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Mallik MK, Qadan LR, Mohanty AK, Alali A, Kapila K. Grading pancreatic adenocarcinomas on fine needle aspiration cytology. The outstanding issues. Cytopathology 2024; 35:256-265. [PMID: 38050715 DOI: 10.1111/cyt.13343] [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: 06/11/2023] [Revised: 10/08/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE The three-tier grading scheme described in "The Papanicolaou Society of Cytopathology (PSC) System for reporting Pancreaticobiliary Cytopathology" (TPSCRPBC) which remained unchanged following the WHO Reporting System for Pancreaticobiliary Cytopathology (WRPBC) was evaluated on pancreatic adenocarcinomas (PACs) reported on endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNAC). METHODS The Papanicolaou and May Grunwald Giemsa-stained smears from 116 cases of PACs were graded using the three-tier grading scheme laid down by TPSCRPBC/WRPBC. Cases exhibiting multiple grades were assigned primary, secondary and tertiary grades. Each case was assigned a grade score, either by adding the primary and secondary grades, by adding the primary and tertiary grades when the tertiary grade was 3 or by doubling the grade when only one grade existed. Necrosis was estimated semi-quantitatively. The inter-observer reproducibility in grading was evaluated using Kappa and Kendall's tau-c. Correlations between the various grades, the stage of the tumour and the amount of necrosis were assessed using Spearman rho and Kendall's tau-b. RESULTS 31.89% of cases showed one grade, and 68.11% showed at least two grades. 16.38% showed three grades. The two commonest grade scores were 3 and 5. The inter-observer reproducibility for grading and grade scoring was satisfactory. A positive correlation was noted between the grades and the amount of necrosis. No significant correlation was found between the grades, grade scores and the stage of the tumours. CONCLUSIONS The TPSCRPBC/WRPBC grading scheme can be suitably applied to PACs with good inter-observer reproducibility. Cases often show multiple grades in the same tumour.
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Affiliation(s)
- Mrinmay Kumar Mallik
- Cytopathology Unit, Department of Laboratory Medicine, Mubarak Al Kabeer Hospital, Safat, Kuwait
| | - Laila Rafiq Qadan
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Asit Kumar Mohanty
- Department of Medical Oncology, Kuwait Cancer Control Center, Shuwaikh, Kuwait
| | - Ali Alali
- Department of Gastroenterology and Hepatology, Mubarak Al Kabeer Hospital, Safat, Kuwait
| | - Kusum Kapila
- Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Alissa DA, Aburas W, Almasuood R, Almudaiheem HY, Al Aseri Z, Alrabiah F, Ezzat H, Moulana AA, Alawi MM, Al-Mutairy E, Alaama T, Alamri MS, Bamousa MS, Alshehri AA, Alosaimi MH, Alali A, Nori R, Devol EB, Mohamed G, Al-Jedai AH. Prevalence and epidemiological trends in mortality due to COVID-19 in Saudi Arabia. Public Health 2023; 215:31-38. [PMID: 36634404 DOI: 10.1016/j.puhe.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES This article describes the prevalence and epidemiological trends of COVID-19 mortality in the largest registry in the Kingdom of Saudi Arabia (KSA). STUDY DESIGN A prospective epidemiological cohort study using data from all healthcare facilities in KSA collected between March 23, 2020, and April 30, 2022. Data on the number of daily deaths directly related to COVID-19 were gathered, analyzed, and reported. METHOD Data analysis was carried out using national and regional crude case fatality rate and death per 100,000 population. Descriptive statistics using numbers and proportions were used to describe age, gender, nationality, and comorbidities. The mortality trend was plotted and compared with international figures. In addition, the most common comorbidities associated with mortality and the proportion of patients who received COVID-19 vaccine were reported. RESULTS The total reported number of deaths between March 23, 2020, and April 30, 2022, was 9085. Crude case fatality rate was 1.21%, and death per 100,000 population was 25.38, which compared favorably to figures reported by several developed countries. The highest percentages of deaths were among individuals aged between 60 and 69 years, males (71%), and individuals with diabetes (60%). Only 2.8% of mortalities occur in patients who received COVID-19 vaccine. Diabetes, hypertension, and heart failure had the highest attributable risk of mortality among patients who died due to COVID-19. CONCLUSION Case fatality rate and death per 100,000 population in KSA are among the lowest in the world due to multiple factors. Several comorbidities have been identified, namely, diabetes, hypertension, obesity, and cardiac arrhythmias.
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Affiliation(s)
- D A Alissa
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
| | - W Aburas
- University of Hail, College of Pharmacy, Hail, Saudi Arabia
| | - R Almasuood
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - H Y Almudaiheem
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - Z Al Aseri
- Department of Emergency Medicine and Critical Care, King Saud University, Riyadh, Saudi Arabia; Adult Critical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - F Alrabiah
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - H Ezzat
- Hematology Programs, Ministry of Health, Saudi Arabia; John Hopkins Aramco Healthcare, Dharan, Saudi Arabia; University of British Columbia, Canada
| | - A A Moulana
- Forensic Medicine Center, Makkah Al Mukarramah, Saudi Arabia
| | - M M Alawi
- Infection Control & Environmental Health Unit, Department of Medical Microbiology & Parasitology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - E Al-Mutairy
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - T Alaama
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
| | - M S Alamri
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - M S Bamousa
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Forensic Medicine General Directorate, Ministry of Health, Riyadh, Saudi Arabia
| | - A A Alshehri
- Forensic Medicine Center, Ministry of Health, Riyadh, Saudi Arabia
| | - M H Alosaimi
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Mortality Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - A Alali
- Internal Medicine and Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - R Nori
- Internal Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - E B Devol
- Department of Biostatistics, Epidemiology & Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - G Mohamed
- Department of Biostatistics, Epidemiology & Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - A H Al-Jedai
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia.
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Shehab M, Alali A, Al-Hindawi A, Alsayegh A, Aldallal U, Abdullah I, Albaghli A, Alrashed F, Alfadhli A, Bessissow T. Impact of tumor necrosis factor antagonist combination and anti-integrin therapies on body mass index in inflammatory bowel disease: A cross-sectional study. Front Med (Lausanne) 2023; 9:1045661. [PMID: 36687448 PMCID: PMC9853179 DOI: 10.3389/fmed.2022.1045661] [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: 09/15/2022] [Accepted: 12/13/2022] [Indexed: 01/08/2023] Open
Abstract
Background The impact of biologic therapies on body mass index (BMI) in patients with inflammatory bowel disease (IBD) is unclear. This study investigates any associations between BMI, type of IBD, and the type of medications taken among patients with IBD with varying weight categories. Methods A cross sectional study was performed in an IBD tertiary care center. Data was obtained from patients with IBD attending outpatient clinics from January 1st, 2021 until November 1st, 2021. Adult patients, older than 18 years, with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were recruited. The primary outcome was the association between BMI and medication used in IBD. The secondary outcome was the association between BMI and disease type and location in patients with IBD. Results The study included a total of 528 patients of which, 66.5% have CD. Patients with normal weight comprises 55.9% of the participants, while those who are underweight, overweight or obese are 3.4, 28.2, and 12.5%, respectively. None of the underweight patients had UC. Among the normal weight, overweight and obese BMI categories, 34.6% vs. 36.2% vs. 31.8% had UC, respectively. Patients who are on tumor necrosis factor inhibitors (anti-TNF) with an immunomodulator (anti-TNF combination), are more likely to be overweight or obese than patients who are not on anti-TNF combination (OR 2.86, 95% CI 1.739-4.711, p < 0.001). Patients on vedolizumab are twice as likely to be overweight or obese than patients not on vedolizumab (OR 2.23, 95% CI 1.086-4.584, p < 0.05). Patients with ileocolonic CD are more likely to be overweight or obese compared to other subtypes of CD (OR 1.78, 95% CI 1.14-2.77, p = 0.01). Conclusion Many patients with IBD are either obese or overweight. Patients with IBD who are on anti-TNF combination therapy or vedolizumab monotherapy are more likely to be obese and overweight. In addition, patients will ileocolonic CD are more likely to be obese or overweight.
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Affiliation(s)
- Mohammad Shehab
- Department of Internal Medicine, Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait University, Jabriya, Kuwait,*Correspondence: Mohammad Shehab,
| | - Ali Alali
- Department of Internal Medicine, Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait University, Jabriya, Kuwait
| | - Ahmed Al-Hindawi
- School of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Al Muharraq, Bahrain
| | - Abdulwahab Alsayegh
- School of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Al Muharraq, Bahrain
| | - Usama Aldallal
- School of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Al Muharraq, Bahrain
| | - Israa Abdullah
- Department of Pharmacy, Kuwait Hospital, Sabah Al-Salem, Kuwait
| | - Abbas Albaghli
- Division of Gastroenterology, Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Fatema Alrashed
- Department of Pharmacy Practice, Faculty of Pharmacy, Health Sciences Center (HSC), Kuwait University, Jabriya, Kuwait
| | - Ahmad Alfadhli
- Department of Internal Medicine, Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait University, Jabriya, Kuwait
| | - Talat Bessissow
- Division of Gastroenterology, Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada
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Ajlan AA, Ali T, Aleid H, Almeshari K, DeVol E, Alkaff MA, Fajji L, Alali A, Halabi D, Althuwaidi S, Alghamdi S, Ullah A, Alrajhi A, Bzeizi K, Almaghrabi R, Marquez KAH, Elmikkaoui B, Albogumi E, Aldakhil H, Al-Awwami M, Broering DC. Comparison of the safety and immunogenicity of the BNT-162b2 vaccine and the ChAdOx1 vaccine for solid organ transplant recipients: a prospective study. BMC Infect Dis 2022; 22:786. [PMID: 36229772 PMCID: PMC9559153 DOI: 10.1186/s12879-022-07764-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its resulting disease, coronavirus disease 2019 (COVID-19), has spread to millions of people worldwide. Preliminary data from organ transplant recipients have shown reduced seroconversion rates after the administration of different SARS-CoV-2 vaccination platforms. However, it is unknown whether different vaccination platforms provide different levels of protection against SARS-CoV-2. To answer this question, we prospectively studied 431 kidney and liver transplant recipients (kidney: n = 230; liver: n = 201) who received either the ChAdOx1 vaccine (n = 148) or the BNT-162b2 vaccine (n = 283) and underwent an assessment of immunoglobulin M/immunoglobulin G spike antibody levels. The primary objective of the study is to directly compare the efficacy of two different vaccine platforms in solid organ transplant recipients by measuring of immunoglobulin G (IgG) antibodies against the RBD of the spike protein (anti-RBD) two weeks after first and second doses. Our secondary endpoints were solicited specific local or systemic adverse events within 7 days after the receipt of each dose of the vaccine. There was no difference in the primary outcome between the two vaccine platforms in patients who received two vaccine doses. Unresponsiveness was mainly linked to diabetes. The rate of response after the first dose among younger older patients was significantly larger; however, after the second dose this difference did not persist (p = 0.079). Side effects were similar to those that were observed during the pivotal trials.
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Affiliation(s)
- Aziza A Ajlan
- Clinical Pharmacy Specialist-Solid Organ Transplant. Transplant Clinical Pharmacy Section. Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre (KFSHRC), P.O. Box 3354, Riyadh, 11211, Kingdom of Saudi Arabia.
| | - Tariq Ali
- Adult Transplant Nephrology, Kidney and Pancreas Health Centre, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Hassan Aleid
- Adult Transplant Nephrology, Kidney and Pancreas Health Centre, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Khalid Almeshari
- Adult Transplant Nephrology, Kidney and Pancreas Health Centre, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Edward DeVol
- Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Morad Ahmed Alkaff
- Immunology and Serology Laboratory, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Layal Fajji
- Clinical Transplant, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ali Alali
- Transplant Coordination Team Leader, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Dani Halabi
- Transplant Clinical Specialist, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Sahar Althuwaidi
- Medical Microbiology, Microbiology, Pathology and Laboratory Medicine Department., King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Saad Alghamdi
- Adult Transplant Hepatology, Adult Transplant Hepatology, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Asad Ullah
- Adult Transplant Nephrology, Kidney and Pancreas Health Centre, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Alrajhi
- Infectious Diseases, Medicine Department-Riyadh, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Khalid Bzeizi
- Adult Transplant Hepatology, Adult Transplant Hepatology, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Reem Almaghrabi
- Infectious Diseases, Organ Transplant Centre of Excellence Department-Riyadh, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Kingdom of Saudi Arabia
| | - Kris Ann Hervera Marquez
- Analytics Data Centre, Organ Transplant Centre of Excellence Department-Riyadh, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Bilal Elmikkaoui
- Clinical Analyst, Data Management, Organ Transplant Centre of Excellence Department-Riyadh, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Kingdom of Saudi Arabia
| | - Eid Albogumi
- Clinical Analyst, Data Management, Organ Transplant Centre of Excellence Department-Riyadh, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Kingdom of Saudi Arabia
| | - Haifa Aldakhil
- Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Moheeb Al-Awwami
- Histocompatibility and Immunogenetics Laboratory, Kidney and Pancreas Health Centre Department, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Dieter C Broering
- Organ Transplant Centre, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
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Barkun AN, Alali A. The Role of Hemostatic Powder in Endoscopic Hemostasis of Nonvariceal Upper Gastrointestinal Bleeding. Ann Intern Med 2022; 175:289-290. [PMID: 34871058 DOI: 10.7326/m21-4267] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alan N Barkun
- Division of Gastroenterology, McGill University and McGill University Health Centre, Montreal, Quebec, Canada
| | - Ali Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Alali A, Moris M, Martel M, Streutker C, Cirocco M, Mosko J, Kortan P, Barkun A, May GR. Predictors of Malignancy in Patients With Indeterminate Biliary Strictures and Atypical Biliary Cytology: Results From Retrospective Cohort Study. J Can Assoc Gastroenterol 2021; 4:222-228. [PMID: 34617004 PMCID: PMC8489527 DOI: 10.1093/jcag/gwaa043] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/15/2021] [Indexed: 11/12/2022] Open
Abstract
Background Atypical cellular features are commonly encountered in patients with indeterminate biliary strictures, which are nondiagnostic of malignancy yet cannot rule it out. This study aims to identify clinical features that could discriminate patients with indeterminate biliary strictures and atypical biliary cytology who may harbor underlying malignancy. Methods All patients with an indeterminate biliary stricture and an atypical brush cytology obtained during endoscopic brushings were identified in a large tertiary-care center. Demographical information, clinical data and the final pathological diagnosis were collected. The study cohort was divided based on the final diagnosis into benign and malignant groups. Descriptive and multivariable analyses were performed. Results A total of 151 patients were included in the analysis. Of these, 62.9% were males with mean age of 61.7 ± 16.4 years. Overall, there was an almost equal distribution of patients in the benign and malignant groups. Older age (≥65 years), jaundice, weight loss, intrahepatic biliary and pancreatic duct dilation, double-duct sign and presence of a mass were associated with malignancy in the univariate analysis. However, only older age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00 to 1.03), jaundice (OR 3.33, 95% CI 1.11 to 9.98) and presence of a mass (OR 12.10, 95% CI 4.94 to 29.67) were significantly associated with malignancy in the multivariate analysis. High CA19-9 was associated with malignancy only in patients with primary sclerosing cholangitis. Conclusion In patients with indeterminate biliary stricture and atypical brush cytology, older age, jaundice and presence of a mass are significant predictors of malignancy. Patients with such characteristics need prompt evaluation to rule out underlying malignancy.
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Affiliation(s)
- Ali Alali
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Haya Al-Habeeb Gastroenterology and Hepatology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Maria Moris
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Digestive Disease Department, Marqués de Valdecilla University Hospital, Cantabria University, Santander, Spain
| | - Myriam Martel
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Catherine Streutker
- Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maria Cirocco
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Mosko
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kortan
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Gary R May
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Alajeel NA, Shehab M, Francis I, Alali A. A Rare Cause of Chronic Liver Disease Diagnosed by Endoscopic Ultrasound-Guided Liver Biopsy. Am J Case Rep 2021; 22:e933002. [PMID: 34276044 PMCID: PMC8311384 DOI: 10.12659/ajcr.933002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Male, 54-year-old Final Diagnosis: Hepatic hemosiderosis Symptoms: Elevated liver enzymes Medication:— Clinical Procedure: Liver biopsy Specialty: Gastroenterology and Hepatology • Hematology
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Affiliation(s)
- Nourah A Alajeel
- Haya Al-Habeeb Gastroenterology and Hepatology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Mohammad Shehab
- Haya Al-Habeeb Gastroenterology and Hepatology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Issam Francis
- Department of Pathology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Ali Alali
- Haya Al-Habeeb Gastroenterology and Hepatology Center, Mubarak Al-Kabeer Hospital, Jabriyah, Kuwait
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Mayhew L, Johnson MI, Francis P, Lutter C, Alali A, Jones G. Incidence of injury in adult elite women's football: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2021; 7:e001094. [PMID: 34422291 PMCID: PMC8323459 DOI: 10.1136/bmjsem-2021-001094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 01/08/2023] Open
Abstract
AIM To estimate the incidence of injury in adult elite women's football and to characterise the nature and anatomical location of injuries. DESIGN Systematic review and meta-analysis. DATA SOURCES Combinations of the key terms were entered into the following electronic databases (PubMed, SPORTDiscus, Science Direct and Discover) from inception to May 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES (1) Used a prospective cohort design; (2) captured data on elite adult women players; (3) reported injury incidence by anatomical site; (4) captured data of at least one season or national team tournament; (5) included a definition of injury; and (6) written in English. RESULTS The search identified 1378 records. Twelve studies published between 1991 and 2018 were included in our review and sampled 129 teams. In domestic club football, injury incidence rate was estimated to be 5.7/1000 hours (total), 19.5/1000 hours (match) and 3.1/1000 hours (training). In tournament, football match incidence was estimated to be 55.7/1000 hours. The knee (22.8%; 368/1822) was the most common site of injury in domestic club football. The ankle (23.7%, 105/443) was the most common site of injury in tournament football. Ligament sprains were the most common type of injury (27.8%), followed by muscle strains (19.1%). Severn studies (58%) had a high risk of bias associated with exposure definition and measurement and considerable heterogeneity exists between the included studies (I2=49.7%-95%). SUMMARY/CONCLUSION Ligament sprains occur more frequently in adult elite women football players. We advise caution in interpretating point estimates of the incidence of injury due to high statistical heterogeneity. Standardising injury reporting and the accurate recording of match and training exposure will overcome such limitations. PROSPERO REGISTRATION NUMBER CRD42019130407.su.
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Affiliation(s)
- Lawrence Mayhew
- Musculoskeletal Health Research Group, School of Clinical and Applied Science, Leeds Beckett University, Leeds, UK
| | - Mark I Johnson
- Centre for Pain Research, School of Clinical and Applied Science, Leeds Beckett University, Leeds, UK
| | - Peter Francis
- Department of Science and Health, Institute of Technology Carlow, Carlow, Ireland
| | - Christoph Lutter
- Musculoskeletal Health Research Group, School of Clinical and Applied Science, Leeds Beckett University, Leeds, UK
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Ali Alali
- Musculoskeletal Health Research Group, School of Clinical and Applied Science, Leeds Beckett University, Leeds, UK
| | - Gareth Jones
- Musculoskeletal Health Research Group, School of Clinical and Applied Science, Leeds Beckett University, Leeds, UK
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Klimek L, Hagemann J, Alali A, Spielhaupter M, Huppertz T, Hörmann K, Stielow S, Freudelsperger L, Matthias C. Telemedicine allows quantitative measuring of olfactory dysfunction in COVID-19. Allergy 2021; 76:868-870. [PMID: 32569393 PMCID: PMC7361410 DOI: 10.1111/all.14467] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Ludger Klimek
- Centre for Rhinology and Allergology Wiesbaden Germany
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Jan Hagemann
- Department of Otorhinolaryngology, Head and Neck Surgery University Medical Center Mainz Germany
| | - Ali Alali
- Centre for Rhinology and Allergology Wiesbaden Germany
| | | | - Tilman Huppertz
- Department of Otorhinolaryngology, Head and Neck Surgery University Medical Center Mainz Germany
| | | | | | - Laura Freudelsperger
- Department of Otorhinolaryngology, Head and Neck Surgery University Medical Center Mainz Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, Head and Neck Surgery University Medical Center Mainz Germany
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Klimek L, Hagemann J, Alali A, Spielhaupter M, Huppertz T, Hormann K, Matthias C. The toll of noninfected CRS patients to the COVID-19 pandemic. Rhinology 2020; 58:522-523. [PMID: 33130830 DOI: 10.4193/rhin20.250] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Social distancing with the aim of avoiding infections and pre-serve critical care capacities during the COVID-19 pandemic has been implemented in Germany according to World Health Organization (WHO) recommendations from early March onwards. Limitations of physical contacts to reduce exposure to SARS-CoV-2 infected individuals were handled strictly, particularly in medical centers dealing with airway diseases, like rhinology and pneumology clinics. Such measures and reluctance to visit out- and inpatient services resulted in a 82% decrease in consultations to the 12 German oto-rhino-laryngological (ORL) centres forming our database during the 50 days following March 09 in 2020 if compared to the same period in 2019. Our data on CRS care underline reports on undertreatment of non-COVID-19 individuals with several different diseases during the current pandemic. We should try to reduce the toll these patients have to pay as much as possible. We established telemedicine, e-Health and artificial intelligence-supported triage for selecting the right patients for onsite-consultations and to advise patients in several demands.
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Affiliation(s)
- L Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - J Hagemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany
| | - A Alali
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | | | - T Huppertz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany
| | - K Hormann
- Mannheim University Hospital, Mannheim, Germany
| | - C Matthias
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany
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Klimek L, Huppertz T, Alali A, Spielhaupter M, Hörmann K, Matthias C, Hagemann J. A new form of irritant rhinitis to filtering facepiece particle (FFP) masks (FFP2/N95/KN95 respirators) during COVID-19 pandemic. World Allergy Organ J 2020; 13:100474. [PMID: 33042359 PMCID: PMC7538121 DOI: 10.1016/j.waojou.2020.100474] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 07/13/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022] Open
Abstract
Filtering facepiece particle (FFP) masks are important items of personal protective equipment in fighting COVID-19 pandemic. They shall protect the wearer of the mask from particles, droplets, and aerosols, but they also can prevent the spread of aerosol-transmitted viruses if the wearer becomes infected. Most often, FFP respirators consist of multiple layers of non-woven fabric made from polypropylene. Worldwide, FFP respirators are subject to various regulatory standards that specify physical properties and performance characteristics. During the SARS-CoV-2 pandemic, health authorities have temporarily repealed standards for respirators. We report on 46 patients that presented with rhinitis-like symptoms strongly associated to the use of FFP masks. Some of them were obliged to use FFP masks in their work environment. Nasal endoscopy showed edemata of the nasal mucosa that significantly decreased after a period of non-use of FFP masks. Subjectively reported symptom levels decreased after cessation of FFP use for 3 or more days. The presence of polypropylene fibres isolated from nasal rinsing solution was significantly associated with the use of FFP masks in our patients. Material safety and performance deregulation of FFP masks can pose a health risk. Thus, especially health care professionals and other individuals with occupational need for FFP masks should be aware of possible hazards that come with COVID-19 pandemic protection measures.
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Key Words
- Allergy
- CE, conformité européenne label indicating conformity to the EU-regulation 765/2008
- COVID-19, coronavirus disease from the year 2019
- ECP, eosinophilic cationic protein
- FFP, filtering facepiece particle
- FFP2-Mask
- Filtering facepiece masks
- Irritant rhinitis
- KN95-Mask
- N95 / KN95, technical / physical standard for filtering face masks (not penetrated by particles larger 0.3 μm, N/KN indicating that aqueous, but not oily aerosols are filtered
- N95-mask
- PPE, personal protective equipment
- SD / SEM, standard deviation / standard error of the mean
- VAS, visual analogue scale
- WHO, World Health Organization
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Affiliation(s)
- Ludger Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - Tilman Huppertz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany
| | - Ali Alali
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Christoph Matthias
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany
| | - Jan Hagemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany
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12
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Baudouin R, Alali A, Hans S, Blumen M, Chabolle F. OSAS and upper pharynx surgery: Does basilingual collapsus always rhyme with failure? Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:135-139. [PMID: 33011105 DOI: 10.1016/j.anorl.2020.07.004] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Drug-induced-sedation endoscopy (DISE) has proved superior to awake clinical examination for diagnosis of upper-airway obstruction sites and surgical planning. Our question is: does multilevel obstruction on DISE systematically entail failure for surgery limited to the upper pharynx? MATERIAL & METHODS We conducted a retrospective single-center study in patients with obstructive sleep apnea syndrome (OSAS) treated by single-level surgery of the upper pharynx (tonsillectomy with or without pharyngoplasty). Preoperative assessment included polysomnography (PSG) and DISE. Surgical efficacy was assessed on postoperative PSG. Treatment response was defined by postoperative apnea-hypopnea index (AHI) <20 events/h with 50% reduction, and cure by AHI <10 (patients with preoperative AHI ≤10 being excluded). Efficacy was compared between groups without (group A) and with basilingual or laryngeal collapsus on DISE (group B). RESULTS We analyzed 63 patients, with mean preoperative AHI 33.8±17.9 events/h. The two groups (A, n=36; B, n=27) were clinically comparable. Postoperative PSG took place at a mean 8.5 ± 11.5 months. The success rate was 66.7% in group A (mean reduction in AHI, 57.3±36.2%) and 59.3% in group B (mean reduction, 53.9±39.2%). Cure rates were respectively 48.5% and 48.1%. There was no statistically significant difference between the two groups (P>0.1). CONCLUSIONS Oropharyngeal surgery can alleviate associated obstructive sites found on DISE in the lower pharynx, and step-by-step treatment shows efficacy equal to that of single-step multilevel surgery.
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Affiliation(s)
- R Baudouin
- Service d'ORL et Chirurgie Cervico-Faciale, Laboratoire d'Exploration du Sommeil, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université Versailles Saint-Quentin-en-Yvelines, 78280 Saint-Quentin-en-Yvelines, France.
| | - A Alali
- Service d'ORL et Chirurgie Cervico-Faciale, Laboratoire d'Exploration du Sommeil, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université Versailles Saint-Quentin-en-Yvelines, 78280 Saint-Quentin-en-Yvelines, France
| | - S Hans
- Service d'ORL et Chirurgie Cervico-Faciale, Laboratoire d'Exploration du Sommeil, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université Versailles Saint-Quentin-en-Yvelines, 78280 Saint-Quentin-en-Yvelines, France
| | - M Blumen
- Service d'ORL et Chirurgie Cervico-Faciale, Laboratoire d'Exploration du Sommeil, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université Versailles Saint-Quentin-en-Yvelines, 78280 Saint-Quentin-en-Yvelines, France
| | - F Chabolle
- Service d'ORL et Chirurgie Cervico-Faciale, Laboratoire d'Exploration du Sommeil, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université Versailles Saint-Quentin-en-Yvelines, 78280 Saint-Quentin-en-Yvelines, France
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13
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Klimek L, Spielhaupter M, Alali A, Cichy M, Huppertz T, Hagemann J. [Elevated Eosinophil Count Associated with Dupilumab Therapy in Patients with Type-2 Inflammation]. Laryngorhinootologie 2020; 99:811-812. [PMID: 32583382 DOI: 10.1055/a-1200-1830] [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] [Indexed: 10/24/2022]
Affiliation(s)
- Ludger Klimek
- Allergologie, HNO, Zentrum für Rhinologie und Allergologie Wiesbaden, Germany
| | | | - Ali Alali
- Allergologie, HNO, Zentrum für Rhinologie und Allergologie Wiesbaden, Germany
| | - Marc Cichy
- Allergologie, HNO, Zentrum für Rhinologie und Allergologie Wiesbaden, Germany
| | - Tilman Huppertz
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsmedizin Mainz, Germany
| | - Jan Hagemann
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsmedizin Mainz, Germany
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14
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Klimek L, Spielhaupter M, Alali A, Freudelsperger L, Cichy M, Huppertz T, Hagemann J. [Case report of contact allergy to filtering facepiece class 2 mask of a medical worker during Covid-19 pandemic]. Laryngorhinootologie 2020; 99:475-477. [PMID: 32492726 PMCID: PMC7356076 DOI: 10.1055/a-1189-6301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | | | - A Alali
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - L Freudelsperger
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsmedizin Mainz
| | - M Cichy
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - T Huppertz
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsmedizin Mainz
| | - J Hagemann
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsmedizin Mainz
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15
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Bosaeed M, Ahmad A, Alali A, Mahmoud E, Alswidan L, Alsaedy A, Aljuhani S, Alalwan B, Alshamrani M, Alothman A. Experience With Ceftolozane-Tazobactam for the Treatment of Serious Pseudomonas aeruginosa Infections in Saudi Tertiary Care Center. Infect Dis (Lond) 2020; 13:1178633720905977. [PMID: 32110036 PMCID: PMC7016308 DOI: 10.1177/1178633720905977] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction: Multidrug-resistant Pseudomonas aeruginosa isolates have multiple resistance mechanisms, and there are insufficient therapeutic options to target them. Ceftolozane-tazobactam is a novel antipseudomonal agent that contains a combination of an oxyimino-aminothiazolyl cephalosporin (ceftolozane) and a β-lactamase inhibitor (tazobactam). Methods: A single-center retrospective observational study between January 2017 and December 2018 for patients who had been diagnosed with carbapenem-resistant P aeruginosa infections and treated with ceftolozane-tazobactam for more than 72 hours. We assessed clinical success based on microbiological clearance as well as the clinical resolution of signs and symptoms of infection. Results: A total of 19 patients fit the inclusion criteria, with a median age was 57 years, and 53% were female. The types of infections were nosocomial pneumonia, acute bacterial skin, and skin structure infections; complicated intra-abdominal infections; and central line–associated bloodstream infections. All of the isolates were resistant to both meropenem and imipenem. The duration of therapy was variable (average of 14 days). At day 14 of starting ceftolozane-tazobactam, 18 of 19 patients had a resolution of signs and symptoms of the infection. Only 14 of 19 patients (74%) had proven microbiological eradication observed at the end of therapy. During therapy, there was no adverse event secondary to ceftolozane-tazobactam, and no Clostridium difficile infection was identified. The 30-day mortality rate was 21% (4/19). Conclusions: Multidrug-resistant P aeruginosa infection is associated with high mortality, which would potentially be improved using a new antibiotic such as ceftolozane-tazobactam. Studies are required to explain the role of combination therapy, define adequate dosing, and identify the proper duration of treatment.
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Affiliation(s)
- M Bosaeed
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - A Ahmad
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - A Alali
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - E Mahmoud
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - L Alswidan
- Pharmaceutical Care Department, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - A Alsaedy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - S Aljuhani
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - B Alalwan
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - M Alshamrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - A Alothman
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
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16
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Alali A, Espino A, Moris M, Martel M, Schwartz I, Cirocco M, Streutker C, Mosko J, Kortan P, Barkun A, May GR. Endoscopic Resection of Ampullary Tumours: Long-term Outcomes and Adverse Events. J Can Assoc Gastroenterol 2019; 3:17-25. [PMID: 32010876 PMCID: PMC6985700 DOI: 10.1093/jcag/gwz007] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background The management of ampullary lesions has shifted from surgical approach to endoscopic resection. Previous reports were limited by small numbers of patients and short follow-up. The aim of this study is to describe short- and long-term outcomes in a large cohort of patients undergoing endoscopic ampullectomy. Methods Retrospective study of endoscopic ampullectomies performed at a tertiary center from January 1999 to October 2016. Information recorded includes patient demographics, clinical outcomes, lesion pathology, procedural events, adverse events and follow-up data. Results Overall, 103 patients underwent endoscopic resection of ampullary tumours (mean age 62.3 ± 14.3 years, 50.5% female, mean lesion size 20.9 mm; 94.9% adenomas, with a majority of lesions exhibiting low-grade dysplasia (72.7%). Complete endoscopic resection was achieved in 82.5% at initial procedure. Final complete endoscopic resection was achieved in all patients with benign pathology on follow-up procedures. Final pathology showed that 11% had previously undiagnosed invasive carcinoma. Delayed postprocedure bleeding occurred in 21.4%, all of which were managed successfully at endoscopy. Acute pancreatitis complicated 15.5% of procedures (mild in 93.8%). Perforation occurred in 5.8%, all treated conservatively except for one patient requiring surgery. Piecemeal resection was associated with significantly higher recurrence compared to en-bloc resection (54.3% versus 26.2%, respectively, P = 0.012). All recurrences were treated endoscopically. Conclusion Endoscopic ampullectomy appears both safe and effective in managing patients with ampullary tumours in experienced hands. Most adverse events can be managed conservatively. Many patients develop recurrence during long-term follow-up but can be managed endoscopically. Recurrence rates may be reduced by performing initial en-bloc resection.
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Affiliation(s)
- Ali Alali
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Haya Al-Habeeb Gastroenterology and Hepatology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Alberto Espino
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Gastroenterology, Pontificia Universidad Católica de Chile, Endoscopy Unit Hospital UC-Christus, Santiago, Chile
| | - Maria Moris
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Myriam Martel
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Ingrid Schwartz
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maria Cirocco
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Streutker
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Mosko
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kortan
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Gary R May
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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17
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Alali A, Mosko J, May G, Teshima C. Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature. Clin Endosc 2017; 50:117-125. [PMID: 28391671 PMCID: PMC5398360 DOI: 10.5946/ce.2017.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/22/2017] [Indexed: 12/19/2022] Open
Abstract
Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.
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Affiliation(s)
- Ali Alali
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Jeffrey Mosko
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Gary May
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Christopher Teshima
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, ON, Canada
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18
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Kadereit S, Mohammad SF, Miller RE, Woods KD, Listrom CD, McKinnon K, Alali A, Bos LS, Iacobucci ML, Sramkoski MR, Jacobberger JW, Laughlin MJ. Reduced NFAT1 protein expression in human umbilical cord blood T lymphocytes. Blood 1999; 94:3101-7. [PMID: 10556195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Umbilical cord blood (UCB) stem cells from related and unrelated allogeneic donors have emerged as novel treatment for patients with hematologic malignancies. The incidence and severity of acute graft-versus-host disease (GVHD) after UCB transplantation compares favorably with that observed in recipients of matched unrelated donor allogeneic grafts, but remains a major cause of morbidity and mortality. It has been shown that stimulated lymphocytes from UCB have reduced production of cytokines including interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha), which play a role in GVHD pathophysiology. We investigated the molecular mechanisms underlying this reduced cytokine production by analyzing expression of nuclear factor of activated T cells-1 (NFAT1) in UCB T cells. We detected no constitutive expression of NFAT1 protein in unstimulated UCB T cells compared with adult T cells. Moreover, although NFAT1 expression in UCB T cells was upregulated after prolonged (40 hours) T-cell stimulation, it was only partially upregulated when compared with adult controls. Our observation of minimal NFAT1 expression after stimulation correlated with reduced cytoplasmic IFN-gamma and TNF-alpha production in UCB T cells studied simultaneously. Reduced NFAT1 expression may blunt amplification of donor UCB T-cell alloresponsiveness against recipient antigens, thereby potentially limiting GVHD incidence and severity after allogeneic UCB transplantation.
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Affiliation(s)
- S Kadereit
- University Hospitals Ireland Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106-5065, USA
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Fischer TA, Ungureanu-Longrois D, Singh K, de Zengotita J, DeUgarte D, Alali A, Gadbut AP, Lee MA, Balligand JL, Kifor I, Smith TW, Kelly RA. Regulation of bFGF expression and ANG II secretion in cardiac myocytes and microvascular endothelial cells. Am J Physiol 1997; 272:H958-68. [PMID: 9124460 DOI: 10.1152/ajpheart.1997.272.2.h958] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Basic fibroblast growth factor (bFGF; fibroblast growth factor-2) and angiotensin II (ANG II), among other peptide signaling autacoids (cytokines), are known to regulate the phenotypic adaptation of cardiac muscle to physiological stress. The cell type(s) in cardiac muscle responsible for ANG II synthesis and secretion and the role of endogenous cytokines in the regulation of bFGF induction remain unclear. With the use of confluent, serum-starved, low-passage cultures of cardiac microvascular endothelial cells (CMEC), ANG II could be detected in cellular lysates and in medium conditioned by these cells with the use of high-performance liquid chromatography followed by radioimmunoassay. The secretion of angiotensins by individual CMEC could be detected with a cell-blot assay technique. ANG II secretion was decreased by brefeldin A, an agent that interrupts constitutive and regulated secretory pathways for peptide autacoid/ hormone synthesis, suggesting de novo synthesis, activation, and secretion of angiotensins by CMEC. In primary isolates of adult rat ventricular myocytes (ARVM) and CMEC, ANG II, acting at ANG II type 1 receptors in both cell types, was found to increase bFGF mRNA levels measured by ribonuclease protection assay. Endothelin-1 (ET-1), which is known to be synthesized by CMEC, and bFGF itself, which has been detected in both ARVM and CMEC, increased bFGF transcript levels in both cell types. Interleukin-1beta (IL-1beta), which like ANG II and ET-1 is known to activate mitogen-activated protein kinases in both ARVM and CMEC, increased bFGF mRNA levels only in cardiac myocytes. Thus cytokines such as ANG II, ET-1, bFGF, and IL-1beta locally generated by cellular constituents of cardiac muscle, including CMEC, regulate bFGF mRNA levels in a cell type-specific manner.
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Affiliation(s)
- T A Fischer
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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20
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Perrella MA, Mäki T, Prasad S, Pimental D, Singh K, Takahashi N, Yoshizumi M, Alali A, Higashiyama S, Kelly RA. Regulation of heparin-binding epidermal growth factor-like growth factor mRNA levels by hypertrophic stimuli in neonatal and adult rat cardiac myocytes. J Biol Chem 1994; 269:27045-50. [PMID: 7929446] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is a recently characterized member of the EGF family of peptide signaling factors that acts as an early response gene to growth stimuli in vascular smooth muscle cells, as well as being a potent mitogen for these cells. As many of these growth stimuli also induce a hypertrophic response in heart muscle, we examined the regulation of HB-EGF mRNA abundance and function in primary cultures of neonatal rat ventricular myocytes and adult rat ventricular myocytes (ARVM). HB-EGF mRNA levels increased 40- and 6-fold in neonatal rat ventricular myocytes and ARVM, respectively, following a 2-4-h exposure to the alpha-adrenergic agonist phenylephrine, a known hypertrophic stimulus for these cells. Phenylephrine had no effect on HB-EGF mRNA stability, and induction of HB-EGF could be blocked completely by actinomycin D. HB-EGF mRNA abundance was also increased 15-fold in ARVM maintained in defined medium that had been induced to contract at 3 Hz by continual uniform electric field stimulation, a mechanical stimulus that we have shown preserves contractile function and induces cell growth in vitro. To determine whether cardiac myocytes would respond to exogenous HB-EGF, quiescent ARVM were exposed to defined medium conditioned by transfected COS MT cells overexpressing HB-EGF. These myocytes exhibited nearly a 2-fold increase in protein content at 24 h compared with unstimulated control ARVM exposed to medium conditioned by COS cells transfected with the plasmid vector alone. Thus, neonatal and adult cardiac muscle cells respond to both neurohumoral and mechanical growth stimuli with a marked increase in HB-EGF mRNA, which may act as an early response gene to facilitate hypertrophic growth in these cells.
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Affiliation(s)
- M A Perrella
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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Perrella MA, Mäki T, Prasad S, Pimental D, Singh K, Takahashi N, Yoshizumi M, Alali A, Higashiyama S, Kelly RA. Regulation of heparin-binding epidermal growth factor-like growth factor mRNA levels by hypertrophic stimuli in neonatal and adult rat cardiac myocytes. J Biol Chem 1994. [DOI: 10.1016/s0021-9258(18)47123-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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