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Antonik M, Sankar S, Shepherd J, Hassan S. The economic and resource burden of e-scooter-related orthopaedic injuries: A district general hospital's experience. Injury 2024:111493. [PMID: 38508983 DOI: 10.1016/j.injury.2024.111493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Electric scooters (e-scooters) are an increasingly popular method of transportation worldwide. However, there are concerns regarding their safety, specifically with regards to orthopaedic injuries. We aimed to investigate the overall burden and financial impact on orthopaedic services as a result of e-scooter-related orthopaedic injuries. METHODS We retrospectively identified all e-scooter-related injuries requiring orthopaedic admission or surgical intervention in a large District General Hospital in England over a 16-month period between September 2020 and December 2021. Injuries sustained, surgical management, inpatient stay and resources used were calculated. RESULTS Seventy-nine patients presented with orthopaedic injuries as a result of e-scooter transportation with a mean age of 30.1 years (SD 11.6), of which 62 were males and 17 were females. A total of 86 individual orthopaedic injuries were sustained, with fractures being the most common type of injury. Of these, 23 patients required 28 individual surgical procedures. The combined theatre and recovery time of these procedures was 5500 min, while isolated operating time was 2088 min. The total cost of theatre running time for these patients was estimated at £77,000. A total of 17 patients required hospital admission under Trauma and Orthopaedics, which accounted for total combined stay of 99 days with a mean length of stay of 5.8 days. CONCLUSION While there are potential environmental benefits to e-scooters, we demonstrate the risks of injury associated with their use and the associated increased burden to the healthcare system through additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.
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Affiliation(s)
- M Antonik
- Trauma & Orthopaedic Surgery Department, Northampton General Hospital, UK
| | - S Sankar
- Trauma & Orthopaedic Surgery Department, Northampton General Hospital, UK
| | - J Shepherd
- Trauma & Orthopaedic Surgery Department, Leicester Royal Infirmary, UK; University of Leicester, Leicester, UK; National Institute for Health and Care Research, Academic Clinical Fellowship Integrated Clinical Academic Training Pathway, UK.
| | - S Hassan
- Trauma & Orthopaedic Surgery Department, Northampton General Hospital, UK
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Barnsley H, Uzoukwu S, Hassan S, Borri M. The use of low dose CT scouts for MR safety screening: A multi-reader evaluation. Radiography (Lond) 2024; 30:168-175. [PMID: 38035429 DOI: 10.1016/j.radi.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Plain film radiographs are recommended to assist in MRI safety screening of patients with unknown medical histories, especially in an emergency setting where patients might be unable to answer a safety questionnaire. This study assesses the performance of CT scout images, which have low radiation dose and are faster and easier to acquire compared to plain film radiographs, in finding and naming a range of head and body implants. METHODS A retrospective analysis of 40 CT Head and Neck (HN) scout images and 40 CT Chest, Abdomen and Pelvis (CAP) scout images was undertaken. A subset of these were chosen to include a range of common internal implants not identifiable externally to the patient. The images were assessed by three readers with varying levels of clinical experience in MRI who were asked to find and name any implants seen. RESULTS Collectively, all readers reached a sensitivity of 85 % in finding internal implants, regardless of their clinical experience or experience in reviewing CT images, and a minimum specificity of 95 %. Implants were correctly named in 74 % of the images presented. CONCLUSION CT scout images were able to reveal most of the implants included. However, clinical experience in reviewing the images enhances a reader's ability to identify the type of implant. IMPLICATIONS FOR PRACTICE In an emergency setting, imaging can be critical in the management of patients presenting with acute illnesses. In the unconscious or unresponsive patient, the use of CT scouts, where this is the only option available, could provide valuable MRI safety information prior to a scan, improving access to the MRI scan in a timely manner.
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Affiliation(s)
- H Barnsley
- Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - S Uzoukwu
- Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - S Hassan
- Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - M Borri
- Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
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Hassan S, Dritsas S, O'Dwyer ST, Aziz O, Sutton P, Wang X, Fish R. Open versus Closed technique for administration of heated intraperitoneal chemotherapy (HIPEC): Morbidity and Mortality outcomes from a high-volume centre. Eur J Surg Oncol 2023; 49:106924. [PMID: 37179147 DOI: 10.1016/j.ejso.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND AIMS Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is an established treatment in selected patients with peritoneal metastases, delivered in the UK in specialist centres. HIPEC can be administered via the open coliseum technique as first described by Sugarbaker (O-HIPEC) or using a closed technique (C-HIPEC). Data comparing the safety and outcomes of these different approaches is limited. This study aims to compare morbidity and mortality rates of O-HIPEC and C-HIPEC following CRS for peritoneal metastases from colorectal cancer and appendiceal tumours. METHODS Consecutive patients undergoing CRS with open (05/2019-04/2020) and closed (05/2020-04/2021) HIPEC were identified from a prospectively maintained database. Baseline data including primary pathology, HIPEC agent and major operative procedures were analysed using Chi-squared and Fishers exact tests to ensure comparability of groups. Primary outcomes were 30- and 60-day postoperative mortality and morbidity (Common Terminology Criteria for Adverse Events, CTCAE). Secondary outcomes were length of critical care and overall hospital stay. In addition, morbidity and mortality were compared between HIPEC agents (mitomycin and oxaliplatin/5-fluorouracil). RESULTS 99 patients (39.3%) and 153 patients (60.7%) underwent O-HIPEC, C-HIPEC respectively. Groups were well matched for baseline demographics, pathology, and HIPEC agent. In the O-HIPEC and C-HIPEC groups respectively, the incidence of 60-day complications (CTCAE 1-4) was 40.4% vs 39.3% (chi squared 0.94) and severe complications (CTCAE 3-4) 14% vs 13% (Fisher's exact p = 1) There was no perioperative mortality but one death in each group within the follow up period. There was no difference in morbidity or mortality between those receiving mitomycin or oxaliplatin. CONCLUSION Closed administration of HIPEC is safe with no difference in post-operative morbidity or mortality compared to open HIPEC administration. Differences in longer term oncological outcomes including overall survival and disease-free survival between open and closed HIPEC techniques are yet to be determined.
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Affiliation(s)
- S Hassan
- Colorectal and Peritoneal Oncology Centre, The Christie NHS FT, Manchester, UK
| | - S Dritsas
- Colorectal and Peritoneal Oncology Centre, The Christie NHS FT, Manchester, UK
| | - S T O'Dwyer
- Colorectal and Peritoneal Oncology Centre, The Christie NHS FT, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - O Aziz
- Colorectal and Peritoneal Oncology Centre, The Christie NHS FT, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - P Sutton
- Colorectal and Peritoneal Oncology Centre, The Christie NHS FT, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - X Wang
- Colorectal and Peritoneal Oncology Centre, The Christie NHS FT, Manchester, UK
| | - R Fish
- Colorectal and Peritoneal Oncology Centre, The Christie NHS FT, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK.
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Monlezun DJ, Badalamenti A, Javaid A, Marmagkiolis K, Honan K, Kim JW, Patel R, Akhanti B, Halperin D, Dasari A, Koutroumpakis E, Kim P, Lopez-Mattei J, Yusuf SW, Cilingiroglu M, Mamas MA, Gregoric I, Yao J, Hassan S, Iliescu C. Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the "forgotten pulmonic valve". Front Cardiovasc Med 2023; 9:1071138. [PMID: 36843627 PMCID: PMC9945326 DOI: 10.3389/fcvm.2022.1071138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023] Open
Abstract
Background Carcinoid heart disease is increasingly recognized and challenging to manage due to limited outcomes data. This is the largest known cohort study of valvular pathology, treatment (including pulmonary and tricuspid valve replacements [PVR and TVR]), dispairties, mortality, and cost in patients with malignant carcinoid tumor (MCT). Methods Machine learning-augmented propensity score-adjusted multivariable regression was conducted for clincal outcomes in the 2016-2018 U.S. National Inpatient Sample (NIS). Regression models were weighted by the complex survey design and adjusted for known confounders and the likelihood of undergoing valvular procedures. Results Among 101,521,656 hospitalizations, 55,910 (0.06%) had MCT. Patients with MCT vs. those without had significantly higher inpatient mortality (2.93 vs. 2.04%, p = 0.002), longer mean length of stay (12.20 vs. 4.62, p < 0.001), and increased mean total cost of stay ($70,252.18 vs. 51,092.01, p < 0.001). There was a step-wise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% vs. 0.01, p < 0.001) and PV (0.03 vs. 0.00, p = 0.040) diagnosed with vs. without MCT for 2016, with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region, except in 2017, when the highest prevalence of PV procedures were performed in the Western North at 50.00% (p = 0.034). In machine learning and propensity score augmented multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did increase cost (respectively, $141,082.30, p = 0.015; $355,356.40, p = 0.012). Conclusion This analysis reflects a favorable trend in recognizing the need for TVR and PVR in patients with MCT, with associated increased cost but not mortality. Our study also suggests that pulmonic valve pathology is increasingly recognized in MCT as reflected by the upward trend in PVRs. Further research and updated societal guidelines may need to focus on the "forgotten pulmonic valve" to improve outcomes and disparities in this understudied patient population.
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Affiliation(s)
- Dominique J. Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States,Center for Artificial Intelligence and Health Equities, Global System Analytics and Structures (GSAS), New Orleans, LA, United States,*Correspondence: Dominique J. Monlezun ✉
| | - Andrew Badalamenti
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Awad Javaid
- Division of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at the University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Kostas Marmagkiolis
- Division of Cardiovascular Disease, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Kevin Honan
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Jin Wan Kim
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Rishi Patel
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Bindu Akhanti
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Dan Halperin
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Arvind Dasari
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Peter Kim
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Syed Wamique Yusuf
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Igor Gregoric
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - James Yao
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
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Honan KA, Hassan S, Deswal A, Herrmann J, Song J, Monlezun D, Halperin D, Mahvash A, Dasari A, Koutroumpakis E, Akay M, Balanescu DV, de Armas IS, Patel M, Nathan S, Kar B, Marmagkiolis K, Lopez-Mattei J, Patel J, Gregoric I, Yao J, Iliescu CA. Bioprosthetic valve monitoring in patients with carcinoid heart disease. Front Cardiovasc Med 2023; 9:1072890. [PMID: 36712267 PMCID: PMC9878394 DOI: 10.3389/fcvm.2022.1072890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023] Open
Abstract
Background Carcinoid heart disease (CnHD) is a frequent cause of morbidity and mortality in patients with neuroendocrine tumors and carcinoid syndrome. Although valve replacement surgery appears to decrease all-cause mortality in patients with advanced CnHD, few studies have investigated the outcomes of patients after valve replacement. Methods We conducted a multi-institution retrospective registry of patients who received both tricuspid and pulmonic bioprosthetic valve (TV/PV) replacements for advanced CnHD from November 2005 to March 2021. Patients were followed post-operatively with echocardiographic studies every 3 months. Carcinoid valvular heart disease scores were used to monitor valve degeneration. Neuroendocrine tumor treatment, their administration times, and associations with echocardiographic findings were recorded. Results Of 87 patients with CnHD, 22 patients underwent simultaneous surgical TV and PV replacement. In 6 patients (27.3%), increased PV Vmax was the first echocardiographic manifestation of valve degeneration in the setting of occult neurohormonal release. Post-operative telotristat ethyl and peptide receptor radionuclide therapy appeared to stabilize PV Vmax. The PV Vmax showed consistent elevation in the entire patient population when compared to baseline, while bioprosthetic TV echocardiographic parameters were relatively unchanged throughout. Post-operative warfarin therapy did not affect the rate of PV degeneration, and no major bleeding was recorded during or after post-operative anticoagulation therapy. Conclusion Bioprosthetic valve degeneration is common in CnHD. Monitoring with echocardiographic studies every 3 months, focusing on PV velocities, could identify patients with occult disease that very likely promotes valve degeneration. Novel neuroendocrine tumor therapies may have a beneficial impact on valve degeneration.
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Affiliation(s)
- Kevin A. Honan
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Juhee Song
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dominique Monlezun
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Daniel Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Armeen Mahvash
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Akay
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Dinu-Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ismael Salas de Armas
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Manish Patel
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sriram Nathan
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Heart and Vascular Institute, Texas Medical Center, Houston, TX, United States
| | - Biswajit Kar
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Heart and Vascular Institute, Texas Medical Center, Houston, TX, United States
| | - Konstantinos Marmagkiolis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jay Patel
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Igor Gregoric
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - James Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar A. Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Cezar A. Iliescu,
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Hassan S, Paudyal N, Emaan A, Ibrahim S. Monkeypox Virus: A comprehensive narrative review. Kathmandu Univ Med J (KUMJ) 2023; 21:86-93. [PMID: 37800433] [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: 10/07/2023]
Abstract
Monkeypox virus, now known as Mpox virus is a large, enveloped, double stranded deoxyribonucleic acid (DNA) virus belonging to the Orthopox viridae genus of the Poxviridae family. Though, Mpox, have earlier been endemic to only African countries, the 2022 outbreak has shown its rapid spread throughout the world. The May 2022 outbreak have shown primarily human to human transmission in contrast to animal to human transmission that had been seen previously. Recent data also suggest a possibility of a pre symptomatic spread. After an incubation period of 9 days, patients with Mpox can present with a prodrome of symptoms followed by a rash. If untreated, severe complications develop in the high-risk groups especially children and pregnant woman. Such groups of people will benefit from antiviral treatments. The current approach to prevent against it is pre-exposure and post exposure prophylaxis with vaccines. The vaccines that have been approved by Food and Drug Administration to date is ACAM2000 and JYNNEOS. Several diagnostic methods exist, among which polymerase chain reaction has proven to be the most specific and sensitive. In this review, we will discuss its epidemiology, the clinical manifestations, diagnostic modalities, complications, treatment approaches and preventive measures.
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Affiliation(s)
- S Hassan
- Nobel Medical College Teaching Hospital, Kanchanbari, Morang, Biratnagar
| | - N Paudyal
- Nobel Medical College Teaching Hospital, Kanchanbari, Morang, Biratnagar
| | - A Emaan
- Nobel Medical College Teaching Hospital, Kanchanbari, Morang, Biratnagar
| | - S Ibrahim
- Nobel Medical College Teaching Hospital, Kanchanbari, Morang, Biratnagar
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Hassan S, Naeem M, Nasir MF, Riaz P, Khan MN, Atiq I. Molecular based identification and phylogenetic relationship by using cytochrome b gene of Pangasius pangasius. BRAZ J BIOL 2022; 84:e268001. [PMID: 36541960 DOI: 10.1590/1519-6984.268001] [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] [Received: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
Molecular appraoch for identification of unknown species by using Cytochrome b gene is an effective and reliable as compared with morphological based identification. For DNA barcoding universal molecular genes were used to identify the species. Cytochrome b is a specific gene used for identification purpose. DNA barcoding is a reliable and effective method compared to the different traditional morphological methods of specie identification. So,in the present study which was conducted to identify the species, a total of 50 fish samples were collected from five different sites. DNA was extracted by using the Phenol Chloroform method from muscle tissue. Five sequences were sequenced (one from each site), analyzed, and identified specific species as Pangasius pangasius. Identified sequences were variable in length from 369 bp (Site 1), 364 bp (Site 2), 364 bp (Site 3), 352 bp (Site 4), and 334 bp (Site 5). Identity matches on the NCBI database confirmed the specific specie as P. pangasius. A distancing tree was drawn to show maximum likelihood among the same and different species. Yet, in many cases fishes on diverse development stages are difficult to identify by morphological characters. DNA-based identification methods offer an analytically powerful addition or even an alternative tool for species identification and phylogenetic study. This work intends to provide an updated and extensive overview on the DNA based methods for fish species identification by using Cytochrome b gene as targeted markers for identification purpose.
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Affiliation(s)
- S Hassan
- Bahauddin Zakariya University, Institute of Zoology, Multan, Punjab, Pakistan
| | - M Naeem
- Bahauddin Zakariya University, Institute of Zoology, Multan, Punjab, Pakistan
| | - M Farhan Nasir
- University of Education, Department of Zoology, Division of Science & Technology, Lahore, Punjab, Pakistan
| | - P Riaz
- Bahauddin Zakariya University, Institute of Zoology, Multan, Punjab, Pakistan
| | - M N Khan
- University of Jhang, Department of Zoology, Jhang, Punjab, Pakistan
| | - I Atiq
- Ghazi University Dera Ghazi Khan, Department of Zoology, Punjab, Pakistan
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Safdar A, Ahmed T, Liu VY, Addoumieh A, Agha AM, Giza DE, Balanescu DV, Donisan T, Dayah T, Lopez-Mattei JC, Kim PY, Hassan S, Karimzad K, Palaskas N, Tsai JY, Iliescu GD, Yang EH, Herrmann J, Marmagkiolis K, Angelini P, Iliescu CA. Trigger related outcomes of takotsubo syndrome in a cancer population. Front Cardiovasc Med 2022; 9:1019284. [PMID: 36386379 PMCID: PMC9651211 DOI: 10.3389/fcvm.2022.1019284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/28/2022] [Indexed: 01/21/2023] Open
Abstract
Background Takotsubo syndrome (TTS) occurs more frequently in cancer patients than in the general population, but the effect of specific TTS triggers on outcomes in cancer patients is not well studied. Objectives The study sought to determine whether triggering event (chemotherapy, immune-modulators vs. procedural or emotional stress) modifies outcomes in a cancer patient population with TTS. Methods All cancer patients presenting with acute coronary syndrome (ACS) between December 2008 and December 2020 at our institution were enrolled in the catheterization laboratory registry. Demographic and clinical data of the identified patients with TTS were retrospective collected and further classified according to the TTS trigger. The groups were compared with regards to major adverse cardiac events, overall survival and recovery of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) after TTS presentation. Results Eighty one of the 373 cancer patients who presented with ACS met the Mayo criteria for TTS. The triggering event was determined to be "cancer specific triggers" (use of chemotherapy in 23, immunomodulators use in 7, and radiation in 4), and "traditional triggers" (medical triggers 22, and procedural 18 and emotional stress in 7). Of the 81 patients, 47 died, all from cancer-related causes (no cardiovascular mortality). Median survival was 11.9 months. Immunomodulator (IM) related TTS and radiation related TTS were associated with higher mortality during the follow-up. Patients with medical triggers showed the least recovery in LVEF and GLS while patients with emotional and chemotherapy triggers, showed the most improvement in LVEF and GLS, respectively. Conclusion Cancer patients presenting with ACS picture have a high prevalence of TTS due to presence of traditional and cancer specific triggers. Survival and improvement in left ventricular systolic function seem to be related to the initial trigger for TTS.
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Affiliation(s)
- Ayesha Safdar
- Department of Medicine, Army Medical College, Rawalpindi, Pakistan
| | - Talha Ahmed
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Victor Y. Liu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Antoine Addoumieh
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ali M. Agha
- Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Dana E. Giza
- Department of Family and Community Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Dinu V. Balanescu
- Department of Family and Community Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tariq Dayah
- Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Juan C. Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Y. Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - January Y. Tsai
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gloria D. Iliescu
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Eric H. Yang
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Joerg Herrmann
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Konstantinos Marmagkiolis
- Department of Cardiovascular Medicine, Florida Hospital Pepin Heart Institute, Tampa, FL, United States
| | - Paolo Angelini
- Department of Cardiology, Texas Heart Institute, Houston, TX, United States
| | - Cezar A. Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Cezar A. Iliescu,
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Boshari T, Hassan S, Hussain K, Billett J, Garry S, Weil L. Development of a refugee health assessment toolkit for specific populations to support primary care. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.243] [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: 11/13/2022] Open
Abstract
Abstract
Issue/problem
The United Kingdom (UK) hosts c.136,000 refugees and last year received the most asylum applications in two decades. Despite this, expertise in migrant health is not widespread in general practice, with few comprehensive toolkits available to support crucial initial health assessments of new arrivals.
Description of the problem
A large influx of Afghan refugees entered the UK in autumn 2021. In London, primary care practitioners quickly identified a lack of readily accessible, comprehensive guidance to support them in conducting health assessments for arrivals with a complex range of needs. This was compounded by many in primary care having little or no experience of migrant health.
Results
To address this gap in advice on conducting initial health assessments, a bespoke toolkit was created. The toolkit consolidated advice from a range of partners and resources: the UK Afghan migrant health guide, clinicians with humanitarian experience, front-line practitioners, Doctors of the World, and those leading on the health and public health response. The toolkit ensured greater consistency in the nature and content of assessments, considered not only primary needs but also broader wellbeing, and was responsive to both anticipated and known health priorities.
Lessons
The initial health assessment toolkit for Afghan migrants was well received by frontline staff and has implications for international practice in other areas providing similar health support. The toolkit and associated supporting information has formed a template that can be rapidly adapted to suit emerging needs, as has been done for new arrivals from Ukraine. This work has fed into best practice by the UK National Asylum Steering Group and is to be a case study for a WHO project on country-specific health assessments.
Key messages
• The toolkit is a proof of concept for partnership working towards holistic initial health assessments of new migrants in primary care, bringing together best evidence and pragmatic practice.
• This work has implications for other countries experiencing similar trends in migration and providing health support to an increasing number of new refugees.
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Affiliation(s)
- T Boshari
- Public Health, London Borough of Newham , London, UK
| | - S Hassan
- London Operations Team, Office for Health Improvement and Disparities , London, UK
| | - K Hussain
- London Operations Team, Office for Health Improvement and Disparities , London, UK
| | - J Billett
- London Operations Team, Office for Health Improvement and Disparities , London, UK
| | - S Garry
- Public Health, London Borough of Southwark , London, UK
- Association of Directors of Public Health Asylum Seekers and Refugees, , London, UK
| | - L Weil
- London Operations Team, Office for Health Improvement and Disparities , London, UK
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Abdul Haris P, Brazil L, Blythe K, Chia K, Hassan S, Loganathan T, Smith D, Swampillai A, Al-Salihi O. P11.30.A Stereotactic Radiosurgery (SRS) for brain metastases in breast cancer: An evaluation of outcomes at a UK tertiary centre. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.219] [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: 11/14/2022] Open
Abstract
Abstract
Background
Brain metastases (BM) occur in approximately 10-30% of patients with breast cancer (BC). Patients with advanced breast cancer are living longer, and the incidence of BM are increasing. Stereotactic Radiosurgery (SRS) has emerged as a strategy to treat BM. We evaluated the outcomes and potential prognostic factors of patients with BM treated with SRS.
Material and Methods
Retrospective review of patients treated with linac-based SRS for BM from BC in a single tertiary centre between August 2017-September 2021. Overall survival (OS), intracranial progression-free survival (IPFS), and prognostic factors were evaluated using Kaplan-Meier analysis, log-rank test, and Cox proportional-hazards model.
Results
76 patients were included in the analysis. Out of these, 56 had first-line local treatment with SRS, either as primary (n=34) or adjuvant to surgery (n=22). Median age was 58 years old (range 37-86), and 88% had PS 0/1. One-year survival rate was 56%.
Median OS and IPFS from SRS was 16 months (95% CI 8-24) and 7 months (95% CI 2-12), respectively. However, there were significant differences in OS (p<0.001) and IPFS (p=0.001) based on molecular subtypes. Patients with triple-negative breast cancer (TNBC) (n=14) had median OS of 7 months (95% CI 2-12), ER+/HER2- (n=22) median OS of 22 months, ER-/HER2+ (n=8) median OS of 4 months (95% CI 0-9), and ER+/HER2+ (n=11) median OS of 36 months. Similar trend was seen with IPFS.
Patients with progressive extracranial disease compared to stable disease had shorter median OS (4 months vs 23 months, HR 2.4, p=0.01) and median IPFS (4 months vs 13 months, HR 2, p=0.03). Age ≥65 years was associated with shorter median OS (4 vs 23 months, HR 2.3, p=0.02). Patients with ≥4 brain metastases had shorter IPFS (4 months vs 11 months, HR 2.4, p=0.012), but no significant difference in OS. Volume of metastases did not affect outcome in this series.
30% of patients progressed intracranially after first-line SRS. 94 % had out-of-field recurrences, and 6% in-field recurrences. 59% had further SRS, 12 % WBRT, 6% surgery, and 23% had no further local treatment.
26 patients had second-line local treatment with SRS after first-line SRS (n=9), WBRT (n=9), or surgery +/- WBRT (n=8). There were no significant differences in outcome based on the modality of first-line local treatment.
Conclusion
SRS is an effective treatment for BM from BC. There were significant differences in survival based on age, molecular subtypes, and extracranial disease status.
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Affiliation(s)
- P Abdul Haris
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - L Brazil
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - K Blythe
- Guy's and St Thomas' NHS Trust , London , United Kingdom
- Department of Medical Physics, Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - K Chia
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - S Hassan
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - T Loganathan
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - D Smith
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - A Swampillai
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - O Al-Salihi
- Guy's and St Thomas' NHS Trust , London , United Kingdom
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Ahmed T, Marmagkiolis K, Ploch M, Irizarry-Caro JA, Amatullah A, Desai S, Aziz MK, Yarrabothula A, Fossas-Espinosa J, Koutroumpakis E, Hassan S, Karimzad K, Kim P, Cilingiroglu M, Iliescu C. The year in Cardio-oncology 2022. Curr Probl Cardiol 2022; 48:101435. [DOI: 10.1016/j.cpcardiol.2022.101435] [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: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 10/14/2022]
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12
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Wan Kim J, Monlezun D, Kun Park J, Chauhan S, Balanescu D, Koutroumpakis E, Palaskas N, Kim P, Hassan S, Botz G, Crommett J, Reddy D, Cilingiroglu M, Marmagkiolis K, Iliescu C. Post-Cardiac Arrest PCI is Underutilized Among Cancer Patients: Machine Learning Augmented Nationally Representative Case-Control Study of 30 Million Hospitalizations. Resuscitation 2022; 179:43-49. [PMID: 35933056 DOI: 10.1016/j.resuscitation.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer patients are less likely to undergo percutaneous coronary intervention (PCI) after cardiac arrest, although they demonstrate improved mortality benefit from the procedure. We produced the largest nationally representative analysis of mortality of cardiac arrest and PCI for patients with cancer versus non-cancer. METHODS Propensity score adjusted multivariable regression for mortality was performed in this case-control study of the United States' largest all-payer hospitalized dataset, the 2016 National Inpatient Sample. Regression models of mortality and PCI weighted by the complex survey design were fully adjusted for age, race, income, cancer metastases, NIS-calculated mortality risk by Diagnosis Related Group (DRG), acute coronary syndrome, and likelihood of undergoing PCI RESULTS: Of the 30,195,722 hospitalized adult patients, 15.43% had cancer, and 0.79% of the whole sample presented with cardiac arrest (of whom 20.57% underwent PCI). In fully adjusted regression analysis among patients with cardiac arrest, PCI significantly reduced mortality (OR 0.15, 95%CI 0.13-0.19; p<0.001) among patients with cancer greater than those without it (OR 0.21, 95%CI 0.20-0.23; p<0.001). CONCLUSIONS This nationally representative study suggests that post-cardiac arrest PCI is underutilized among patients with cancer despite its significant mortality reduction for such patients (independent of clinical acuity).
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Affiliation(s)
- Jin Wan Kim
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Dominique Monlezun
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jong Kun Park
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Siddharth Chauhan
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dinu Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Botz
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Crommett
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dereddi Reddy
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Mohd Yasin N, Abdul Hamid FS, Hassan S, Mat Yusoff Y, Mohd Sahid EN, Esa E. An insight of -50 (G>A) mutation in the direct repeat element of the β-globin gene: From Malaysian perspective. Malays J Pathol 2022; 44:301-302. [PMID: 36043595] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
No abstract available.
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Affiliation(s)
- N Mohd Yasin
- Institute for Medical Research, Cancer Research Centre, Haematology Unit, 50588 Kuala Lumpur, Malaysia.
| | - F S Abdul Hamid
- Institute for Medical Research, Cancer Research Centre, Haematology Unit, 50588 Kuala Lumpur, Malaysia
| | - S Hassan
- Institute for Medical Research, Cancer Research Centre, Haematology Unit, 50588 Kuala Lumpur, Malaysia
| | - Y Mat Yusoff
- Institute for Medical Research, Cancer Research Centre, Haematology Unit, 50588 Kuala Lumpur, Malaysia
| | - E N Mohd Sahid
- Institute for Medical Research, Cancer Research Centre, Haematology Unit, 50588 Kuala Lumpur, Malaysia
| | - E Esa
- Institute for Medical Research, Cancer Research Centre, Haematology Unit, 50588 Kuala Lumpur, Malaysia
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Batcho AA, Jabbar B, Sarwar MB, Rashid B, Hassan S, Husnain T. Transient Expression Analysis of Agave sisalana Heat Shock Protein Gene (AsHSP70) in Model Species (Nicotiana benthamiana) under Heat Stress. BIOL BULL+ 2022. [DOI: 10.1134/s1062359022030037] [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: 11/23/2022]
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Nweke UC, Hassan S, Meenakshi J. POS1458 HOW EASY IS IT FOR PATIENTS TO READ AND UNDERSTAND AVAILABLE PATIENT EDUCATIONAL MATERIALS FOR LUPUS? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundHealth Literacy (HL) informs health behaviors such as follow-up with health care providers & management plans. Poor HL is linked to poor health outcomes & healthcare disparity. In addition to personal HL, health care providers/systems & Organizations can also empower patients by developing & providing educational resources that foster HL & support a patient’s understanding of their health condition (organizational HL). Patient educational handouts are frequently provided after a physician visit to supplement instructions/education & are often obtained from online resources accessible to both physicians & patients.Lupus, a multisystem disease, preferentially effects people of color, a group at higher risk of health disparities, & poor HL. It is paramount for lupus patients to understand their disease & management to optimize health outcomes & reduce health disparities. The provision of easy to read & comprehend patient educational resources are one way to address this need.ObjectivesThe Center for Disease Control (CDC) recommends the readability of patient educational material to be at eight-grade level, while the National Institute of Health (NIH) & the American Medical Association (AMA) recommend a level no higher than sixth-grade. The Readability & Comprehension (RC) of commonly available lupus-related patient educational materials are not known & may offer an opportunity to improve patient care & outcomes.MethodsWe searched for the RC of Lupus-related patient educational materials, available at the American College of Rheumatology (ACR) & Lupus Foundation of America (LFA) websites. These reputable national organizations are at the forefront of Lupus education & research. RC were evaluated using the following measures: Flesch Kincaid Readability Ease (FKRE), Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GFS), Simple Measure of Gobbledygook (SMOG) Index, Coleman Liau Index (CLI) & Automated Readability Index (ARI).FKRE score is a widely used measure of readability with scores ranging from 0-100 & higher scores denoting greater reading ease (Goal is >60). FKGL represents the U.S. school grade needed to comprehend the text (Target is 7th grade). GFS estimates the years of formal education required to understand the text on the first reading (Goal is 7-8). SMOG index estimates the years of education needed to comprehend written materials. CLI is used to assess the U.S. grade level necessary to comprehend text material. The ARI assesses how easy a text material is to learn & estimates the U.S. grade level necessary to comprehend a passage.Descriptives for RC were obtained & compared using t test between the two sources.ResultsThere were 12 patient educational pamphlets on Lupus available (4 from ACR & 8 from LFA). Mean (SD) FKRE & FKGL were 52.73 (11.44) & 10.46 (2.14) respectively (Table 1). Mean GFS & CLI exceeded 12, while mean ARI was 18.Table 1.Reading & Comprehension of Patient Educational Materials on LupusRC Test (Values are Mean (SD))AllACRLFAPFlesch Kincaid Reading Ease52.7347.1855.500.25(11.44)(4.93)(13.00)Flesch Kincaid Grade Level10.4610.7310.330.78(2.14)(0.64)(2.64)Gunning Fog Score12.1912.6511.960.41(1.78)(0.31)(2.19)SMOG Index8.949.68.610.27(1.41)(0.67)(1.60)Coleman Liau Index13.5114.6512.940.18(2.04)(1.34)(2.15)Automated Readability Index18.0211.121.470.49(23.13)(1.45)(28.27)There were no significant differences in the RC scores among patient educational materials from the ACR or LFA.ConclusionPatient educational materials on Lupus, available at the ACR & LFA websites, are not easy to read or comprehend, using standardized RC metrics. Additionally, they are not aligned with recommended reading levels suggested by leading organizations (CDC, NIH or AMA). Patient’s understanding is critical in a complex disease like lupus to optimize health outcomes.Revision of patient lupus educational resources at these websites, to target 6-7th grade RC metrics, is recommended & could be overseen by the development of a new taskforce.Disclosure of InterestsNone declared
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Hassan S, Jameson M, Batumalai V, Crawford D, Moutrie Z, Hogan L, Loo C, Picton M, Pagulayan C, Jelen U, Alvares S, Heinke M, Sampaio S, Simon K, Twentyman T, Dwivedi N, de Leon J. PO-1374 Feasibility of magnetic resonance-guided adaptive post-prostatectomy radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03338-2] [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: 11/16/2022]
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Dearnaley D, Hinder V, Hijab A, Horan G, Srihari N, Rich P, Houston G, Henry A, Gibbs S, Venkitaraman R, Cruickshank C, Hassan S, Mason M, Pedley I, Payne H, Brock S, Wade R, Robinson A, Din O, Lees K, Murray J, Parker C, Griffin C, Sohaib A, Hall E. OC-0105 PROMPTS RCT of screening MRI for spinal cord compression in prostate cancer (ISRCTN74112318). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02481-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Honan K, Monlezun D, Koutroumpakis E, Palaskas NL, Cilingiroglu M, Lopez-Mattei JC, Marmagkiolis K, Akkanti B, Kar B, Gregoric ID, Deswal A, Iliescu C, Hassan S. TRICUSPID AND PULMONARY VALVE REPLACEMENT IN CARCINOID HEART DISEASE: INSIGHTS AND TRENDS FROM A NATIONALLY REPRESENTATIVE DATABASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02884-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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liu V, Monlezun D, Agrawal N, Pushparaji B, Thomason N, Palaskas NL, Cilingiroglu M, Marmagkiolis K, Koutroumpakis E, Lopez-Mattei JC, Kim PY, Hassan S, Iliescu C. PCI IS SAFE AND INCREASING AMONG CANCER PATIENTS: NATIONALLY REPRESENTATIVE PROPENSITY SCORE ADJUSTED AND MACHINE LEARNING AUGMENTED STUDY OF 100 MILLION HOSPITALIZATIONS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ahmad N, Hussain SM, Azam SM, Shahzad MM, Noureen A, Yaqoob R, Lateef M, Yawer A, Riaz D, Usman A, Faizan M, Hassan S, Ishtiaq A, Riaz P, Ali A, Amin F, Imran M, Kausar R, Ahmed M, Bashir W, Adnan M, Siddique A, Farooq M, Ahmad S. Effects of Se nanoparticles supplementation on growth performance, hematological parameters and nutrient digestibility of Labeo rohita fingerling fed sunflower meal based diet. BRAZ J BIOL 2022; 84:e253555. [PMID: 35019098 DOI: 10.1590/1519-6984.253555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study is to assess the effects of selenium nanoparticles on the growth, hematology and nutrients digestibility of Labeorohita fingerlings. Fingerlings were fed with seven isocaloric sunflower meal-based diet supplemented with different concentrations of nanoparticles naming T1 to T7 (0, 0.5, 1, 1.5, 2, 2.5, and 3 mg/kg), with 5% wet body weight while chromic oxide was used as an indigestible marker. After experimentation for 90 days T3 treated group (1mg/kg -1Se-nano level) showed the best result in hematological parameters (WBC's 7.97 ×103mm-3, RBC's 2.98 ×106 mm-3 and Platelet count 67), nutrient digestibility (crude protein: 74%, ether extract: 76%, gross energy: 70%) and growth performance (weight gain 13.24 g, weight gain% 198, feed conversion ratio 1.5, survival rate 100%) as compared to the other treatment groups. Specific growth rates were found significantly higher in T5 than in other groups. The present study indicated positive effect of 1 mg/kg Se-nanoparticles on growth advancement, hematological parameters, and nutrients digestibility of L. rohita fingerlings.
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Affiliation(s)
- N Ahmad
- University of Jhang, Department of Zoology, Punjab, Pakistan
| | - S M Hussain
- Government College University, Department of Zoology, Fish Nutrition Lab, Faisalabad, Pakistan
| | - S M Azam
- University of Education Lahore, Division of Science and Technology, Department of Zoology, Punjab, Pakistan
| | - M M Shahzad
- University of Education Lahore, Division of Science and Technology, Department of Zoology, Punjab, Pakistan
| | - A Noureen
- The University of Lahore, Institute of Molecular Biology & Biotechnology - IMBB, Department of Zoology, Lahore,Pakistan
| | - R Yaqoob
- University of Education Lahore, Division of Science and Technology, Department of Zoology, Punjab, Pakistan
| | - M Lateef
- University of Education Lahore, Division of Science and Technology, Department of Zoology, Punjab, Pakistan
| | - A Yawer
- Racetox, Masaryk University, Faculty of Science, Kamenice, Brno Czech Republic
| | - D Riaz
- University of Education Lahore, Division of Science and Technology, Department of Zoology, Punjab, Pakistan
| | - A Usman
- Government College University, Department of Chemistry, Faisalabad, Pakistan Lahore, Punjab, Pakistan
| | - M Faizan
- University of Agriculture, Department of Zoology, Faisalabad, Punjab, Pakistan
| | - S Hassan
- Institute of Pure & Applied Biology Bahauddin Zakariya University, Multan, Pakistan
| | - A Ishtiaq
- Institute of Pure & Applied Biology Bahauddin Zakariya University, Multan, Pakistan
| | - P Riaz
- Institute of Pure & Applied Biology Bahauddin Zakariya University, Multan, Pakistan
| | - A Ali
- Institute of Pure & Applied Biology Bahauddin Zakariya University, Multan, Pakistan
| | - F Amin
- University of Veterinary & Animal Sciences Punjab, Department of Zoology, Lahore,Pakistan
| | - M Imran
- BahuddinZakariya University Multan, Department of Statistics, Punjab, Pakistan
| | - R Kausar
- University of Baluchistan, Department of Zoology, Quetta, Pakistan
| | - M Ahmed
- COMSATS University Islamabad, Department of Management Sciences, Vehari Campus, Vehari, Pakistan
| | - W Bashir
- Department of Zoology, Government College University, Faisalabad, Pakistan
| | - M Adnan
- Department of Zoology, Government Graduate Taleem-ul-Islam College Chenab Nagar, Chiniot, Pakistan
| | - A Siddique
- Department of Chemistry, Lahore College for Women University Lahore, Pakistan
| | - M Farooq
- Department of Zoology, Ghazi University Dera Ghazi Khan, Pakistan
| | - S Ahmad
- Institute of Pure & Applied Biology Bahauddin Zakariya University, Multan, Pakistan
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Elsayed SA, Hassan S, Hakam M, Mekhemer S, Mobarak F. Effect of two fascial incision options for access to the temporomandibular joint on facial nerve function: objective investigation. Int J Oral Maxillofac Surg 2021; 51:933-941. [PMID: 34972618 DOI: 10.1016/j.ijom.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
This study was performed to compare the effects on facial nerve (FN) function of the deep supra-temporalis muscle subfascial approach (DSFA) and traditional fascial approach (TFA) for access to the temporomandibular joint (TMJ), via qualitative and quantitative evaluations. Thirty patients requiring open TMJ surgery were randomly allocated to one of two groups: group A patients underwent the DSFA approach, while group B patients underwent the TFA approach. The TMJ was accessed via modified endaural incision with temporal extension. Clinical examinations, FN conduction tests, and electromyography (EMG) of the frontalis and orbicularis oculi muscles were used to assess FN function. A FN function deficit was noted in 50% of the whole sample population immediately after surgery, with no statistically significant difference between the groups (P = 0.082). Overall, 37.5% of the total study population experienced temporary loss of frontalis muscle activity, while zygomatic nerve injury was seen only in 25% of group A. Within 2-6 months, normal function returned in both groups. Nerve conduction studies showed no statistically significant difference between the groups in terms of nerve amplitude or latency after surgery. However, EMG of orbicularis oculi activity showed a significant difference between the groups after 6 months (P = 0.010). The results suggest that the traditional dissection approach is more protective of the FN, especially the zygomatic branch, than the deeper dissection technique.
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Affiliation(s)
- S A Elsayed
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University for Girls, Cairo, Egypt; Department of Oral and Maxillofacial Surgery, Taibah University Dental College and Hospital, Almadinah Almunawwarah, Saudi Arabia.
| | - S Hassan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | - M Hakam
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S Mekhemer
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - F Mobarak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
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22
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Heidari-Bateni G, Durand JB, Iliescu C, Gladish G, Deswal A, Patel AR, Kim P, Song J, Hassan S, Palaskas N, Baldassarre LA, Bucciarelli-Ducci C, Lopez-Mattei J. Clinical Impact of Cardiovascular Magnetic Resonance in Cancer Patients With Suspected Cardiomyopathy. Front Cardiovasc Med 2021; 8:734820. [PMID: 34765654 PMCID: PMC8576269 DOI: 10.3389/fcvm.2021.734820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives: To assess the clinical impact of Cardiovascular Magnetic Resonance (CMR) in clinical decision making of cancer patients with a suspected cardiomyopathy in a tertiary cancer center. Background: Cardiomyopathies of diverse etiologies are frequently encountered in a Cardio-Oncology practice. The clinical impact of CMR after a presumptive diagnosis of cardiomyopathy has not been studied in cancer patients. Methods: We reviewed data on cancer patients with presumptive diagnosis of cardiomyopathy who underwent CMR in a tertiary cancer center. The clinical impact of CMR was defined as either change in clinical diagnosis or management post CMR results. Univariate and multivariate logistic regression models were used to assess whether any of the baseline characteristics were predictive of the clinical impact of CMR. Results: A total of 110 consecutive patients were identified. Clinical impact of CMR was seen in 68 (62%) patients. Change in the clinical diagnosis and management was seen in 56 (51%) and 41 (37%) of patients, respectively. The most common change was prevention of endomyocardial biopsy in 26 patients (24%). Overall, patients with higher left ventricular ejection fraction (LVEF) by echocardiography (echo), clinical impact was influenced more by CMR (LVEF of 37.2 ± 12.3% vs. 51.5 ± 11.6%, p < 0.001). Cancer diagnosis of multiple myeloma was associated with change in the management post CMR (adjusted OR of 25.6, 95% CI 4.0–162.4, p = 0.001). Suspicion of infiltrative cardiomyopathy was associated with a higher likelihood of change in diagnosis. Having an LVEF≥40 by echo was associated with change in diagnosis and management by CMR. Conclusions: Utilization of CMR has a significant clinical impact in cancer patients with suspected cardiomyopathy. Patients with cancer diagnosis of multiple myeloma, suspicion of infiltrative cardiomyopathy and those with higher LVEF by echo seem to benefit more from CMR.
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Affiliation(s)
- Giv Heidari-Bateni
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Jean-Bernard Durand
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Greg Gladish
- Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, United States
| | - Anita Deswal
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Amit R Patel
- Cardiology Division, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Peter Kim
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | | | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
| | - Juan Lopez-Mattei
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States.,Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, United States
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23
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Paletta A, Hassan S, Nicali A. Rimozione di un calcolo del dotto di Wharton con sialodocoplastica. Dental Cadmos 2021. [DOI: 10.19256/d.cadmos.2021.36] [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: 11/20/2022]
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24
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Javaid A, Monlezun D, Iliescu G, Palaskas N, Kim P, Hassan S, Lopez-Mattei J, Cilingiroglu M, Marmagiolis K, Iliescu C. Trends in hospitalized patients with cancer and stress cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2875] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Although cardiovascular disease (CVD) and cancer remain the top two causes of death worldwide, novel therapeutics have resulted in a decreased mortality rate in both groups. Accordingly, there has been a heightened awareness of patients with cancer experiencing stress cardiomyopathy (SC). In patients with cancer, the emotional stress of the diagnosis of cancer is compounded by the physical stress of treatments such as surgery, chemotherapy, immunotherapy, and radiotherapy. Previous studies have shown that SC in patients with cancer is associated with higher odds of in-hospital mortality when compared to patients with SC alone. No studies have examined the differences between patients with active cancer and SC compared to patients with active cancer without SC.
Purpose
To explore the unique impact that a diagnosis of SC has on patients with specific types of cancer, so that clinicians may recognize these phenomena and reduce morbidity associated with this disease.
Methods
We queried the 2016 United States National Inpatient Sample, which is the largest publicly available all-payer inpatient healthcare database, to identify demographic characteristics and outcomes in patients with active cancer and SC.
Results
Of 30,195,722 adult hospitalized patients, 4,719,591 (15.63%) had active cancer of whom 568,239 (12.04%) had SC. Among patients with active cancer, patients with SC versus those without SC were significantly more likely to have the following characteristics: female sex, white race, commercial insurance, hypertension, anemia, thrombocytopenia, and coagulation disorder (p<0.003 for all variables). The five most common primary malignancies in patients with SC were breast (13.4%), lung (10.2%), skin (9.5%), colon (8.1%), and leukemia (4.8%) (Figure 1).
In machine learning-augmented propensity score-adjusted multivariable regression fully adjusting for age, race, income, and presence of metastases, the only primary malignancies that significantly increased the likelihood of SC were lung cancer (OR 1.25; p=0.003) and breast cancer (OR 1.81; p<0.001) (Table 1). In separate regression, neither SC alone nor having both SC and cancer was significantly associated with mortality. The presence of concomitant SC and breast cancer was significantly associated with reduced mortality (OR 0.48; p=0.032).
Conclusion
In patients with active cancer, SC was not associated with in-hospital mortality. In addition, patients with both SC and breast cancer had significantly reduced mortality when compared to all patients with cancer. Further investigation will be necessary to confirm these findings and determine the possible protective factors in patients with SC and breast cancer. Furthermore, clinicians should be aware, early during hospitalization, of the increased likelihood of SC in patients with lung cancer and breast cancer, in order to reduce morbidity associated with these diagnoses.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Javaid
- University of Nevada, Las Vegas School of Medicine, Internal Medicine, Las Vegas, United States of America
| | - D Monlezun
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - G Iliescu
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - N Palaskas
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - P Kim
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - S Hassan
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - J Lopez-Mattei
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - M Cilingiroglu
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - K Marmagiolis
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - C Iliescu
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
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25
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Javaid AI, Monlezun DJ, Iliescu G, Tran P, Filipescu A, Palaskas N, Lopez-Mattei J, Hassan S, Kim P, Madjid M, Cilingiroglu M, Charitakis K, Marmagkiolis K, Iliescu C, Koutroumpakis E. Stress cardiomyopathy in hospitalized patients with cancer: machine learning analysis by primary malignancy type. ESC Heart Fail 2021; 8:4626-4634. [PMID: 34612022 PMCID: PMC8712856 DOI: 10.1002/ehf2.13647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/17/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022] Open
Abstract
Aims Previous studies have shown that patients with stress (Takotsubo) cardiomyopathy (SC) and cancer have higher in‐hospital mortality than patients with SC alone. No studies have examined outcomes in patients with active cancer and SC compared to patients with active cancer without SC. We aimed to assess the potential association between primary malignancy type and SC and their shared interaction with inpatient mortality. Methods and results We analysed SC by primary malignancy type with propensity score adjusted multivariable regression and machine learning analysis using the 2016 United States National Inpatient Sample. Of 30 195 722 adult hospitalized patients, 4 719 591 had active cancer, of whom 568 239 had SC. The mean age of patients with cancer and SC was 69.1, of which 74.7% were women. Among patients with cancer, those with SC were more likely to be female and have white race, Medicare insurance, hypertension, heart failure with reduced ejection fraction, obesity, cerebrovascular disease, anaemia, and chronic obstructive pulmonary disease (P < 0.003 for all). In machine learning‐augmented, propensity score multivariable regression adjusted for age, race, and income, only lung cancer [OR 1.25; 95% CI: 1.08–1.46; P = 0.003] and breast cancer [OR 1.81; 95% CI: 1.62–2.02; P < 0.001] were associated with a significantly increased likelihood of SC. Neither SC alone nor having both SC and cancer was significantly associated with in‐hospital mortality. The presence of concomitant SC and breast cancer was significantly associated with reduced mortality (OR 0.48; 95% CI: 0.25–0.94; P = 0.032). Conclusions This analysis demonstrates that primary malignancy type influences the likelihood of developing SC. Further studies will be necessary to delineate characteristics in patients with lung cancer and breast cancer which contribute to development of SC. Additional investigation should confirm lower mortality in patients with SC and breast cancer and determine possible explanations and protective factors.
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Affiliation(s)
- Awad I Javaid
- Division of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, 1701 W Charleston Blvd, Las Vegas, NV, USA
| | - Dominique J Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.,Center for Artificial Intelligence and Health Equities, Global System Analytics & Structures, New Orleans, LA, USA
| | - Gloria Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Phi Tran
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Alexandru Filipescu
- Department of Obstetrics and Gynecology, "Elias" Emergency University Hospital, Bucharest, Romania
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mohammad Madjid
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Konstantinos Charitakis
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Efstratios Koutroumpakis
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
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26
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Jacob R, Palaskas NL, Lopez-Mattei J, Hassan S, Kim P, Donisan T, Balanescu DV, Cilingiroglu M, Marmagkiolis K, Iliescu C. How to Perform Pericardiocentesis in Cancer Patients With Thrombocytopenia: A Single-Center Experience. JACC CardioOncol 2021; 3:452-456. [PMID: 34604808 PMCID: PMC8463729 DOI: 10.1016/j.jaccao.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/12/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- Robin Jacob
- Department of Cardiology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nicolas L. Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Address for correspondence: Dr Cezar Iliescu, Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, Texas 77030, USA. @onco_cardiology@cezar_iliescu
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27
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Hassan S, Stambulic T, King M, Norman P, Payne D, Derry K, El Diasty M. POST-OPERATIVE PAIN AND ANALGESIC USE FOR CARDIAC SURGERY WITH MEDIAN STERNOTOMY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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28
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Hassan S, Paleczny S, Redfearn D, Glover B, Enriquez A, Bisleri G. SIMULTANEOUS HYBRID ABLATION WITH EPI-ENDOCARDIAL MAPPING FOR THE TREATMENT OF LONG STANDING PERSISTENT ATRIAL FIBRILLATION. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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29
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Quintana RA, Bui LP, Moudgil R, Palaskas N, Hassan S, Abe JI, Mouhayar E, Yusuf SW, Hernandez A, Banchs J. Speckle-Tracking Echocardiography in Cardio-Oncology and Beyond. Tex Heart Inst J 2021; 47:96-107. [PMID: 32603473 DOI: 10.14503/thij-18-6736] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/13/2022]
Abstract
Speckle-tracking echocardiography has enabled clinicians to detect changes in myocardial function with more sensitivity than that afforded by traditional diastolic and systolic functional measurements, including left ventricular ejection fraction. Speckle-tracking echocardiography enables evaluation of myocardial strain in terms of strain (percent change in length of a myocardial segment relative to its length at baseline) and strain rate (strain per unit of time). Both measurements have potential for use in diagnosing and monitoring the cardiovascular side effects of cancer therapy. Regional and global strain measurements can independently predict outcomes not only in patients who experience cardiovascular complications of cancer and cancer therapy, but also in patients with a variety of other clinical conditions. This review and case series examine the clinical applications and overall usefulness of speckle-tracking echocardiography in cardio-oncology and, more broadly, in clinical cardiology.
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Affiliation(s)
- Raymundo A Quintana
- Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas 77030.,Dr. Quintana is now at Emory University School of Medicine, Atlanta, Georgia
| | - Linh P Bui
- Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas 77030
| | - Rohit Moudgil
- Division of Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Nicolas Palaskas
- Division of Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Saamir Hassan
- Division of Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Jun-Ichi Abe
- Division of Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Elie Mouhayar
- Division of Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Syed Wamique Yusuf
- Division of Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Antonieta Hernandez
- Division of Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Jose Banchs
- Division of Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
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30
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Grable C, Yusuf S, Song J, Viola GM, Ulhaq O, Banchs J, Jensen CT, Goel H, Hassan S. Characteristics of infective endocarditis in a cancer population. Open Heart 2021; 8:openhrt-2021-001664. [PMID: 34344722 PMCID: PMC8336187 DOI: 10.1136/openhrt-2021-001664] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background Infective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE. Objectives Limited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality. Methods A retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed. Results Following the findings of vegetations by echocardiography, the median survival time was 8.5 months. Staphylococcus aureus was the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients with S. aureus endocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis. Conclusions Overall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.
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Affiliation(s)
- Cullen Grable
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Syed Yusuf
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George M Viola
- Department of Infectious Diseases, Infection Control and Employee Health, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, Houston, Texas, USA
| | - Owais Ulhaq
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Banchs
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Corey T Jensen
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Harsh Goel
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Saamir Hassan
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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31
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Agha AM, Palaskas N, Patel AR, DeCara J, Parwani P, Iliescu C, Durand JB, Kim P, Hassan S, Gladish G, Lee HC, Kaufman GP, Lopez-Mattei JC. Cardiac Magnetic Resonance Predicting Outcomes Among Patients at Risk for Cardiac AL Amyloidosis. Front Cardiovasc Med 2021; 8:626414. [PMID: 34268341 PMCID: PMC8276072 DOI: 10.3389/fcvm.2021.626414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/29/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Patients with systemic AL amyloidosis (AL) should be evaluated for cardiac amyloidosis (CA), as prognosis is strongly related to cardiac involvement. We assessed the characteristics of patients referred to cardiac magnetic resonance (CMR) with suspected CA from a cancer center and determine predictors of mortality/heart failure hospitalizations (HFH). Methods: Forty-four consecutive patients referred for CMR with suspected CA were retrospectively included. Variables collected included cardiac biomarkers, in addition to echocardiographic and CMR variables. Survival analyses were performed to determine which variables were more predictive of mortality and HFH. Results: Of the 44 patients included, 55% were females. 73% of patients were diagnosed with CA by CMR; 56% of them had an established diagnosis of AL. Patients with CA by CMR had higher native T1, higher extracellular volume (ECV) fraction, higher T2, less negative GLS by Echo, and higher troponin I and B-type natriuretic peptide (BNP). Kaplan-Meier survival analysis revealed that the following were predictive of mortality: an ECV ≥ 0.50 (p = 0.0098), CMR LVEF < 50% (p = 0.0010), T2/ECV ≤ 100 (p = 0.0001), and troponin I > 0.03 (p = 0.0025). In a stepwise conditional Cox logistic regression model, the only variable predictive of a composite of mortality and HFH was ECV (HR: 1.17, 95% CI = 1.02–1.34 p = 0.030). Conclusion: ECV seems to be an important biomarker that could be a predictor of outcomes in cardiac AL amyloidosis. In combination, CMR and serum cardiac biomarkers might help to establish prognosis in patients with CA.
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Affiliation(s)
- Ali M Agha
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX, United States
| | - Nicolas Palaskas
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Amit R Patel
- Cardiology Section, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Jeanne DeCara
- Cardiology Section, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, United States
| | - Cezar Iliescu
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jean B Durand
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Kim
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gregory Gladish
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hans C Lee
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gregory P Kaufman
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan C Lopez-Mattei
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Division of Diagnostic Imaging, Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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32
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Abdul Razzack A, Abdul Razzack S, Shenasan P, Shenasan N, Mishra S, Zarrar R, Pablo Sosa J, Mercedes Ferreira Caceres M, Garimella R, Andrews K, Mukhtar S, Agolli A, Agolli O, Hassan S, Rocha Castellanos DM, Pothuru S, Theja Reddy K. POS0701 ANIFROLUMAB, AN ANTI-INTERFERON-Α RECEPTOR MONOCLONAL ANTIBODY IN SYSTEMIC LUPUS ERYTHEMATOSUS- A META ANALYSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Type I interferons such as Anifrolumab have been implicated in Systemic lupus erythematosus (SLE) pathogenesis on the basis of increased interferon-stimulated gene expression and genetic susceptibility. Little is known regarding its efficacy and safety profile.Objectives:To assess the efficacy and safety of Anifrolumab in patients with SLE.Methods:Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception until December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p<0.05. The primary outcome of interest was British Isles Lupus Assessment Group (BILAG)-based Composite Lupus Assessment (BICLA). Secondary outcomes included the proportion of patients who achieved an SLE responder index of 4 (SRI-4) reduction of 50% or more in the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), reductions in the glucocorticoid dose and adverse effects.Results:A total of three studies1,2,3 with 839 participants (Anifrolumab=372, Placebo=467) were included in our analysis. Follow-up duration was at week 52. A statistically significant different was observed in the Anifrolumab arm in terms of BICLA response (OR 0.44 95%CI 0.34-0.59;p < 0.00001, I2=4), ≥50% reduction in CLASI activity score (OR 0.36 95%CI 0.21-0.60;p=0.0001, I2=0), glucocorticoid reduction (OR 0.41 95%CI 0.28-0.59;p<0.00001; I2=0) and SRI-4 response (OR 0.52 95% CI 0.30-0.90; p=0.02, I2=75). However, Adverse events were less likely in the placebo arm as compared to Anifrolumab (OR 1.54 95%CI 1.05-2.25; p=0.03; I2=0).Conclusion:Anifrolumab was found to be more effective than placebo for the management of SLE, but may also cause more severe adverse effects.References:[1]Morand EF, Furie R, Tanaka Y, Bruce IN, Askanase AD, Richez C, Bae SC, Brohawn PZ, Pineda L, Berglind A, Tummala R; TULIP-2 Trial Investigators. Trial of Anifrolumab in Active Systemic Lupus Erythematosus. N Engl J Med. 2020 Jan 16;382(3):211-221. doi: 10.1056/NEJMoa1912196. Epub 2019 Dec 18. PMID: 31851795.[2]Furie R, Khamashta M, Merrill JT, Werth VP, Kalunian K, Brohawn P, Illei GG, Drappa J, Wang L, Yoo S; CD1013 Study Investigators. Anifrolumab, an Anti-Interferon-α Receptor Monoclonal Antibody, in Moderate-to-Severe Systemic Lupus Erythematosus. Arthritis Rheumatol. 2017 Feb;69(2):376-386. doi: 10.1002/art.39962. PMID: 28130918; PMCID: PMC5299497.[3]Furie RA, Morand EF, Bruce IN, et al. Type I interferon inhibitor anifrolumab in active systemic lupus erythematosus (TULIP-1): a randomised, controlled, phase 3 trial. Lancet Rheumatol 2019; 1(4):e208-e219.Disclosure of Interests:None declared
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Hassan F, Arshad MA, Hassan S, Bilal RM, Saeed M, Rehman MS. Physiological role of Arginine in growth performance, gut health and immune response in broilers: a review. WORLD POULTRY SCI J 2021. [DOI: 10.1080/00439339.2021.1925198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- F. Hassan
- Institute of Animal and Dairy Sciences, Faculty of Animal Husbandry, University of Agriculture, Faisalabad, Pakistan
| | - M. A. Arshad
- Institute of Animal and Dairy Sciences, Faculty of Animal Husbandry, University of Agriculture, Faisalabad, Pakistan
| | - S. Hassan
- Institute of Animal and Dairy Sciences, Faculty of Animal Husbandry, University of Agriculture, Faisalabad, Pakistan
| | - R. M. Bilal
- College of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - M. Saeed
- Faculty of Animal Production and Technology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - M. S. Rehman
- Institute of Animal and Dairy Sciences, Faculty of Animal Husbandry, University of Agriculture, Faisalabad, Pakistan
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Addoumieh A, Balanescu D, Donisan T, Lopez-Mattei J, Kim P, Hassan S, Palaskas N, Marmagkiolis K, Yang EH, Iliescu C. TRIGGERS AND OUTCOMES OF TAKOTSUBO CARDIOMYOPATHY IN CANCER PATIENTS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04665-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lacey L, Henderson I, Hassan S, Hunter H, Sajjad Y, Akhtar MA. Can preoperative parameters predict successful sperm retrieval and live birth in couples undergoing testicular sperm extraction and intracytoplasmic sperm injection for azoospermia? Middle East Fertil Soc J 2021. [DOI: 10.1186/s43043-021-00052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aimed to determine if the success of TESE and live-birth following TESE-ICSI can be predicted from readily available preoperative parameters for couples with azoospermia. Our methodology was as follows, this was a cohort study of couples who attended the fertility service (from 2009-2019) at an NHS hospital in whom the male partner was diagnosed with azoospermia and required conventional TESE with multiple biopsies to obtain sperm. Of 414 men included, 223 had successful TESE and of those 178 have used sperm in ICSI cycle(s). Predictive models were developed using logistic regression. We assessed model performance by internally validated concordance statistics and calibration plots. Successful sperm retrieval was defined as the presence of motile sperm which survived the freeze-thaw process and live-birth defined as delivery after 34 weeks of gestation.
Results
Successful TESE was associated with higher male age and lower FSH. The TESE model discriminated well with a c statistic of 0.81 (0.77-0.85). Live-birth was associated with lower maternal age, earlier ICSI cycle, and lower testicular volume. The live-birth model also discriminated well with a c statistic of 0.70 (0.64-0.76).
Conclusions
These results support the pragmatic counselling of couples diagnosed with azoospermia about the chances of success of the TESE procedure and of biological parenthood prior to surgical intervention. The models help to discriminate between men who have a high or low chance of successful TESE and couples who have a higher chance of achieving a live-birth after successful TESE. This will allow couples to make a better assessment of the balance of risk versus benefit prior to commitment to surgical interventions.
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Kim P, Masha L, Olson A, Iliescu C, Karimzad K, Hassan S, Palaskas N, Durand JB, Leung CH, Lopez-Mattei J. QT Prolongation in Cancer Patients. Front Cardiovasc Med 2021; 8:613625. [PMID: 33718445 PMCID: PMC7946823 DOI: 10.3389/fcvm.2021.613625] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/02/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: QT prolongation and torsades de pointes pose a major concern for cardiologists and oncologists. Although cancer patients are suspected to have prolonged QT intervals, this has not been investigated in a large population. The purpose of this study was to analyze the QT interval distribution in a cancer population and compare it to a non-cancer population in the same institution. Methods: The study was a retrospective review of 82,410 ECGs performed in cancer patients (51.8% women and 48.2% men) and 775 ECGs performed in normal stem cell donors (47.9% women and 52.1% men) from January 2009 to December 2013 at the University of Texas MD Anderson Cancer Center. Pharmacy prescription data was also collected and analyzed during the same time period. Correction of the QT interval for the heart rate was performed using the Bazett and Fridericia formulas. Results: After QT correction for heart rate by the Fridericia formula (QTcF), the mean and 99% percentile QTc for cancer patients were 414 and 473 ms, respectively. These were significantly longer than the normal stem cell donors, 407 and 458 ms, p < 0.001, respectively. Among the cancer patients, the QTc was longer in the inpatient setting when compared to both outpatient and emergency center areas. The most commonly prescribed QT prolonging medications identified were ondansetron and methadone. Conclusion: Our study demonstrates significantly longer QTc intervals in cancer patients, especially in the inpatient setting. Frequently prescribed QT prolonging medications such as antiemetics and analgesics may have a causative role in QT prolongation seen in our cancer hospital.
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Affiliation(s)
- Peter Kim
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Luke Masha
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Cardiology, Oregon Health and Science University, Portland, OR, United States
| | - Amanda Olson
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kaveh Karimzad
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas Palaskas
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jean-Bernard Durand
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cheuk Hong Leung
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Idress H, Zaidi SZJ, Sabir A, Shafiq M, Khan RU, Harito C, Hassan S, Walsh FC. Cellulose acetate based Complexation-NF membranes for the removal of Pb(II) from waste water. Sci Rep 2021; 11:1806. [PMID: 33469047 PMCID: PMC7815919 DOI: 10.1038/s41598-020-80384-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/02/2020] [Indexed: 01/21/2023] Open
Abstract
This study investigates the removal of Pb(II) using polymer matrix membranes, cellulose acetate/vinyl triethoxysilane modified graphene oxide and gum Arabic (GuA) membranes. These complexation-NF membranes were successfully synthesized via dissolution casting method for better transport phenomenon. The varied concentrations of GuA were induced in the polymer matrix membrane. The prepared membranes M-GuA2–M-GuA10 were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, transmission electron microscopy, atomic force microscope and bio-fouling studies. Thermal stability of the membranes was determined by thermogravimetric analysis under nitrogen atmosphere. Dead end nanofiltration was carried out to study the perm- selectivity of all the membranes under varied pressure and concentration of Pb(NO3)2. The complexation-NF membrane performances were significantly improved after the addition of GuA in the polymer matrix membrane system. M-GuA8 membrane showed optimum result of permeation flux 8.6 l m−2 h−1. Rejection of Pb(II) ions was observed to be around 97.6% at pH 9 for all the membranes due to electrostatic interaction between CA and Gum Arabic. Moreover, with the passage of time, the rate of adsorption was also increased up to 15.7 mg g−1 until steady state was attained. Gum Arabic modified CA membranes can open up new possibilities in enhancing the permeability, hydrophilicity and anti-fouling properties.
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Affiliation(s)
- H Idress
- Department of Polymer Engineering and Technology, University of the Punjab, Lahore, 54590, Pakistan.
| | - S Z J Zaidi
- Institute of Chemical Engineering and Technology, University of the Punjab, Lahore, Pakistan.
| | - A Sabir
- Department of Polymer Engineering and Technology, University of the Punjab, Lahore, 54590, Pakistan
| | - M Shafiq
- Department of Polymer Engineering and Technology, University of the Punjab, Lahore, 54590, Pakistan
| | - R U Khan
- Department of Polymer Engineering and Technology, University of the Punjab, Lahore, 54590, Pakistan
| | - C Harito
- Industrial Engineering Department, Faculty of Engineering, Bina Nusantara University, Jakarta, 11480, Indonesia
| | - S Hassan
- Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - F C Walsh
- Electrochemical Engineering Laboratory, Faculty of Engineering and Environment, Engineering Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
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Asif E, Yakoob J, Hassan S, Khan U, Saifullah S, Ali N. The signal peptide region of vacuolating cytotoxin-A gene of Helicobacter pylori in patients with gastrointestinal disorders. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.490] [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: 11/26/2022] Open
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Von Renteln F, Hassan S, Szummer K, Edfors R, Venetsanos D, Kober L, Braunschweig F, Lewinter C. Immediate versus staged revascularisation in multivessel coronary disease: an updated meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1487] [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
Background
Percutaneous coronary interventions (PCIs) are often aimed at the culprit vessel in acute coronary syndromes (ACSs) followed by revascularisation of other stenoses later in the index hospitalisation or shortly after discharge. PCI delay of non-culprit coronary vessels stenoses is supported by lower contrast fluid use and thrombocyte aggregation. Distinct coronary interventions increase the risk of both non- and coronary artery complications, e.g. acute abdominal and periphery artery bleeding, suggesting undertaking all PCIs at the same time.
Purpose
To assess the effect on mortality and re-myocardial infarction (MI) of immediate versus staged revascularisation in multivessel coronary disease, with the latter constrained to initial PCI of the culprit coronary vessel.
Methods
The syntax of “randomised controlled trial (RCT) & acute coronary syndrome & complete revascularisation” was undertaken in PubMed.
Clinical characteristics were gathered at the index hospitalisation. The intervention scenario was acute coronary syndrome or not.
Meta-analyses calculated relative risk (RR) reductions on outcomes of 1) mortality and 2) re-MI. Meta-regression assessed linear difference between interventional treatment benefits and baseline characteristics.
Results
A total of 148 studies was found. Of those, 8 was found eligible for further analyses and their baseline characteristics are shown in Table 1.
Comparison of immediate versus staged revascularisation on mortality was nonsignificant (RR, 1.19; 95% CI: 0.78–1.81, p=0.43) (Figure 1). The impact of Immediate vs staged revascularisation on re-MI was also nonsignificant (RR, 0.83; 95% CI: 0.44–1.55, p=0.56). Meta-regression found no associations between the outcomes and study characteristics (not shown).
Conclusion
The intervention of immediate compared to staged revascularisation assessed on outcomes of all-cause mortality and re-MI were nonsignificant.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - S Hassan
- Karolinska University Hospital, Stockholm, Sweden
| | - K Szummer
- Karolinska University Hospital, Stockholm, Sweden
| | - R Edfors
- Karolinska University Hospital, Stockholm, Sweden
| | - D Venetsanos
- Karolinska University Hospital, Stockholm, Sweden
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Copenhagen, Denmark
| | | | - C Lewinter
- Karolinska University Hospital, Stockholm, Sweden
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Hughes BA, Hassan S, Stallard J, Louette S, Smith J, Knight SL, Fenn C, Peach H, Thornton DJ, Hernon C, Goodenough J, Bhat W, West CC, Bains RD, Bourke G, Smith IM, Liddington MI. Plastic physicians: The surgical salamanders of the COVID-19 pandemic. J Plast Reconstr Aesthet Surg 2020; 74:401-406. [PMID: 33097434 PMCID: PMC7502252 DOI: 10.1016/j.bjps.2020.08.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
At the time of writing, coronavirus disease-2019 (COVID-19) has affected 6.42 million people globally and over 380,000 deaths, with the United Kingdom now having the highest death rate in Europe. The plastic surgery department at Leeds Teaching Hospitals put necessary steps in place to maintain an excellent urgent elective and acute service whilst also managing COVID-positive medical patients in the ward. We describe the structures and pathways implemented together with complex decision-making, which has allowed us to respond early and effectively. We hope these lessons will prove a useful tool as we look to open conversations around the recovery of normal activity.
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Affiliation(s)
- B A Hughes
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK.
| | - S Hassan
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - J Stallard
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - S Louette
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - J Smith
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - S L Knight
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - C Fenn
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - H Peach
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - D J Thornton
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - C Hernon
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - J Goodenough
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - W Bhat
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - C C West
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - R D Bains
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - G Bourke
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - I M Smith
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - M I Liddington
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
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Hassan S, D L, Jacob L, Babu S, Kn L, Ah R, Lk R, Saldanha S, Thottian A. Corrigendum to ‘Socioeconomic and Administrative Factors Associated with Healthcare Delay and Treatment of Esophageal and Gastric Carcinoma: Experience at a Tertiary Care Centre in a Developing Country’. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bawadi H, Hassan S, Shanbeh Zadeh A, Sarv H, Kerkadi A, Tur JA, Shi Z. Age and gender specific cut-off points for body fat parameters among adults in Qatar. Nutr J 2020; 19:75. [PMID: 32711520 PMCID: PMC7382859 DOI: 10.1186/s12937-020-00569-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Excessive body fat is the leading cause of many metabolic disorders. Therefore, assessing levels of body fat associated with risk of disease in specific populations is crucial. The present study aimed to identify optimal cut-off values of body fat composition including total body fat, body fat percentage, visceral fat, and trunk fat, in order to predict metabolic risk in the Qatari population. Methods This cross-sectional study was based on Qatar Biobank data of 2407 Qatari adults (1269 male and 1138 female) aged 21–70 years old. Individuals’ height, weight and body fat percentage were obtained. Blood test data including lipid profile, blood glucose and HbA1c data were also obtained. The area under the curve was calculated using ROC analysis to obtain the body fat percentage associated with risk of disease. Results The cut-off points for total fat for those aged < 40 were 34.0 kg, and for those aged ≥40 were 30.7 kg and 35.6 kg in men and women, respectively. The cut-off for body fat percent for those aged < 40 were 35.1 and 45.1%, and for those aged ≥40 were 34.8 and 46.3% in men and women, respectively. The cut-off points for trunk fat percent for those aged < 40 were 19.5 and 22.4%, and for those aged ≥40 were 21.6 and 23.4% in men and women, respectively. The cut-off points for visceral fat percent for those aged < 40 were 1.4 and 1.0%, and for those aged ≥40 were 1.9 and 1.4% in men and women, respectively. Conclusion This study established Qatari adult-specific cut-off values of body fat for different age and gender groups.
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Affiliation(s)
- H Bawadi
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, 2713, Qatar.
| | - S Hassan
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, 2713, Qatar
| | - A Shanbeh Zadeh
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, 2713, Qatar
| | - H Sarv
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, 2713, Qatar
| | - A Kerkadi
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, 2713, Qatar
| | - Josep A Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands & CIBEROBN, 07122, Palma de Mallorca, Spain
| | - Z Shi
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, 2713, Qatar
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Hassan S, Seung SJ, Clark RE, Gibbs JC, McArthur C, Mittmann N, Thabane L, Kendler D, Papaioannou A, Wark JD, Ashe MC, Adachi JD, Templeton JA, Giangregorio LM. Describing the resource utilisation and costs associated withvertebral fractures: the Build Better Bones with Exercise (B3E) Pilot Trial. Osteoporos Int 2020; 31:1115-1123. [PMID: 32219499 DOI: 10.1007/s00198-020-05387-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/10/2020] [Indexed: 11/26/2022]
Abstract
UNLABELLED This analysis examined costs/resources of 141 women with vertebral fractures, randomised to a home exercise programme or control group. Total, mean costs and the incremental cost-effectiveness ratio (ICER) were calculated. Quality of life was collected. Cost drivers were caregiver time, medications and adverse events (AEs). Results show adding an exercise programme may reduce the risk of AEs. INTRODUCTION This exploratory economic analysis examined the health resource utilisation and costs experienced by women with vertebral fractures, and explored the effects of home exercise on those costs. METHODS Women ≥ 65 years with one or more X-ray-confirmed vertebral fractures were randomised 1:1 to a 12-month home exercise programme or equal attention control group. Clinical and health system resources were collected during monthly phone calls and daily diaries completed by participants. Intervention costs were included. Unit costs were applied to health system resources. Quality of life (QoL) information was collected via EQ-5D-5L at baseline, 6 and 12 months. RESULTS One hundred and forty-one women were randomised. Overall total costs (CAD 2018) were $664,923 (intervention) and $614,033 (control), respectively. The top three cost drivers were caregiver time ($250,269 and $240,811), medications ($151,000 and $122,145) and AEs ($58,807 and $71,981). The mean cost per intervention participant of $9365 ± $9988 was higher compared with the mean cost per control participant of $8772 ± $9718. The mean EQ-5D index score was higher for the intervention participants (0.81 ± 0.11) compared with that of controls (0.79 ± 0.13). The differences in quality-adjusted life year (QALY) (0.02) and mean cost ($593) were used to calculate the ICER of $29,650. CONCLUSIONS Women with osteoporosis with a previous fracture experience a number of resources and associated costs that impact their care and quality of life. Caregiver time, medications and AEs are the biggest cost drivers for this population. The next steps would be to expand this feasibility study with more participants, longer-term follow-up and more regional variability.
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Affiliation(s)
- S Hassan
- HOPE Research Centre, Sunnybrook Research Institute, Toronto, Ontario, M4N 3M5, Canada.
| | - S J Seung
- HOPE Research Centre, Sunnybrook Research Institute, Toronto, Ontario, M4N 3M5, Canada
| | - R E Clark
- University of Waterloo, Waterloo, Canada
| | - J C Gibbs
- McGill University, Montreal, Quebec, Canada
| | | | | | - L Thabane
- McMaster University, Hamilton, Canada
| | - D Kendler
- University of British Columbia, Vancouver, Canada
| | | | - J D Wark
- University of Melbourne, Melbourne, Australia
| | - M C Ashe
- University of British Columbia, Vancouver, Canada
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Abdi A, Bordbar MR, Hassan S, Rosendaal FR, van der Bom JG, Voorberg J, Fijnvandraat K, Gouw SC. Prevalence and Incidence of Non-neutralizing Antibodies in Congenital Hemophilia A- A Systematic Review and Meta-Analysis. Front Immunol 2020; 11:563. [PMID: 32457734 PMCID: PMC7221178 DOI: 10.3389/fimmu.2020.00563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/17/2019] [Accepted: 03/12/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives: In hemophilia A the presence of non-neutralizing antibodies (NNAs) against Factor VIII (FVIII) may predict the development of neutralizing antibodies (inhibitors) and accelerate the clearance of administrated FVIII concentrates. This systematic review aimed to assess: (1) the prevalence and incidence of NNAs in patients with congenital hemophilia without inhibitors and (2) the association between NNAs and patient and treatment characteristics. Methods: We conducted a search in MEDLINE, Embase, Web of Science and the Cochrane database. We included cross-sectional and longitudinal studies reporting on NNAs in patients with hemophilia A and B, who were inhibitor-negative at the start of the observation period. Data were extracted on: hemophilia type and severity, patient and treatment characteristics, NNA prevalence and incidence, NNA assays and inhibitor development. Two independent reviewers performed study selection, data extraction and risk of bias assessment, using adapted criteria of the Joanna Briggs Institute. Studies were classified as high-quality when ≥5/9 criteria were met. NNA assays were classified as high-quality when both quality criteria were met: (1) use of positive controls and (2) competition with FVIII to establish FVIII-specificity. We reported NNA prevalence and incidence for each study. The pooled NNA prevalence was assessed for well-designed studies in previously treated patients, employing high-quality NNA assays. Results: We included data from 2,723 inhibitor-negative patients with hemophilia A, derived from 28 studies. Most studies were cross-sectional (19/28) and none reported on NNAs in hemophilia B. Study design was of high quality in 16/28 studies and the NNA assay quality was high in 9/28 studies. Various NNA assays were used, predominantly ELISA (18/28) with different cut-off values. We found a large variety in NNA prevalence (Range, 0–100%). The pooled NNA prevalence in high-quality studies was 25% (95% CI, 16–38%). The incidence of new NNA development was reported in one study (0.01 NNA per person-exposure day). Conclusion: This systematic review identified studies that were heterogeneous in study design, patient population and NNA assay type, with NNA prevalence ranging from 0 to 100% in inhibitor-negative patients with hemophilia A. The pooled NNA prevalence was 25% in high-quality studies including only previously treated patients and performing high-quality NNA assays.
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Affiliation(s)
- A Abdi
- Department of Pediatric Hematology, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - M R Bordbar
- Hematology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Hassan
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - J G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands
| | - J Voorberg
- Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands.,Department of Experimental Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - K Fijnvandraat
- Department of Pediatric Hematology, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands.,Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - S C Gouw
- Department of Pediatric Hematology, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
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Sudasena D, Balanescu DV, Donisan T, Hassan S, Palaskas N, Kim P, Karimzad K, Lopez-Mattei J, Arain S, Gould KL, Iliescu C. Fulminant Vascular and Cardiac Toxicity Associated with Tyrosine Kinase Inhibitor Sorafenib. Cardiovasc Toxicol 2020; 19:382-387. [PMID: 30543051 DOI: 10.1007/s12012-018-9499-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The use of vascular endothelial growth factor inhibitors such as sorafenib is limited by a risk of severe cardiovascular toxicity. A 28-year-old man with acute myeloid leukemia treated with prednisone, tacrolimus, and sorafenib following stem cell transplantation presented with severe bilateral lower extremity claudication. The patient was discharged against medical advice prior to finalizing a cardiovascular evaluation, but returned 1 week later with signs suggestive of septic shock. Laboratory tests revealed troponin I of 12.63 ng/mL, BNP of 1690 pg/mL, and negative infectious workup. Electrocardiogram showed sinus tachycardia and new pathologic Q waves in the anterior leads. Coronary angiography revealed severe multivessel coronary artery disease. Peripheral angiography revealed severely diseased left anterior and posterior tibial arteries, tibioperoneal trunk, and peroneal artery, and subtotal occlusion of the right posterior tibial artery. Multiple coronary and peripheral drug-eluting stents were implanted. An intra-aortic balloon pump was placed. Cardiac magnetic resonance imaging revealed chronic left ventricular infarction with some viability, 17% ejection fraction, and left ventricular mural thrombi. The patient opted for medical management. Persistent symptoms 9 months later led to repeat angiography, showing total occlusion of the second obtuse marginal artery due to in-stent restenosis with proximal stent fracture, and chronic total occlusion of the right internal iliac artery extending to the pudendal branch. Cardiac positron emission tomography/computed tomography viability study demonstrated viable myocardium, deeming revascularization appropriate. Symptom resolution was obtained with no recurrences. Sorafenib-associated vasculopathy may follow a fulminant course. Multimodality cardiovascular imaging is essential for optimal management.
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Affiliation(s)
- Daryl Sudasena
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Salman Arain
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Lance Gould
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA.
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46
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Zarifa A, Salih M, Lopez-Mattei J, Lee HJ, Iliescu C, Hassan S, Palaskas N, Durand JB, Mouhayar E, Kim J, Kim P. Cardiotoxicity of FDA-approved immune checkpoint inhibitors: A rare but serious adverse event. ACTA ACUST UNITED AC 2020. [DOI: 10.4103/jipo.jipo_15_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
Refractory cancer represents a challenge for oncologists in providing treatment options without excessive toxicity and has led to the investigation of immune mechanisms. Immune checkpoint inhibitors (ICIs) directly interfere with the tumor cells' ability to evade the innate and adaptive immune system by targeting specific proteins such as cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), programmed cell death protein-1 (PD-1), and programmed cell death protein-ligand 1 (PD-L1), which are involved as negative regulators of T-cell function. Their growing success has led to the investigation for frontline treatment in several types of cancers. Even though these ICIs have demonstrated efficacy in the treatment of a variety of cancers, their use has been associated with the development of rare but severe adverse events. These events are the result of targeting specific checkpoint proteins on normal cells of the body as well as secondary downstream off-target effects on normal tissue. Similar to combined conventional cancer treatment, treating with combined ICIs are also associated with a higher risk of adverse events. Although cardiotoxicities related to immunotherapy are reportedly rare, they can be severe and associated with life-threatening conditions such as fulminant heart failure, hemodynamic instability, and cardiac arrest. Oncologists must carefully weigh the risk versus the therapeutic benefit of these agents in determining the best option for improving overall survival and minimizing morbidity and mortality of their patients. Our review focuses on the approved ICIs, their mechanism of action, their oncologic efficacy, and the associated potential for cardiovascular toxicity.
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Affiliation(s)
- Abdulrazzak Zarifa
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Mohammed Salih
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Juan Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Hun Ju Lee
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Cezar Iliescu
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Saamir Hassan
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Nicolas Palaskas
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Jean-Bernard Durand
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Elie Mouhayar
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Joseph Kim
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
- Department of Biology, The University of Texas at Austin, Austin, Texas, USA
| | - Peter Kim
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
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Hassan S, Trenado C, Rageh T, Schnitzler A, Groiss S. P4 Effect of conditioning and test stimulus intensity on cortical excitability by using triad-conditioning Transcranial Magnetic Stimulation. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.115] [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: 11/30/2022]
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Agha AM, Gill C, Balanescu DV, Donisan T, Palaskas N, Lopez-Mattei J, Hassan S, Kim PY, Charitakis K, Cilingiroglu M, Oo TH, Kroll M, Durand JB, Hirsch-Ginsberg C, Marmagkiolis K, Iliescu C. Identifying Hemostatic Thresholds in Cancer Patients Undergoing Coronary Angiography Based on Platelet Count and Thromboelastography. Front Cardiovasc Med 2020; 7:9. [PMID: 32118047 PMCID: PMC7033624 DOI: 10.3389/fcvm.2020.00009] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/21/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the role of platelet count and thromboelastogram (TEG) in the treatment of thrombocytopenic cancer patients with suspected coronary artery disease (CAD). Background: Cancer patients with CAD and thrombocytopenia are often treated non-invasively (i.e., without coronary angiography when clinically indicated) due to perceived high risk of bleeding. We sought to evaluate coagulability based on TEG and determine if platelet count and TEG could predict bleeding risk/mortality among cancer patients undergoing coronary angiography (CA). Methods: Baseline demographics, platelet count, and TEG parameters were recorded among cancer patients that underwent CA and had a concomitant TEG. Logistic regression and univariate proportional hazards regression analysis were performed to determine the impact of platelet count and coagulability on 24-month overall survival (OS). Results: All patients with platelet count <20,000/mm3 and nearly all patients with platelet count 20,000–49,000/mm3 were hypocoagulable based on TEG results. In contrast, nearly all patients with platelet counts of 50,000–99,999/mm3 had normal TEG results and OS similar to those with platelet counts of ≥100,000/mm3. Coagulability based on TEG was not associated with OS. However, a platelet count of <50,000/mm3 was associated with worse 24-month OS (hazard ratio = 2.76; p = 0.0072) when compared with a platelet count of ≥100,000/mm3. No major bleeding complications were observed in all groups. Conclusion: The majority of cancer patients with platelet counts of <50,000/mm3 were hypocoagulable based on TEG and had worse OS at 24 months. The relatively normal TEGs in the >50,000/mm3 groups, as well as the improved survival, suggest that with appropriate clinical indication and risk/benefit assessment, a cut-off of 50,000/mm3 platelets can be considered for CA in cancer patients.
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Affiliation(s)
- Ali M Agha
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Clarence Gill
- Department of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Teodora Donisan
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Y Kim
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Konstantinos Charitakis
- Department of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, University of Arkansas, Little Rock, AR, United States
| | - Thein Hlaing Oo
- Department of Hematology, MD Anderson Cancer Center, Houston, TX, United States
| | - Michael Kroll
- Department of Hematology, MD Anderson Cancer Center, Houston, TX, United States
| | - Jean Bernard Durand
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | | | | | - Cezar Iliescu
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
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Moorby J, Hassan S, McMillan A, Anwar MU, Muthayya P. A survey of current burns knowledge in UK undergraduate medical students. J Plast Reconstr Aesthet Surg 2020; 73:1174-1205. [PMID: 32008939 DOI: 10.1016/j.bjps.2020.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- J Moorby
- Hull-York Medical School, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, United Kingdom.
| | - S Hassan
- Department of Plastic and Burns Surgery, Pinderfields General Hospital, Wakefield, United Kingdom
| | - A McMillan
- Hull-York Medical School, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, United Kingdom
| | - M U Anwar
- Department of Plastic and Burns Surgery, Pinderfields General Hospital, Wakefield, United Kingdom
| | - P Muthayya
- Department of Plastic and Burns Surgery, Pinderfields General Hospital, Wakefield, United Kingdom
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50
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Ebisike PI, Habib SG, Hassan S, Suwaid MA, Hikima MS, Saleh MK, Jibo U, Yusuf L. Transorbital sonographic measurement of optic nerve sheath diameter among HIV-Positive patients in Northwestern Nigeria. Niger J Clin Pract 2020; 22:1570-1575. [PMID: 31719279 DOI: 10.4103/njcp.njcp_622_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Human immunodeficiency virus (HIV) is a pandemic disease affecting all regions across the globe and Nigeria having the second highest prevalence worldwide. Highly active antiretroviral therapy (HAART) has profound negative effect on the optic nerve even though (HAART) has improved the health status of the affected individuals and overall reduction in mortality. Imaging modality especially ultrasound has a great role in the assessment of the optic nerve because of its availability, affordability, and easy operability with reliable sensitivity. Subjects and Methods This cross-sectional study was conducted at the Department of Radiology and Ophthalmology, AKTH, Kano, from October 2017 to June 2018. A total of 143 consenting HIV-positive adults age 18-60 years on HAART were recruited. Optic nerve sheath diameter (ONSD) of each eye was measured using 11-14 MHz linear transducer. Ethical approval was obtained from the ethic and research committee of the hospital. Results The mean ONSD value of the right eye was 3.49 mm ± 1.04 standard deviation (SD) and 3.55 mm ± 1.11 SD for the left eye. The optic nerve diameter was found to be larger on the left eye and increased slightly with age (P < 0.05). There was nonsignificantly higher values of ONSD among female (3.59 mm ± 1.12 SD) when compared with males (3.332 mm ± 0.878) with P value >0.005. Conclusion ONSD values among HIV-positive patients are significantly higher in the left eye and among female subjects. Also, patients with HIV on HAART have thicker optic nerves when compared with general population in Kano, Nigeria.
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Affiliation(s)
- P I Ebisike
- Department of Ophthalmology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - S G Habib
- Department of Ophthalmology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - S Hassan
- Department of Ophthalmology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - M A Suwaid
- Department of Radiology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - M S Hikima
- Department of Radiology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - M K Saleh
- Department of Radiology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - U Jibo
- Department of Radiology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - L Yusuf
- Department of Radiology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
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