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Longitudinal analysis of the skin microbiome in association with hand eczema, hand hygiene practices and moisturizer use. J Eur Acad Dermatol Venereol 2024. [PMID: 38419413 DOI: 10.1111/jdv.19906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The skin microbiota maintains a physical and immunological barrier to the environment. Little is known about how the microbiome changes over time or the effect of hand hygiene practices and moisturizer use. OBJECTIVES To assess sex-specific changes in skin bacteria over time, and how the microbiome is related to self-reported hand eczema, hand hygiene practices and use of moisturizers. METHODS Swab samples from the dorsal hand were collected at baseline and 6.5 years later during the COVID-19 pandemic, in 168 participants from the RHINESSA study in Bergen, Norway. The skin samples were analysed by 16S rRNA amplicon sequencing. RESULTS The alpha diversity of the hand microbiome increased from baseline to follow-up, and beta diversity differed by sex at both time points. The relative abundance increased for several bacteria from baseline to follow-up, with sex-specific differences. Current hand eczema and aggravating hand eczema during the COVID-19 pandemic were associated with an increase in Staphylococcus. High hand washing frequency at home was associated with lower alpha diversity and with higher abundance of Staphylococcus, Corynebacterium, Finegoldia, and Pseudomonas and lower abundance of Propionibacterium and Pelomonas. The alpha diversity increased with increasing time passing between hand washing and sampling, whereas more frequent moisturizer use was associated with significantly lower alpha diversity, and a change in abundance for some bacteria, such as more Pseudomonas. CONCLUSIONS This longitudinal study revealed an overall increase in skin microbial diversity over a 6-year period, which was unexpected since follow-up was performed during the COVID-19 pandemic when vigorous hand hygienic practices were introduced. Sex-specific differences were identified at both time points. Individuals with hand eczema seem to develop a more dysbiotic skin bacterial community over time. Hand washing and use of moisturizers, with typically gender-specific habitual patterns, may lead to change in bacterial composition.
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Integrating avatar technology into a telemedicine application in heart failure patients : A pilot study. Wien Klin Wochenschr 2023; 135:680-684. [PMID: 36732377 PMCID: PMC9894666 DOI: 10.1007/s00508-022-02150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Heart failure is a severe condition and telemedicine can improve the care of heart failure. Many patients are unable to use telemedicine applications due to visual impairment and limited health-related literacy. Avatar technology might help to overcome these limitations. METHODS A telemedicine application was combined with a nurse avatar and offered to heart failure outpatients for 3 months. System usability and patient satisfaction were evaluated monthly by the system usability score (maximum score=100) and the patient satisfaction scale (maximum score=50). RESULTS In total, 37 heart failure patients were enrolled. The mean system usability score after 1 month was 73 (standard deviation=24) and 72 (standard deviation=10) after 3 months of follow-up, which was not significantly different (p = 0.40). The mean patient satisfaction scale after 1 month was 42 (standard deviation=5) and 39 (standard deviation=8) after 3 months, which was not significantly different (p = 0.10). CONCLUSION A nurse look-a-like avatar integrated into a telemedicine application was positively assessed by heart failure patients. Future studies are warranted to clarify the role of avatar technology in telemedicine.
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Webtool to enhance the accuracy of diagnostic algorithms for HFpEF: a prospective cross-over study. ESC Heart Fail 2023; 10:3493-3503. [PMID: 37724334 PMCID: PMC10682885 DOI: 10.1002/ehf2.14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/22/2023] [Indexed: 09/20/2023] Open
Abstract
AIMS Diagnosis of heart failure with preserved ejection fraction (HFpEF) can be challenging. This study aimed to evaluate the potential of a webtool to enhance the scoring accuracy when applying the complex HFA-PEFF and H2 FPEF algorithms, which are commonly used for diagnosing HFpEF. METHODS AND RESULTS We developed an online tool, the HFpEF calculator, that enables the automatic calculation of current HFpEF algorithms. We assessed the accuracy of manual vs. automatic scoring, defined as the percentage of correct scores, in a cohort of cardiologists with varying clinical experience. Cardiologists scored eight online clinical cases using a triple cross-over design (i.e. two manual-two automatic-two manual-two automatic). Data were analysed in study completers (n = 55, 29% heart failure specialists, 42% general cardiologists, and 29% cardiology residents). Manually calculated scores were correct in 50% (HFA-PEFF: 50% [50-75]; H2 FPEF: 50% [38-50]). Correct scoring improved to 100% using the HFpEF calculator (HFA-PEFF: 100% [88-100], P < 0.001; H2 FPEF: 100% [75-100], P < 0.001). Time spent on clinical cases was similar between scoring methods (±4 min). When corrections for faulty algorithm scores were displayed, cardiologists changed their diagnostic decision in up to 67% of cases. At least 67% of cardiologists preferred using the online tool for future cases in clinical practice. CONCLUSIONS Manual calculation of HFpEF diagnostic algorithms is often inaccurate. Using an automated webtool to calculate HFpEF algorithms significantly improved correct scoring. This new approach may impact the eventual diagnostic decision in up to two-thirds of cases, supporting its routine use in clinical practice.
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The changing role of patients, and nursing and medical professionals as a result of digitalization of health and heart failure care. J Nurs Manag 2022; 30:3847-3852. [PMID: 36329647 PMCID: PMC10098485 DOI: 10.1111/jonm.13888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/16/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIM The aim of the study is to discuss the changing role of patients, nurses and doctors in an era of digital health and heart failure care. BACKGROUND With a growing demand for heart failure care and a shortage of health care professionals to meet it, digital technologies offer a potential solution to overcoming these challenges. EVALUATION In reviewing pertinent research evidence and drawing on our collective clinical and research experiences, including the co-design and development of an autonomous remote system, DoctorME, we offer some reflections and propose some practical suggestions for nurturing truly collaborative heart failure care. KEY ISSUES Digital health offers real opportunities to deliver heart failure care, but patients and health care professionals will require digital skills training and appropriate health services technological infrastructure. CONCLUSIONS Heart failure care is being transformed by digital technologies, and innovations such as DoctorME have profound implications for patients, nurses and doctors. These include major cultural change and health service transformation. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers should create inclusive and supportive working environments where collaborative working and digital technologies in heart failure care are embraced. Nurse managers need to recognize, value and communicate the importance of digital health in heart failure care, ensuring that staff have appropriate digital skills training.
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Can artificial intelligence fill in the gaps in heart failure guidelines by providing precision medicine in medication advice? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The treatment of heart failure (HF) consists of many different types of medication. It is not yet known which patients benefit most from which medication type. Artificial intelligence (AI) may be helpful to predict the best individual combination of drugs and dosages, but such a model is lacking.
Purpose
We present an AI model that can predict optimal medication regimen per patient based on mortality and hospitalisation risk.
Methods
A total of 620 patients of the Randomized controlled multicenter Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) study were divided into a training and a test population across different sections of patients. They were evaluated by a fixed multi-layer combination of different AI/machine learning models. The steps of the model include; (1) making segmentation by medication treatment: optimal or not optimal; (2) evaluation by general prognostic model and model optimised for patients with non-optimal medication (3); finding optimal medication recommendation for all outcomes of step 2. After optimising the model with the training population, the model was validated retrospectively on the test population. Prognosis was based on mortality and hospitalisation during up to 5 years follow-up.
Results
Of the 620 patients, 59% were male, age 76.9±7.6 years, and median follow-up was 2.2 years. The optimised model identified variables that are important to generate an accurate medication recommendation. These included biomarkers, symptoms, and patient characteristics. In the first step of clustering, data showed that at T0, 68% of the patients were not in optimal medical therapy range, and their outcome prediction was poor (Figure 1). During the follow-up period, this group decreased to 36%, and was almost equal in size to the group with good prognosis despite not optimal medication range (38%). Furthermore, the group with a good medical therapy range and good prognosis increased during the study.
Finally, validation of the medication prediction model showed that model-based therapy adjustments could significantly reduce hospitalisation rate and death. For patients who had therapy according to the AI model recommendation, the death rate and hospitalisation rate were three times lower (Table 1).
Conclusion
The AI model was successful in predicting the optimal medication regimen in the validation population. Where HF guidelines are ambiguous about optimal treatment, the model may fill these knowledge gaps. Furthermore, the model emphasises the hypothesis that a standard approach to HF treatment is not beneficial for all patients. There is a group outside the optimal medication range that has a poor outcome, but there is also a group that has a good outcome despite a non-optimal medication range. Therefore, the latter group would possibly be better off with less medication. These findings need to be validated prospectively in further research.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): INTERREG-NWE
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EP08.02-111 RMC-4630, a SHP2 Inhibitor, in Combination with Sotorasib for Advanced KRASG12C NSCLC After Failure of Prior Standard Therapies: A Phase 2 Trial. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Quality of Life, Risk and Recovery in a National Forensic Mental Health Service: A D-FOREST study from DUNDRUM Hospital. Eur Psychiatry 2022. [PMCID: PMC9567632 DOI: 10.1192/j.eurpsy.2022.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Secure forensic mental health services have a dual role, to treat mental disorder and reduce violent recidivism. Quality of life is a method of assessing an individual patients’ perception of their own life and is linked to personal recovery. Placement in secure forensic hospital settings should not be a barrier to achieving meaningful quality of life. The WHO-QuOL measure is a self-rated tool, internationally validated used to measure patients own perception of their quality of life.
Objectives
This aim of this study was to assess self-reported quality of life in a complete National cohort of forensic in-patients, and ascertain the associations between quality of life and measures of violence risk, recovery and functioning.
Methods
This is a cross sectional study, set in Dundrum Hospital, the site of Ireland’s National Forensic Mental Health Service. It therefore includes a complete national cohort of forensic in-patients. The WHO-QuOL was offered to all 95 in-patients in Dundrum Hospital during December 2020 – January 2021, as was PANSS (Positive and Negative Symptoms for Schizophrenia Scale). During the study period the researchers collated the scores from HCR-20 (violence risk), therapeutic programme completion (DUNDRUM-3) and recovery (DUNDRUM-4). Data was gathered as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST).
Results
Lower scores on dynamic violence risk, better recovery and functioning scores were associated with higher self-rated quality of life.
Conclusions
The quality of life scale was meaningful in a secure forensic hospital setting. Further analysis will test relationships between symptoms, risk and protective factors and global function.
Disclosure
No significant relationships.
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AB0623 A review of the evidence behind the recommendation of rituximab for ANCA associated vasculitis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCyclophosphamide (CYC) is currently used to induce remission in patients with ANCA-associated vasculitis (AAV). Once remission induction is successful Azathioprine (AZA) is given as maintenance (1). Concerns surround the use of cyclophosphamide which has an undesirable safety profile, limiting its use in patients. AZA has shown to be effective at maintenance, however rates of relapse on AZA are high.Rituximab (RTX) is a biologic with a high specificity to B cells. Its mechanism of action (B cell apoptosis) may mean that it can be used for both the induction and maintenance of remission, with a superior long-term safety profile.ObjectivesTo conduct a systematic review of literature to determine the efficacy of rituximab as a remission inducing and maintaining agent.MethodsA systematic review of literature was conducted by searching PubMed and Cochrane library with the search phrase “rituximab AND ANCA-associated vasculitis”. The following criteria was then applied: randomised controlled trial (RCT) in the English language. Only original papers were accepted if it pertained to RTX for either induction or maintenance of remission.Results1008 papers were initially identified and after the search strategy was applied 9 RCTs were analysed.The RAVE trial compared RTX to CYC in 197 patients with AAV in a double-blind double-dummy trial. The result of the RAVE trial indicated that RTX was as effective as CYC at maintaining remission. The RITUXVAS trial, which was partially blinded and had a sample of 44 patients also came to the same conclusion. Both the RAVE and RITUXVAS trials also showed that an initial dose of RTX was as effective as continuous immunosuppression over the trial length.Further RCTs were published from the RAVE and RITUXVAS studies including a follow up of patients from the RITUXVAS trial at 24 months which showed no increased rates of relapse or adverse events between the groups. The RAVE study also showed that RTX was effective to be used on multiple occasions to induce remission irrespective of the initial remission inducing agent.The MAINRITSAN1 study was a non-blinded randomised trial which compared RTX with azathioprine for maintenance in 115 patients with AAV. The results of this trial showed that RTX was superior than AZA at maintenance with only 5% on RTX compared with 29% on AZA relapsing. The long-term follow up of patients in the trial, showed that at 60 months, patients who received RTX were less likely to have relapsed.The MAINRITSAN2 trial indicated that there was no difference between a fixed vs tailored RTX dose, meaning that a lower tailored dose was as effective as a higher fixed dose. The MAINRITSAN 3 paper was a double-blind trial that indicated that biannual RTX for maintenance was superior than placebo at maintaining remission.ConclusionRTX is as effective as CYC at inducing remission, with both the RAVE and RITUXVAS trials sharing similar conclusions.Currently the research indicates that an initial dose of RTX can maintain remission at similar rates as continuous AZA, however its superiority is yet to be determined. The MAINRITSAN 1 trial was unblinded in its protocol with the data indicating it drastically overestimated the efficacy of both RTX and AZA. Therefore, more research is needed to validate the claim that RTX is superior than AZA at maintenance.References[1]Yates, M, et al. 2016. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Annals of the Rheumatic Diseases 75, 1583–1594. doi:10.1136/annrheumdis-2016-209133AcknowledgementsI would like to thank Dr Marwan Bukhari for his continued support and feedback during this project.Disclosure of InterestsNone declared
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76TiP RMC-4630 and sotorasib for advanced KRASG12C NSCLC after failure of prior standard therapies: A phase II trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Improving diagnosis and risk stratification across the ejection fraction spectrum: the Maastricht Cardiomyopathy registry. ESC Heart Fail 2022; 9:1463-1470. [PMID: 35118823 PMCID: PMC8934928 DOI: 10.1002/ehf2.13833] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/05/2022] [Accepted: 01/18/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Heart failure (HF) represents a clinical syndrome resulting from different aetiologies and degrees of heart diseases. Among these, a key role is played by primary heart muscle disease (cardiomyopathies), which are the combination of multifactorial environmental insults in the presence or absence of a known genetic predisposition. The aim of the Maastricht Cardiomyopathy registry (mCMP-registry; NCT04976348) is to improve (early) diagnosis, risk stratification, and management of cardiomyopathy phenotypes beyond the limits of left ventricular ejection fraction (LVEF). METHODS AND RESULTS The mCMP-registry is an investigator-initiated prospective registry including patient characteristics, diagnostic measurements performed as part of routine clinical care, treatment information, sequential biobanking, quality of life and economic impact assessment, and regular follow-up. All subjects aged ≥16 years referred to the cardiology department of the Maastricht University Medical Center (MUMC+) for HF-like symptoms or cardiac screening for cardiomyopathies are eligible for inclusion, irrespective of phenotype or underlying causes. Informed consented subjects will be followed up for 15 years. Two central approaches will be used to answer the research questions related to the aims of this registry: (i) a data-driven approach to predict clinical outcome and response to therapy and to identify clusters of patients who share underlying pathophysiological processes; and (ii) a hypothesis-driven approach in which clinical parameters are tested for their (incremental) diagnostic, prognostic, or therapeutic value. The study allows other centres to easily join this initiative, which will further boost research within this field. CONCLUSIONS The broad inclusion criteria, systematic routine clinical care data-collection, extensive study-related data-collection, sequential biobanking, and multi-disciplinary approach gives the mCMP-registry a unique opportunity to improve diagnosis, risk stratification, and management of HF and (early) cardiomyopathy phenotypes beyond the LVEF limits.
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Range of factors in the reduction of hyperhydricity associated with in vitro shoots of Salvia santolinifolia Bioss. BRAZ J BIOL 2021; 83:e246904. [PMID: 34706025 DOI: 10.1590/1519-6984.246904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
Hyperhydricity is a serious physiological disorder and affects In vitro propagation of many plants and as well of Salvia santolinifolia. The donor material to initiate the in vitro culture was the callus taken from the in vitro shoots produced on Murashig and Skoogs (MS) medium at 4.0 mg/l BA. This callus formed numerous hyperhydric shoots on culturing upon the medium of the same composition. The aim was to systematically evaluate the effect of cytokinins (Benzyladnine (BA) and N6-(-2-isopentenyl) adenine (2iP), culture vessels magnitude, medium solidification, source of nitrogen and calcium chloride for the alleviation of hyperhydricity. In the tissue cultures of S. santolinifolia BA and 2iP induced severe hyperhydricity, when other factors i.e. culture vessels magnitude and a suitable concentration of agar, ammonium nitrate (NH4NO3), potassium nitrate (KNO3) & calcium chloride (CaCl2.2H2O) were not optimized. After 30 days' culture, we observed 83.82% hyperhydric shoots at increased level (1.5 mg/l 2iP) and 81.59% at decreased levels (1.0 mg/l 2iP). On the other hand, hyperhydricity percentage at decreased (0.4%) and at increased (0.8%) levels of agar were 72.37% and 39.08%, respectively. MS medium modification with NH4NO3 (412 mg/l), KNO3 (475 mg/l) and CaCl2.2H2O (880 mg/l) was found the best medium to reduced hyperhydricity (23.6%).
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Topic: AS08-Treatment/AS08a-Current treatment options - Hypomethylating agents. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106681.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Future perspective of heart failure care: benefits and bottlenecks of artificial intelligence and eHealth. Future Cardiol 2021; 17:917-921. [PMID: 33576271 DOI: 10.2217/fca-2021-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Tweetable abstract #eHealth and #ArtificialIntelligence (AI) bring new possibilities for #HeartFailure (HF) care. We elaborate on potential benefits of #AI in #HF and highlight important bottlenecks for its implementation. #Editorial #Cardiology.
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Compliance of atrial fibrillation treatment with the ABC pathway in patients with concomitant diabetes mellitus in the Middle East based on the Gulf SAFE registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Atrial fibrillation (AF) and diabetes mellitus (DM) constitute a heavy burden on healthcare expenditure due to their negative impact on clinical outcomes in patients. DM is highly prevalent in the Middle East. The Atrial fibrillation Better Care (ABC) pathway provides a simple step-by-step strategy with an integrated, holistic approach to AF management: A, Avoid stroke (Anticoagulation); B, Better symptom management; C, Cardiovascular and comorbidity risk management.
Aim
Evaluation of the AF treatment compliance to ABC pathway regimen in patients with DM based on a large real-world registry from the Middle East region. We assessed the impact of ABC-pathway compliance on all-cause mortality and the composite outcome of stroke or systemic embolism, all-cause death and cardiovascular hospitalizations.
Methods
From 2043 patients in the Gulf SAFE registry, 603 patients with DM were included in an analysis of compliance with components of the ABC pathway: A, oral anticoagulation (OAC) use in patients with CHA2DS2-VASc score ≥1 (≥2 in females); B, AF symptoms according to the European Heart Rhythm Association (EHRA) score; C, Optimized management of cardiovascular comorbidities e.g. blood pressure control, statins for vascular disease, etc.
Results
From 606 patients, 86 (14.3%) patients were treated in compliance with the ABC pathway. During 1-year follow-up, 207 composite outcome events and 87 deaths occurred. Mortality was significantly lower in the ABC-adherent group vs non-ABC compliant (5.8% vs 15.9%, p=0.0014, respectively) (Figure). On multivariate analysis, ABC-adherent management was associated with a lower risk of all-cause death and the composite outcome after 6 months (OR 0.18; 95% CI, 0.42–0.75 and OR 0.54; 95% Cl, 0.30–1.00, respectively) and at 1 year (OR 0.30; 95% Cl,0.11–0.76 and OR 0.57; 95% Cl, 0.33–0.97, respectively) vs the non-ABC group (Table).
Conclusions
Integrated AF care, according to ABC pathway, was independently associated with a lower risk of all-cause death and the composite outcome, in DM patients with AF. This highlights the importance of a comprehensive and holistic approach to AF management.
Events rates and outcomes odds ratio
Funding Acknowledgement
Type of funding source: None
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Pharmacological inhibition of C-C chemokine receptor 4 aggravates atherosclerosis through prevention of regulatory T cell recruitment to the lesions. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Regulatory T cells (Tregs) are demonstrated to play a protective role in the development of atherosclerosis. However, their sites of action in atherosclerosis remain unclear. Although C-C chemokine receptor 4 (CCR4) has been shown to contribute to the accumulation of Tregs in inflamed tissues and prevention of experimental autoimmune diseases, the role of CCR4 in Treg migration to atherosclerotic lesions and suppression of plaque formation remains unknown.
Methods and results
We intraperitoneally injected 8-week-old apolipoprotein E–deficient mice fed a normal diet with vehicle (n=9) or a 4-μg dose of a CCR4 antagonist (n=10) 3 times weekly for 8 weeks and evaluated atherosclerotic lesions at 16 weeks old. Administration of the CCR4 antagonist significantly aggravated atherosclerotic plaque formation (aortic sinus plaque area: 2.91±0.87×104 μm2 versus 5.41±0.98×104 μm2 in control vehicle-treated and CCR4 antagonist-treated mice, respectively; P<0.05), associated with increased accumulation of macrophages and CD4+T cells in the plaques. Flow cytometric analysis revealed a decrease in Foxp3+ Tregs in the para-aortic lymph nodes and thoracoabdominal aortas of CCR4 antagonist-treated mice, along with a tendency toward increase in CD44highCD62Lloweffector T cells in para-aortic lymph nodes, indicating CCR4-dependent migration of Tregs to atherosclerotic lesions and their possible atheroprotective role. We observed no changes in splenic Foxp3+ Tregs and effector T cells following CCR4 antagonist treatment. We also investigated the effect of CCR4 blockade on advanced atherosclerosis using LDL receptor–deficient mice fed a high-cholesterol diet. Although 8-week treatment with the CCR4 antagonist led to a decrease in Foxp3+ Tregs in the atherosclerotic lesions, atherosclerotic lesion formation was not significantly affected, suggesting that CCR4-dependent Treg accumulation in atherosclerotic lesions is not critical for prevention of advanced atherosclerosis.
Conclusions
Our findings indicate an important role for CCR4 in promotion of Treg recruitment into atherosclerotic lesions and subsequent prevention of early atherosclerosis and suggest CCR4 as a novel therapeutic target for atherosclerosis.
Funding Acknowledgement
Type of funding source: None
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Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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1436Overexpression of Cytotoxic T-Lymphocyte Associated Antigen-4 suppresses aortic immunoinflammatory responses and prevents angiotensin II-induced abdominal aortic aneurysm formation in mice. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Vascular inflammation via T-cell-mediated immune responses has been shown to be critically involved in the pathogenesis of abdominal aortic aneurysm (AAA). T-cell coinhibitory molecule cytotoxic T-lymphocyte–associated antigen-4 (CTLA-4) is known to act as a potent negative regulator of immune responses. However, the role of this molecule in the development of AAA remains completely unknown. In the present study, we determined the effects of CTLA-4 overexpression on experimental AAA.
Methods and results
We continuously infused 12-week-old CTLA-4 transgenic (CTLA-4-Tg)/apolipoprotein E–deficient (Apoe−/−) mice (n=35) or control Apoe−/− mice (n=40) fed a high-cholesterol diet with angiotensin II by implanting osmotic mini-pumps and evaluated the development of AAA. Ninety percent of angiotensin II-infused mice developed AAA, with 50% mortality because of aneurysm rupture. Overexpression of CTLA-4 significantly reduced the incidence (66%), mortality (26%), and diameter (18%) of AAA (incidence: P=0.0104; mortality: P=0.031; diameter: P=0.011). These protective effects were associated with a decreased number of effector CD4+ T cells and the downregulated expression of costimulatory molecules CD80 and CD86, ligands for CTLA-4, on CD11c+ dendritic cells in lymphoid tissues. In addition, by performing in situ zymography of the abdominal aortic aneurysm lesions, we observed a trend toward a decrease in MMP activity in the aneurysmal lesion following overexpression of CTLA-4. Finally, CTLA-4-Tg/Apoe−/− mice had reduced macrophage and CD4+ T cell accumulation and MMP activity in the aneurysmal lesion, leading to attenuated aortic inflammation, preserved vessel integrity, and decreased susceptibility to AAA and aortic rupture.
Conclusion
Our findings suggest that CTLA-4 protects against AAA by suppressing immunoinflammatory responses and could be an attractive therapeutic target for AAA.
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Safety and efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) for depression in mild to moderate Traumatic Brain Injury (TBI): a non-controlled study. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Reprogramming of Molecular Switching Events in UPR Driven ER Stress: Scope for Development of Anticancer Therapeutics. Curr Mol Med 2017; 16:690-701. [PMID: 27573195 DOI: 10.2174/1566524016666160829152658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/19/2016] [Accepted: 08/11/2016] [Indexed: 11/22/2022]
Abstract
The incitement of unfolded protein response (UPR) during endoplasmic reticulum (ER) stress by diverse intracellular (hypoxia, nutrient deprivation, etc.) or extracellular (environmental or drug induced) stimuli is considered a major threat for perturbing cellular homeostasis leading to the aggregation of unfolded proteins inside the cell. The catastrophic UPR events emerge as a prime cellular adaptation by remodeling cancer cell signaling and restoring ER homeostasis in favor of tumor growth. The transient ER stress protects cancer cells from undergoing apoptosis, whereas the prolonged stress response further activates many cell death pathways. The present review summarizes the UPR mediated triggering of transcriptional and translational reprogramming, which will provide novel therapeutic strategies towards pro-death mechanisms rather than a cellular adaptation in tumorigenesis. Nonetheless, the current topic also points out the reprogramming of emerging molecular switching events by complex UPR-mediated signaling to trigger apoptosis. The novel agents from various natural, semi-synthetic and synthetic sources that target ER stress signaling pathway to modulate selectively the UPR phenomena with preclinical efficacy are outlined. Since major emphasis on ER stress-induced transcriptional and translational reprogramming remains to be explored, we believe that the current subject will instigate more attention from the biomedical researchers in this certain research direction.
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Management of infusion-related reactions (IRRs) in patients (pts) receiving daratumumab plus standard of care for the treatment of multiple myeloma (MM) in the phase 3 studies CASTOR and POLLUX. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx373.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De novo transcriptome analysis shows differential expression of genes in salivary glands of edible bird's nest producing swiftlets. BMC Genomics 2017; 18:504. [PMID: 28673247 PMCID: PMC5496224 DOI: 10.1186/s12864-017-3861-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 06/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Edible bird's nest (EBN), produced from solidified saliva secretions of specific swiftlet species during the breeding season, is one of the most valuable animal by-products in the world. The composition and medicinal benefits of EBN have been extensively studied, however, genomic and transcriptomic studies of the salivary glands of these birds have not been conducted. RESULTS The study described the transcriptomes of salivary glands from three swiftlet species (28 samples) generated by RNASeq. A total of 14,835 annotated genes and 428 unmapped genes were cataloged. The current study investigated the genes and pathways that are associated with the development of salivary gland and EBN composition. Differential expression and pathway enrichment analysis indicated that the expression of CREB3L2 and several signaling pathways involved in salivary gland development, namely, the EGFR, BMP, and MAPK signaling pathways, were up-regulated in swiftlets producing white EBN (Aerodramus fuciphagus) and black EBN (Aerodramus maximus) compared with non-EBN-producing swiftlets (Apus affinis). Furthermore, MGAT, an essential gene for the biosynthesis of N-acetylneuraminic acid (sialic acid), was highly expressed in both white- and black-nest swiftlets compared to non-EBN-producing swiftlets. Interspecies comparison between Aerodramus fuciphagus and Aerodramus maximus indicated that the genes involved in N-acetylneuraminic and fatty acid synthesis were up-regulated in Aerodramus fuciphagus, while alanine and aspartate synthesis pathways were up-regulated in Aerodramus maximus. Furthermore, gender-based analysis revealed that N-glycan trimming pathway was significantly up-regulated in male Aerodramus fuciphagus from its natural habitat (cave) compared to their female counterpart. CONCLUSIONS Transcriptomic analysis of salivary glands of different swiftlet species reveal differential expressions of candidate genes that are involved in salivary gland development and in the biosynthesis of various bioactive compounds found in EBN.
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DARATUMUMAB, BORTEZOMIB AND DEXAMETHASONE (DVD) VS BORTEZOMIB AND DEXAMETHASONE (VD) IN RELAPSED OR REFRACTORY MULTIPLE MYELOMA (RRMM): EFFICACY AND SAFETY UPDATE (CASTOR). Hematol Oncol 2017. [DOI: 10.1002/hon.2439_152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Twenty-four-hour in-house neonatologist coverage and long-term neurodevelopmental outcomes of preterm infants. Paediatr Child Health 2017; 22:249-254. [PMID: 29479228 DOI: 10.1093/pch/pxx051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare short- and long-term neurodevelopmental outcomes at 3 years of corrected age of preterm infants cared for by 24-hour in-house staff neonatologists and those cared for by staff neonatologists during daytime only. Methods Retrospective analysis of prospectively collected follow-up data on all nonanomalous preterm infants from 1998 to 2004 excluding year 2001 as a washout period. Infants were divided into two groups based on care provided by staff neonatologists: 24-hour in-house coverage (24-hour coverage 1998-2000) and daytime coverage (day coverage 2002-2004). Short- and long-term outcomes were compared. Results A total of 387 (78%) of the screened infants were included. Twenty-four-hour coverage (n=179) and day coverage (n=208) groups had a median birth weight (BW) of 875 g (range 470-1250) and 922 g (480-1530; P=0.028), respectively, and both had a median gestational age of 27 weeks. In the day coverage group, a smaller proportion of mothers had chorioamnionitis (20% vs. 30%; P=0.025), received less antibiotics (62% vs. 73%; P=0.023), and infants had fewer cases of confirmed sepsis (14% vs. 23%; P=0.022). In the day coverage group, a larger number of infants had respiratory distress syndrome (87% vs. 77%; P=0.011) and required prolonged mechanical ventilation (median 31 vs. 21 days; P=0.002). The incidence of major neurodevelopmental impairment was not significantly different between the two groups (odds ratio 0.76; 95% confidence interval 0.34-1.65). Conclusions Duration of mechanical ventilation was reduced with 24-hour in-house coverage by staff neonatologists. However, 24-hour coverage was not associated with any difference in neurodevelopmental (ND) outcomes at 3-year corrected age.
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Sildenafil Postconditioning in a Rat Model of Ventricular Fibrillation/ Resuscitation. Exp Clin Cardiol 2017. [DOI: 10.4172/2155-9880.1000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Phase 3 randomised study of daratumumab, bortezomib and dexamethasone (DVd) vs bortezomib and dexamethasone (Vd) in patients (pts) with relapsed or refractory multiple myeloma (RRMM): CASTOR. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw375.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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EuReCa ONE27 Nations, ONE Europe, ONE Registry. Resuscitation 2016; 105:188-95. [DOI: 10.1016/j.resuscitation.2016.06.004] [Citation(s) in RCA: 334] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 05/31/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
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Extracurricular elective course ‘Resuscitation Medicine’. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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EFFECT OF DIETARY SUPPLEMENTAL ZINC SOURCE AND LEVEL ON GROWTH PERFORMANCE, DIGESTIBILITY COEFFICIENTS AND IMMUNE RESPONSE OF NEW ZEALAND WHITE RABBITS. ACTA ACUST UNITED AC 2015. [DOI: 10.21608/ejnf.2015.104497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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A new approach in CPR training: Maastricht Quantity-orientated Resuscitation Session. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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277 Single-Item Health Literacy Screening Validation in Predicting Limited Health Literacy in an Academic Emergency Department. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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268 Limited Health Literacy Is Not Associated With Increased Emergency Department Length of Stay. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gulf Heart Assocation 2015 Conference Proceedings Abstracts14Immediate and In-hospital Complications of Percutaneous Coronary Intervention22Mitral Valve Replacement in the Presence of Severe Pulmonary Hypertension in Upper Egypt33Anomalous Left Anterior Descending Coronary Artery Arising from Pulmonary Artery in a 63 year-old patient Case Report34Accuracy of global longitudinal strain analysis in early diagnosis and localization of significant coronary artery lesions in non st - elevation acute coronary syndrome37Heart rate at discharge is an independent predictor of readmission and mortality among patients admitted with acute heart failure. Cohort analysis from Salmaniya Medical Complex - Kingdom of Bahrain38More than 200 heart transplantation from the single centre in the Middle East. All time high: 22 heart transplantation during the first 10 months at King Faisal Specialist Hospital and Research Centre, Riyadh39Outcomes of patients with reduced left ventricular systolic function undergoing heart surgery at King Faisal Hospital & Research Center40Pattern of in-hospital Cardiac Catheterization for Patients with Acute Coronary Syndrome in Kuwait42Incidence of Malignancies among Post Heart Transplant Patients in the Middle East; is it of Any Significance to the Rest of the World?52Percutaneous Mitral Balloon Valvuloplasty in Yemeni Patients; The challenges Never Ends53Importance of Health Education in improving the Quality of life of people with Chronic Diseases55Influence of Rescuers' Gender and Body Mass Index on Cardiopulmonary Resuscitation According to the American Heart Association 2010 Resuscitation Guidelines56Postoperative Mid-Term Results of Tricuspid Valve Surgery: Does Valve Repair Have a Better Outcome?58Clinical and Angiographic gender differences in patients undergoing Coronary Angiography61Sonographic chest B-lines with echocardiography Probe anticipate Elevated N-terminal pro-brain-type natriuretic peptide, irrespective of ejection fraction62Regain Interest in Semi-continuous Sutures in Prosthetic Valve Replacement65Accuracy of Predictive Operative Mortality Models in Octogenarians; a 10-Year Follow-Up Post Open Heart Surgery66What is the optimum management of Pacemaker Lead Endocarditis with multiple vegetations?67Should digoxin be prescribed in atrial fibrillation patients with or without heart failure? Results from Gulf Survey of Atrial Fibrillation Events (Gulf SAFE) in the Middle East69Detection of Early Left Ventricular Systolic and Diastolic Dysfunction in Patients with Maternoplacental Syndrome byTissue Doppler and Strain Rate Imaging70Right Ventricular Function Assessment in Single LAD lesion Patients Using Strain and Strain Rate Imaging74Anxiety traits and long-term risk of myocardial infarction and stroke in female population 25–64 years in Russia: MONICA-Psychosocial Epidemiological Study75The effect of personal anxiety on 16 years risk of an arterial hypertension in female population aged 25–64 in Russia: based on WHO epidemiological program MONICA-psychosocial77Comparison between Kuwaitis and expatriates in clinical features and outcome of primary PCI for acute ST elevation MI78Gender-related differences in the presentation, performance and outcome of primary PCI in a tertiary center in Kuwait79Venous saturations from central venous line and from venous side of heart lung machine are not interchangeable with mixed venous saturation from the pulmonary artery in children undergoing open heart surgery83Practice of smoking cessation counselling among physicians in Kuwait84Patterns of tobacco smoking among physicians in Kuwait85Cardiac Status among End Stage Renal Disease Patients on Maintenance Haemodialysis in Aden, Yemen: A Cross Sectional Study92Management and outcomes of Gulf citizens with ST elevation myocardial infarction: Findings from Gulf COAST99The Effect of Acute Epicatechin-3-gallate, Epigallocatechin and Epigallocatechin-3 Gallate Treatment on Tobacco Smoking Induced Heart Failure, In Ischemia/Reperfusion Rat Heart Model103Smoking patterns and smoking cessation counseling practices among medical students in Kuwait104Early Experience in Percutaneous Coronary Intervention for complex Lesion among Yemeni Patients106Influence of gender on presentation and outcomes of atrial fibrillation in Kuwait107Characteristics and outcomes of patients with atrial fibrillation in Kuwait108Prognostic Value of Normal Dobutamine Stress Echocardiography in Patients with Acute Chest Pain: A 15-years Follow up Study109Mitral Stenosis– Impact of Deranged Pulmonary Function Tests on Early Postoperative Outcome111Analysis of in-hospital delay components in patients with STEMI going for primary PCI in a single center112Association between Oral Hygiene Practices and Coronary Heart Disease in Kuwait113Under-utilization of Nuclear Myocardial Perfusion Imaging in the Middle East114Temporal Trends of Cardiorespiratory Fitness in Saudi Arabia: A Call for Action117Radiofrequency catheter ablation of atrial tachycardia using 3D mapping with the EnSite system118Exercise Intolerance in Postoperative Fallot Repair, Does it Correlate with Pulmonary Regurgitation?119Incremental Prognostic Value of Myocardial Perfusion Imaging in Patients with Renal Dysfunction120Impact of bleeding in patients with acute coronary syndrome on morbidity and mortality in the Gulf Region121Improving Documentation of Cardio-Vascular Disease Risk in Medical Records of Diabetic Patients attending Non Communicable Disease Clinics at West Bay Health Center in Qatar124The non-hyperemic coronary pressure notch as an indicator of the physiologic significance of coronary artery stenosis125Cardioprotective Effect Of Selenium And N-Acetylcysteine Versus Their Combination Against Myocardial Ischemia–Reperfusion Injury126Association between albuminuria and abnormal cardiac Findings in patients with type 2 diabetic nephropathy: Role of Urine Albumin Excretion129Sub-clinical cardiovascular changes in chronic obstructive pulmonary disease patients: Doppler ultrasound evaluation130Interleukin-6 and C-reactive protein as a marker of severity in Adult with diabetic ketoacidosis131Carotid artery stenting in asymptomatic tight carotid artery stenosis scheduled for elective CABG surgery. (CASCADE study)132Prevalence of metabolic syndrome in patients with acute coronary syndrome in Yemen Data from Gulf Race133Catheterization in Post CABG (Coronary Artery Bypass Graft); Lessons Learned. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Impact of Digoxin on Mortality in Patients With Atrial Fibrillation Stratified by Heart Failure: Findings From Gulf Survey of Atrial Fibrillation Events in the Middle East. J Cardiovasc Pharmacol Ther 2015; 21:273-9. [PMID: 26341119 DOI: 10.1177/1074248415603505] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/09/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The use of digoxin in patients having atrial fibrillation (AF) with or without heart failure (HF) is not without controversy. The aim of this study was to examine the impact of digoxin therapy on mortality stratified by HF. METHODS Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department of 23 hospitals in 6 countries in the Middle East. Patients were recruited between October 2009 and June 2010 and followed up for 1 year after enrollment. Analyses were performed using univariate and multivariate statistical techniques. RESULTS The study included a total of 1962 patients with AF, with an overall mean age of 56 ± 16 years, and 52% (n = 1026) were males. At hospital discharge, digoxin was prescribed in 36% (n = 709) of the patients, whereas HF was present in 27% (n = 528) of the cohort. A total of 225 (12.1%) patients died during the 12-month follow-up period after discharge (5.3% [n = 104] were lost to follow-up). Patients with HF were consistently associated with higher mortality at 1 month (5.1% vs 2.1%; P < .001), 6 months (17.2% vs 5.0%; P < 0.001), and 12 months (24.3% vs 7.6%; P < .001) when compared to those without HF. When stratified by HF, digoxin therapy was associated with significantly higher mortality in those without HF at 6 months (8.7% vs 3.7%; adjusted odds ratio (aOR), 5.07; P < .001) and 12 months (12.3% vs 6.0%; aOR, 4.22; P < .001) but not in those with HF (6 months: 18.6% vs 14.7%; aOR, 1.62; P = .177 and 12 months: 25.4% vs 22.4%; aOR, 1.37; P = .317). CONCLUSIONS In patients with AF and HF, digoxin did not offer any survival advantages. However, in those without HF, digoxin therapy was, in fact, associated with significantly higher long-term mortality.
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One year all-cause mortality in patients with atrial fibrillation and peripheral vascular disease: The bad companion. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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141: Self-Evaluation of Procedural Skill Competencies By Neonatal Perinatal Medicine Trainees in Canada. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Opinions of secondary school students about obligatory CPR training in school. Resuscitation 2014. [DOI: 10.1016/j.resuscitation.2014.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Prior to CPR training, courage of secondary school students predominates their self-perceived ability to provide CPR, but results depend on school type. Resuscitation 2014. [DOI: 10.1016/j.resuscitation.2014.03.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Efforts by medical students joined in Taskforce QRS to increase survival chances in South-Netherlands. Resuscitation 2014. [DOI: 10.1016/j.resuscitation.2014.03.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Knowledge of the European Emergency Number in secondary schools for different grades and education level groups. Resuscitation 2013. [DOI: 10.1016/j.resuscitation.2013.08.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality? [Short communication]. Public Health Action 2013; 3:125-7. [DOI: 10.5588/pha.12.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 03/11/2013] [Indexed: 11/10/2022] Open
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Assessment of stroke risk in Middle Eastern patients with atrial fibrillation: the Gulf SAFE registry. Int J Cardiol 2013; 168:1644-6. [PMID: 23481910 DOI: 10.1016/j.ijcard.2013.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
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Long-term outcomes of acute coronary syndrome in young adults: Findings from Gulf RACE-2. J Saudi Heart Assoc 2012. [DOI: 10.1016/j.jsha.2012.06.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Practicing medicine without borders: tele-consultations and tele-mentoring for improving paediatric care in a conflict setting in Somalia? Trop Med Int Health 2012; 17:1156-62. [PMID: 22845678 DOI: 10.1111/j.1365-3156.2012.03047.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In a district hospital in conflict-torn Somalia, we assessed (i) the impact of introducing telemedicine on the quality of paediatric care, and (ii) the added value as perceived by local clinicians. METHODS A 'real-time' audio-visual exchange of information on paediatric cases (Audiosoft Technologies, Quebec, Canada) took place between clinicians in Somalia and a paediatrician in Nairobi. The study involved a retrospective analysis of programme data, and a perception study among the local clinicians. RESULTS Of 3920 paediatric admissions, 346 (9%) were referred for telemedicine. In 222 (64%) children, a significant change was made to initial case management, while in 88 (25%), a life-threatening condition was detected that had been initially missed. There was a progressive improvement in the capacity of clinicians to manage complicated cases as demonstrated by a significant linear decrease in changes to initial case management for meningitis and convulsions (92-29%, P = 0.001), lower respiratory tract infection (75-45%, P = 0.02) and complicated malnutrition (86-40%, P = 0.002). Adverse outcomes (deaths and lost to follow-up) fell from 7.6% in 2010 (without telemedicine) to 5.4% in 2011 with telemedicine (30% reduction, odds ratio 0.70, 95% CI: 0.57-0.88, P = -0.001). The number needed to be treated through telemedicine to prevent one adverse outcome was 45. All seven clinicians involved with telemedicine rated it to be of high added value. CONCLUSION The introduction of telemedicine significantly improved quality of paediatric care in a remote conflict setting and was of high added value to distant clinicians.
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Long-term outcomes of acute coronary syndrome in young adults: findings from GULF RACE-2. BMC Proc 2012. [PMCID: PMC3426031 DOI: 10.1186/1753-6561-6-s4-p23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Impact of in-hospital recurrent ischemia event: findings from GULF RACE-2. BMC Proc 2012. [PMCID: PMC3426049 DOI: 10.1186/1753-6561-6-s4-o17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Treating Spontaneous Pneumothorax with Room Air Versus Supplemental Oxygen. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.33ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Effectiveness of simple strategies in reducing multidrug resistant bloodstream infections in the NICU of a tertiary care hospital in Karachi, Pakistan. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Procedural Skills in Pediatric Residency: Re-Evaluating the Competencies. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.17aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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