grashow R, Radmanesh F, Cote DJ, Yahya T, Dhand A, Taylor H, Shih SL, Albastaki O, Rovito C, Snider SB, Whalen M, Nathan DM, Miller KK, Speizer FE, Baggish A, Weisskopf MG, Zafonte R. Association of Traumatic Brain Injury With the Risk of Developing Chronic Cardiovascular, Endocrine, Neurological, and Psychiatric Disorders. JAMA Netw Open 2022; 5:e229478. [PMID: 35482306 PMCID: PMC9051987 DOI: 10.1001/jamanetworkopen.2022.9478] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Increased risk of neurological and psychiatric conditions after traumatic brain injury (TBI) is well-defined. However, cardiovascular and endocrine comorbidity risk after TBI in individuals without these comorbidities and associations with post-TBI mortality have received little attention. OBJECTIVE To assess the incidence of cardiovascular, endocrine, neurological, and psychiatric comorbidities in patients with mild TBI (mTBI) or moderate to severe TBI (msTBI) and analyze associations between post-TBI comorbidities and mortality. DESIGN, SETTING, AND PARTICIPANTS This prospective longitudinal cohort study used hospital-based patient registry data from a tertiary academic medical center to select patients without any prior clinical comorbidities who experienced TBI from 2000 to 2015. Using the same data registry, individuals without head injuries, the unexposed group, and without target comorbidities were selected and age-, sex-, and race-frequency-matched to TBI subgroups. Patients were followed-up for up to 10 years. Data were analyzed in 2021. EXPOSURES Mild or moderate to severe head trauma. MAIN OUTCOMES AND MEASURES Cardiovascular, endocrine, neurologic, and psychiatric conditions were defined based on International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Associations between TBI and comorbidities, as well as associations between the comorbidities and mortality, were analyzed. RESULTS A total of 4351 patients with mTBI (median [IQR] age, 45 [29-57] years), 4351 patients with msTBI (median [IQR] age, 47 [30-58] years), and 4351 unexposed individuals (median [IQR] age, 46 [30-58] years) were included in analyses. In each group, 45% of participants were women. mTBI and msTBI were significantly associated with higher risks of cardiovascular, endocrine, neurologic, and psychiatric disorders compared with unexposed individuals. In particular, hypertension risk was increased in both mTBI (HR, 2.5; 95% CI, 2.1-2.9) and msTBI (HR, 2.4; 95% CI, 2.0-2.9) groups. Diabetes risk was increased in both mTBI (HR, 1.9; 95% CI, 1.4-2.7) and msTBI (HR, 1.9; 95% CI, 1.4-2.6) groups, and risk of ischemic stroke or transient ischemic attack was also increased in mTBI (HR, 2.2; 95% CI, 1.4-3.3) and msTBI (HR, 3.6; 95% CI, 2.4-5.3) groups. All comorbidities in the TBI subgroups emerged within a median (IQR) of 3.49 (1.76-5.96) years after injury. Risks for post-TBI comorbidities were also higher in patients aged 18 to 40 years compared with age-matched unexposed individuals: hypertension risk was increased in the mTBI (HR, 5.9; 95% CI, 3.9-9.1) and msTBI (HR, 3.9; 95% CI, 2.5-6.1) groups, while hyperlipidemia (HR, 2.3; 95% CI, 1.5-3.4) and diabetes (HR, 4.6; 95% CI, 2.1-9.9) were increased in the mTBI group. Individuals with msTBI, compared with unexposed patients, had higher risk of mortality (432 deaths [9.9%] vs 250 deaths [5.7%]; P < .001); postinjury hypertension (HR, 1.3; 95% CI, 1.1-1.7), coronary artery disease (HR, 2.2; 95% CI, 1.6-3.0), and adrenal insufficiency (HR, 6.2; 95% CI, 2.8-13.0) were also associated with higher mortality. CONCLUSIONS AND RELEVANCE These findings suggest that TBI of any severity was associated with a higher risk of chronic cardiovascular, endocrine, and neurological comorbidities in patients without baseline diagnoses. Medical comorbidities were observed in relatively young patients with TBI. Comorbidities occurring after TBI were associated with higher mortality. These findings suggest the need for a targeted screening program for multisystem diseases after TBI, particularly chronic cardiometabolic diseases.
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Affiliation(s)
- Saef Izzy
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Patrick M Chen
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Zabreen Tahir
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rachel Grashow
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- The Football Players Health Study at Harvard University, Boston, Massachusetts
| | - Farid Radmanesh
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David J Cote
- Harvard Medical School, Boston, Massachusetts
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Taha Yahya
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amar Dhand
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Network Science Institute, Northeastern University, Boston, Massachusetts
| | - Herman Taylor
- The Football Players Health Study at Harvard University, Boston, Massachusetts
- Morehouse School of Medicine, Atlanta, Georgia
| | - Shirley L Shih
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, Boston
| | - Omar Albastaki
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Craig Rovito
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Samuel B Snider
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Michael Whalen
- Department of Pediatrics, Massachusetts General Hospital, Boston
| | - David M Nathan
- Harvard Medical School, Boston, Massachusetts
- The Football Players Health Study at Harvard University, Boston, Massachusetts
- Diabetes Center, Massachusetts General Hospital, Boston
| | - Karen K Miller
- Harvard Medical School, Boston, Massachusetts
- The Football Players Health Study at Harvard University, Boston, Massachusetts
- Neuroendocrine Unit, Massachusetts General Hospital, Boston
| | - Frank E Speizer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- The Football Players Health Study at Harvard University, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Aaron Baggish
- Harvard Medical School, Boston, Massachusetts
- The Football Players Health Study at Harvard University, Boston, Massachusetts
- Department of Internal Medicine, Cardiovascular Performance Center, Massachusetts General Hospital, Boston
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- The Football Players Health Study at Harvard University, Boston, Massachusetts
| | - Ross Zafonte
- Harvard Medical School, Boston, Massachusetts
- The Football Players Health Study at Harvard University, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, Boston
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
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Ali AB, Khawaja AM, Reilly A, Tahir Z, Rao SS, Bernstock JD, Chen P, Molino J, Gormley W, Izzy S. Venous Thromboembolism Risk and Outcomes Following Decompressive Craniectomy in Severe Traumatic Brain Injury: An Analysis of the Nationwide Inpatient Sample Database. World Neurosurg 2022; 161:e531-e545. [DOI: 10.1016/j.wneu.2022.02.069] [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] [Received: 12/01/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
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Stopa BM, Tahir Z, Mezzalira E, Boaro A, Khawaja A, Grashow R, Zafonte RD, Smith TR, Gormley WB, Izzy S. The Impact of Age and Severity on Dementia After Traumatic Brain Injury: A Comparison Study. Neurosurgery 2021; 89:810-818. [PMID: 34392366 DOI: 10.1093/neuros/nyab297] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/10/2020] [Accepted: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Growing evidence associates traumatic brain injury (TBI) with increased risk of dementia, but few studies have evaluated associations in patients younger than 55 yr using non-TBI orthopedic trauma (NTOT) patients as controls to investigate the influence of age and TBI severity, and to identify predictors of dementia after trauma. OBJECTIVE To investigate the relationship between TBI and dementia in an institutional group. METHODS Retrospective cohort study (2000-2018) of TBI patients aged 45 to 100 yr vs NTOT controls. Primary outcome was dementia after TBI (followed ≤10 yr). Cox proportional hazards models were used to assess risk of dementia; logistic regression models assessed predictors of dementia. RESULTS Among 24 846 patients, TBI patients developed dementia (7.5% vs 4.6%) at a younger age (78.6 vs 82.7 yr) and demonstrated higher 10-yr mortality than controls (27% vs 14%; P < .001). Mild TBI patients had higher incidence of dementia (9%) than moderate/severe TBI (5.4%), with lower 10-yr mortality (20% vs 31%; P < .001). Risk of dementia was significant in all mild TBI age groups, even 45 to 54 yr (hazard ratio 4.1, 95% CI 2.7-7.8). A total of 10-yr cumulative incidence was higher in mild TBI (14.4%) than moderate/severe TBI (11.3%) and controls (6.8%) (P < .001). Predictors of dementia include TBI, sex, age, hypertension, hyperlipidemia, stroke, depression, anxiety, and Injury Severity Score. CONCLUSION Mild and moderate/severe TBI patients experienced higher incidence of dementia, even in the youngest group (45-54 yr old), than NTOT controls. All TBI patients, especially middle-aged adults with minor injury who are more likely to be overlooked, should be monitored for dementia.
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Affiliation(s)
- Brittany M Stopa
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Zabreen Tahir
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elisabetta Mezzalira
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessandro Boaro
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Institute of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, Universiy of Verona, Verona, Italy
| | - Ayaz Khawaja
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Neurology, Wayne State University, Detroit, Michigan, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Football Players Healthy Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross D Zafonte
- Football Players Healthy Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - William B Gormley
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Saef Izzy
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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5
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Izzy S, Tahir Z, Grashow R, Cote DJ, Jarrah AA, Dhand A, Taylor H, Whalen M, Nathan DM, Miller KK, Speizer F, Baggish A, Weisskopf MG, Zafonte R. Concussion and Risk of Chronic Medical and Behavioral Health Comorbidities. J Neurotrauma 2021; 38:1834-1841. [PMID: 33451255 DOI: 10.1089/neu.2020.7484] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 12/20/2022] Open
Abstract
While chronic neurological effects from concussion have been studied widely, little is known about possible links between concussion and long-term medical and behavioral comorbidities. We performed a retrospective cohort study of 9205 adult patients with concussion, matched to non-concussion controls from a hospital-based electronic medical registry. Patients with comorbidities before the index visit were excluded. Behavioral and medical comorbidities were defined by International Classification of Diseases, Ninth and Tenth Revision codes. Groups were followed for up to 10 years to identify comorbidity incidence after a concussion. Cox proportional hazards models were used to calculate associations between concussion and comorbidities after multi-variable adjustment. Patients with concussion were 57% male (median age: 31; interquartile range [IQR] = 23-48 years) at enrollment with a median follow-up time of 6.1 years (IQR = 4.2-9.1) and well-matched to healthy controls. Most (83%) concussions were evaluated in outpatient settings (5% inpatient). During follow-up, we found significantly higher risks of cardiovascular risks developing including hypertension (hazard ratio [HR] = 1.7, 95% confidence interval [CI]: 1.5-1.9), obesity (HR = 1.7, 95% CI: 1.3-2.0), and diabetes mellitus (HR = 1.8, 95% CI: 1.4-2.3) in the concussion group compared with controls. Similarly, psychiatric and neurological disorders such as depression (HR = 3.0, 95% CI: 2.6-3.5), psychosis (HR = 6.0, 95% CI: 4.2-8.6), stroke (HR = 2.1 95% CI: 1.5-2.9), and epilepsy (HR = 4.4, 95% CI: 3.2-5.9) were higher in the concussion group. Most comorbidities developed less than five years post-concussion. The risks for post-concussion comorbidities were also higher in patients under 40 years old compared with controls. Patients with concussion demonstrated an increased risk of development of medical and behavioral health comorbidities. Prospective studies are warranted to better describe the burden of long-term comorbidities in patients with concussion.
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Affiliation(s)
- Saef Izzy
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Zabreen Tahir
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rachel Grashow
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA
| | - David J Cote
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Al Jarrah
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amar Dhand
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Network Science Institute, Northeastern University, Boston, Massachusetts, USA
| | - Herman Taylor
- The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Michael Whalen
- Department of Pediatrics, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David M Nathan
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Diabetes Center, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen K Miller
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Neuroendocrine Unit, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Frank Speizer
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Aaron Baggish
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Department of Internal Medicine, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marc G Weisskopf
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA
| | - Ross Zafonte
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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6
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Aldhaeefi M, Tahir Z, Cote DJ, Izzy S, El Khoury J. Comorbidities and Age Are Associated With Persistent COVID-19 PCR Positivity. Front Cell Infect Microbiol 2021; 11:650753. [PMID: 33889551 PMCID: PMC8056299 DOI: 10.3389/fcimb.2021.650753] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/07/2021] [Accepted: 03/18/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives The impact of demographics and comorbidities on the duration of COVID-19 nasopharyngeal swab PCR positivity remains unclear. The objective of our analysis is to determine the impact of age, intensive care unit (ICU) admission, comorbidities, and ethnicity on the duration of COVID-19 PCR positivity among hospitalized patients in a large group of hospital. Method We studied 530 patients from a large hospital system and time to SARS-CoV-2 virus RNA PCR negativity at any-time during hospitalization or following discharge from the hospital was the primary endpoint. We included patients 18 years or older who tested positive for COVID-19 during an inpatient, outpatient, or emergency room visit between February 1, 2020, and April 14, 2020. Results Overall, 315 (59.4%) of our patient population continued to have a positive SARS-CoV-2 virus RNA PCR 4 weeks after the initial positive test. We found that age>70 years, chronic kidney disease, hypertension, hyperlipidemia, obesity, or coronary artery disease are associated with persistent PCR positivity for more than 4 weeks after initial diagnosis. Conclusion Age, and the presence of co-morbidities should be taken into consideration when interpreting a positive COVID PCR test.
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Affiliation(s)
- Mohammed Aldhaeefi
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, United States
| | - Zabreen Tahir
- Department of Neurology, Neurocritical Care, Brigham and Women's Hospital, Boston, MA, United States
| | - David J Cote
- Harvard Medical School, Boston, MA, United States
| | - Saef Izzy
- Department of Neurology, Neurocritical Care, Brigham and Women's Hospital, Boston, MA, United States.,Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Joseph El Khoury
- Department of Neurology, Neurocritical Care, Brigham and Women's Hospital, Boston, MA, United States.,Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
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Rahman SU, Sana MK, Tahir Z, Ali A, Shah PA. Paraneoplastic syndromes in cholangiocarcinoma. World J Hepatol 2020; 12:897-907. [PMID: 33312417 PMCID: PMC7701960 DOI: 10.4254/wjh.v12.i11.897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
Paraneoplastic syndromes are the symptoms or signs which result from damage to tissues that are distant from the site of malignancy, due to complex interactions between the body’s immune system and malignant neoplasm. Cholangiocarcinoma (CCA) is an aggressive epithelial malignancy of hepatobiliary tree and it is found to be associated with various paraneoplastic syndromes. These syndromes can present as dermatological, neurological, renal, hematological, or multi-systemic manifestations. Clinical suspicion and timely recognition of these syndromes can lead to early diagnosis of covert malignancies like CCA. The management plan remains the removal of the underlying cause which in this case is CCA.
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Affiliation(s)
- Saad Ur Rahman
- Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Muhammad Khawar Sana
- Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Zabreen Tahir
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Aamir Ali
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Pir Ahmad Shah
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX 78229, United States
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Ali H, Tahir M, Rai D, Tahir Z, Dawdy J, Kabashneh S, Lieberman R. Is implantable loop recorder the answer to reduce the increased risk of stroke in cancer patients? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Recent epidemiologic data suggests increased risk of ischaemic stroke in cancer patients. The etiology of increased ischaemic stroke is unknown. Atrial fibrillation (AF) is among the potential etiologies. The risk of AF has not been studied among cancer patients in the United States.
Purpose
Ascertain the association of AF in cancer patients in the USA by using the largest database i.e. National Inpatient Sample (NIS).
Methods
Patients ≥18 years old were selected in the NIS database for years 2010 to 2014 and stratified based on presence or absence of any of four cancers (lung, colon, breast and prostate; 4CA) using ICD 9 codes. Atrial fibrillation and stroke/TIA were also identified using ICD 9 codes. Components of CHADS2 score (CHF, hypertension, Age>75, diabetes and stroke/TIA) were identified using ICD 9 codes. χ2 tests performed for prevalence of AF in patients with or without these cancers stratified by CHADS2 score. Binary logistic regression was used to analyze individual components of CHADS2 score.
Results
AF and stroke/TIA were significantly higher among 4CA than non-4CA group (18.7% vs 12.0%, P<0.001 and 5.4% vs 4.8%, P<0.001 respectively). AF prevalence increased with CHADS2 and was significantly higher in 4CA group with CHADS2 score 0 to 4 (Table 1 and Figure 1). Logistic regression for the outcome of AF showed “Age >75” OR (3.0), CHF (2.8), CVA (1.2), HTN (1.3) and DM (1.1).
Conclusion
This is the first study using a national database of USA patients to estimate prevalence of AF in cancer patients compared to non-cancer patients and reaffirms the higher burden of AF in cancer patients. Prevalence of both AF and stroke were greater in cancer patients when stratified by CHADS2 score. This may indicate not just an increased risk of AF but an increased risk of stroke/TIA for the same CHADS2 score. Stroke incidence was also higher in the 4CA group (5.4% vs. 4.8% P<0.001). Cancer patients with CHADS2 score >1 may benefit from screening with loop recorder to identify previously undetected AF and initiate anticoagulation therapy. Prospective longitudinal studies are needed to validate this retrospective study.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Ali
- Wayne State University/Detroit Medical Center, Internal Medicine, Detroit, United States of America
| | - M.W Tahir
- Rochester General Hospital, Internal Medicine, Rochester, United States of America
| | - D Rai
- Rochester General Hospital, Internal Medicine, Rochester, United States of America
| | - Z Tahir
- Sharif Medical and Dental College, Lahore, Pakistan
| | - J Dawdy
- Wayne State University/Detroit Medical Center, Internal Medicine, Detroit, United States of America
| | - S Kabashneh
- Wayne State University/Detroit Medical Center, Internal Medicine, Detroit, United States of America
| | - R Lieberman
- Wayne State University, Detroit, United States of America
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9
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Izzy S, Tahir Z, Cote DJ, Al Jarrah A, Roberts MB, Turbett S, Kadar A, Smirnakis SM, Feske SK, Zafonte R, Fishman JA, El Khoury J. Characteristics and Outcomes of Latinx Patients With COVID-19 in Comparison With Other Ethnic and Racial Groups. Open Forum Infect Dis 2020; 7:ofaa401. [PMID: 33088846 PMCID: PMC7499713 DOI: 10.1093/ofid/ofaa401] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is a limited understanding of the impact of coronavirus disease 2019 (COVID-19) on the Latinx population. We hypothesized that Latinx patients would be more likely to be hospitalized and admitted to the intensive care unit (ICU) than White patients. METHODS We analyzed all patients with COVID-19 in 12 Massachusetts hospitals between February 1 and April 14, 2020. We examined the association between race, ethnicity, age, reported comorbidities, and hospitalization and ICU admission using multivariable regression. RESULTS Of 5190 COVID-19 patients, 29% were hospitalized; 33% required the ICU, and 4.3% died. Forty-six percent of patients were White, 25% Latinx, 14% African American, and 3% Asian American. Ethnicity and race were significantly associated with hospitalization. More Latinx and African American patients in the younger age groups were hospitalized than whites. Latinxs and African Americans disproportionally required the ICU, with 39% of hospitalized Latinx patients requiring the ICU compared with 33% of African Americans, 24% of Asian Americans, and 30% of Whites (P < .007). Within each ethnic and racial group, age and male gender were independently predictive of hospitalization. Previously reported preexisting comorbidities contributed to the need for hospitalization in all racial and ethnic groups (P < .05). However, the observed disparities were less likely related to reported comorbidities, with Latinx and African American patients being admitted at twice the rate of Whites, regardless of such comorbidities. CONCLUSIONS Latinx and African American patients with COVID-19 have higher rates of hospitalization and ICU admission than White patients. The etiologies of such disparities are likely multifactorial and cannot be explained only by reported comorbidities.
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Affiliation(s)
- Saef Izzy
- Department of Neurology, Neurocritical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Zabreen Tahir
- Department of Neurology, Neurocritical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - David J Cote
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Al Jarrah
- Department of Neurology, Neurocritical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Matthew Blake Roberts
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah Turbett
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aran Kadar
- Department of Medicine, Division of Pulmonary Critical Care, Newton Wellesley Hospital, Newton, Massachusetts
| | - Stelios M Smirnakis
- Department of Neurology, Neurocritical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Steven K Feske
- Department of Neurology, Neurocritical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ross Zafonte
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation Massachusetts General Hospital, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Jay A Fishman
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph El Khoury
- Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
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10
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Roberts MB, Izzy S, Tahir Z, Al Jarrah A, Fishman JA, El Khoury J. COVID-19 in solid organ transplant recipients: Dynamics of disease progression and inflammatory markers in ICU and non-ICU admitted patients. Transpl Infect Dis 2020; 22:e13407. [PMID: 32654303 PMCID: PMC7404585 DOI: 10.1111/tid.13407] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND COVID-19 infection varies in severity from minimal symptoms to critical illness associated with a hyperinflammatory response. Data on disease progression in immunosuppressed solid organ transplant (SOT) recipients are limited. METHODS We examined the electronic medical records of all SOT recipients with COVID-19 from 12 Massachusetts hospitals between February 1, and May 6, 2020. We analyzed the demographics, clinical parameters, course, and outcomes of illness in these patients. RESULTS Of 52 COVID-19-positive SOT patients, 77% were hospitalized and 35% required ICU admission. Sixty-nine percent of hospitalized patients had immunosuppression reduced, 6% developed suspected rejection. Co-infections occurred in 45% in ICU vs 5% in non-ICU patients (P = .037). A biphasic pattern of evolution of laboratory tests was observed. In the first 5 days of illness, inflammatory markers were moderately increased. Subsequently, WBC, CRP, ferritin, and D Dimer increased with increasing stay in the ICU, and lymphocyte counts were similar. Five patients (16%) died. CONCLUSIONS Our data indicate that SOT is associated with high rate of hospitalization, ICU admission, and death from COVID-19 compared to data in the general population of patients with COVID-19. Despite reduction in immunosuppression, suspected rejection was rare. The clinical course and trend of laboratory biomarkers is biphasic with a later, pronounced peak in inflammatory markers seen in those admitted to an ICU. CRP is a useful marker to monitor disease progression in SOT.
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Affiliation(s)
- Matthew B Roberts
- Division of Infectious Diseases, Department of Medicine and MGH Transplant Centre, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Saef Izzy
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Neurocritical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zabreen Tahir
- Department of Neurology, Neurocritical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ali Al Jarrah
- Department of Neurology, Neurocritical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Joseph El Khoury
- Division of Infectious Diseases, Department of Medicine and MGH Transplant Centre, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Abstract
We report the first case of double-hit (MYC and BCL-6) monomorphic post-transplant lymphoproliferative disorder in a patient status post liver transplantation. Our patient is a 71-year-old man with a past medical history of Budd-Chiari syndrome complicated by cirrhosis and hepatocellular carcinoma. He underwent a deceased donor liver transplantation 2 years prior to presentation and was maintained on tacrolimus and mycophenolate mofetil for immunosuppression. He presented with a 3-week history of classical B-symptoms. Initial workup was notable for elevated lactate dehydrogenase. Abdomen ultrasound revealed multiple hypoechoic lesions, raising suspicion for a post-transplant lymphoproliferative disorder. Biopsy showed pleomorphic large neoplastic cells throughout, consistent with a diagnosis of diffuse large B-cell lymphoma. Cytogenetics then revealed rearrangements in both MYC and BCL-6, consistent with double-hit lymphoma. His immunosuppressive regimen was subsequently tapered and he was started on DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab) regimen.
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Affiliation(s)
- Zabreen Tahir
- Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julia Peters
- Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kathleen Leahy
- Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Felipe Batalini
- Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA .,Medicine, Harvard Medical School, Boston, Massachusetts, USA
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12
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Razak I, Ghani W, Doss J, Ramanathan A, Tahir Z, Ridzuan N, Edgar S, Zain R. Mouth Self-Examination (MSE) As a Screening Tool for Oral Potentially Malignant Disorders Among a High-Risk Indigenous Population With a Low Socioeconomic Status. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.37700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Oral cancer can be preceded by a group of conditions termed oral potentially malignant disorders (OPMDs). Oral cancers are associated with a 5-year survival of less than 50%, largely attributed to diagnoses at advanced stages. As pain associated with oral cancer manifests only at late stages, delay in detection often occurs. Screening has been found to aid in detection at an early stage, however it is only feasible if targeted toward high risk individuals. Mouth self-examination (MSE) is a relatively quick, inexpensive and simple to perform method of screening. Aim: To evaluate the efficacy of MSE as a screening tool for detection of oral mucosal lesions and OPMDs in a high risk indigenous population with a high prevalence of tobacco and betel quid chewing habit. Methods: Two villages were selected as the sampling frame based on prevalence of tobacco and betel quid chewing habit. Respondents were asked to check their mouth for presence of lesion or abnormalities. Education on oral cancer, including MSE was provided. Subsequently, respondents were asked to perform MSE. Finally, a comprehensive oral examination (COE) was done by a specialist and the presence of oral mucosal lesions was recorded. Results: Almost 64.5% of respondents exhibited high levels of difficulty and low mucosal visualization and retracting ability, whereas 3.0% demonstrated high attention level when performing MSE. Prevalence of oral mucosal lesions was 59.0%, whereas the prevalence of oral potentially malignant disorders (OPMDs) was 9.0%. Detection of oral lesions by respondents using MSE was lower than detection by the gold standard. Sensitivity and specificity of MSE for detection of all types of lesions were 8.6% and 95.0% respectively. When analyzing each lesion type separately, MSE was found to be most sensitive in detection of swellings (10.0%), and most specific in identifying red lesions (100.0%). For detection of OPMDs, MSE yielded a high specificity of 98.9%, with an accuracy rate of 91.8%. Conclusion: MSE is a potentially good screening tool for OPMDs and oral cancer; however, awareness level of the public on oral cancer and its associated signs and symptoms needs to be improved.
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Affiliation(s)
- I.A. Razak
- MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - W.M.N. Ghani
- MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - J.G. Doss
- MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - A. Ramanathan
- MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - Z. Tahir
- MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - N.A. Ridzuan
- MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - S. Edgar
- MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - R.B. Zain
- MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
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Hussain A, Tahir Z, Qadri S, Habib A, Khalil M, Chaudhry M, Loubani M. Incidence of post-operative atrial fibrillation in thoracoscopic versus open lobectomy for lung cancer. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30211-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Toomey D, Prattley S, Mohiyaddin S, Tahir Z, Acharya M. Can ccs and nyha and lung functions be an indicator of mortality in female coronary artery bypass grafting patients for risk stratification in cardiac surgery. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tahir Z, Yusuf NW, Ashraf M, Yusuf AW, Aziz F. Fine needle aspiration of unilocular ovarian cysts--a cytohistological correlation. J PAK MED ASSOC 2004; 54:266-9. [PMID: 15270187] [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: 04/30/2023]
Abstract
OBJECTIVE To assess the diagnostic efficacy of Fine Needle Aspiration Cytology in differentiating neoplastic and non-neoplastic dysfunctional ovarian cysts--cytological findings to be verified with histology of excised cyst. METHODS In this prospective study fifty-three cases with unilocular nonseptate ovarian cystic masses,detected on ultrasound examination were subjected to ultrasound guided fine needle aspiration of the cyst contents at Department of Pathology, Allama Iqbal Medical College Lahore, from January 1999 - January 2000. Aspirated fluid was examined cytologicaly using Giemsa stain on the smears prepared from centrifuged deposit. The same cyst removed surgically was examined histologicaly and cytohistological correlation was carried out. RESULTS In this series of 53 cases, histologically confirmed break up of various types of cysts was follicular cysts (n=25), leuteal cysts (n=6), serous cysts (n=15), mucous cysts (N=4) and Endometriotic cysts (n=3). Non-diagnostic fine needle aspirate was obtained in 19/53 cases, majority being the follicular cysts. The cytohistological correlation revealed no false positive but 40% false negative results for follicular cysts on cytological examination of the aspirate. Hence the specificity and sensitivity for cytological diagnosis of follicular cyst was 100% and 60% respectively. For leuteal cysts, false positive and false negative results on cytological examination were 0% and 16.6% respectively with a specificity and sensitivity value of 100% and 83% respectively. For neoplastic serous cysts cytologically false positive and false negative diagnosis was 0% and 46.6% respectively with specificity and sensitivity of 100% and 53%. For mucinous cystadenomas sensitivity and specificity of cytological diagnosis was 100%. For endometriotic cysts a sensitivity of 67% and specificity of 100% was procured with cytological evaluation. CONCLUSION Guided fine needle aspiration cytology may prove to be one of the most valuable and acceptable tools in the differential diagnosis of ovarian cystic lesions.
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Affiliation(s)
- Z Tahir
- Department of Pathology, Allama Iqbal Medical College, Lahore
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