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Farmakis I, Valerio L, Mavromanoli AC, Bikdeli B, Connors JM, Giannakoulas G, Goldhaber SZ, Hobohm L, Hunt BJ, Keller K, Klok FA, Spyropoulos AC, Kucher N, Konstantinides S, Barco S. Mortality related to pulmonary embolism in the United States before and during the COVID-19 pandemic: an analysis of the CDC Multiple Cause of Death database. Eur Heart J 2022. [PMCID: PMC9619500 DOI: 10.1093/eurheartj/ehac544.1869] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The COVID-19 pandemic caused a large number of excess deaths. COVID-19 emerged as a prothrombotic disease often complicated by pulmonary embolism (PE). In light of this, we hypothesized that PE-related mortality rates (stable before the pandemic) would be characterized by an increasing trend following the COVID-19 outbreak. Purpose To investigate the mortality rates associated with PE among deaths with or without COVID-19 during the 2020 pandemic in the United States (US). Methods For this retrospective epidemiological study, we analyzed public medically certified vital registration data (death certificates encompassing underlying and multiple causes of death) from the Mortality Multiple Cause-of-Death database provided by the Division of Vital Statistics of the US Centers for Disease Control and Prevention (CDC; US, 2018–20). We investigated the time trends in monthly PE-related crude mortality rates for 2018–2019 and for 2020 (the latter associated vs. not associated with COVID-19), utilizing annual national population totals from the US Census Bureau. Second, we calculated the PE-related proportionate mortality among COVID-19 deaths (overall and limited to autopsy-based diagnosis). We performed subgroup analyses based on age groups, sex and race. Results During 2020, 49,423 deaths in association with PE were reported, vs. 39,450 in 2019 and 38,215 in 2018. The crude PE-related mortality rate without COVID-19 was 13.3 per 100,000 population in 2020 compared to 11.7 in 2018 and 12.0 in 2019 (Figure 1A). The PE-related mortality rate with COVID-19 was 1.6 per 100,000 population in 2020. Among non-COVID-19-related deaths, the crude PE-related mortality rate was higher in women; among COVID-19-related deaths, it was higher in men. PE-related mortality rates were approximately two-fold higher among black (vs. white) general population irrespective of COVID-19 status (Figures 1B and 1C). Among COVID-19 deaths, PE-related deaths corresponded to 1.4% of total; the value rose to 6.0% when an autopsy was performed. This figure was higher in men and its time evolution is depicted in Figure 2A. The proportionate mortality of PE in COVID-19 deaths was higher for younger age groups (15–44 years) compared to non-COVID-19-related deaths (Figure 2B). Conclusion In 2020, an overall 20%-increase in PE-related mortality was reported, not being limited to patients with COVID-19. Our findings could be interpreted in the context of undiagnosed COVID-19 cases, uncounted late sequelae, and possibly sedentary lifestyle and avoidance of healthcare facilities during the pandemic that may have prevented timely diagnosis and treatment of other diseases. Whether vaccination programs had an impact on PE-associated mortality in the year 2021, remains to be determined. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- I Farmakis
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | - L Valerio
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | | | - B Bikdeli
- Brigham and Women's Hospital, Cardiovascular Medicine Division , Boston , United States of America
| | - J M Connors
- Brigham and Women's Hospital, Hematology Division , Boston , United States of America
| | - G Giannakoulas
- AHEPA University General Hospital, Department of Cardiology , Thessaloniki , Greece
| | - S Z Goldhaber
- Brigham and Women's Hospital, Cardiovascular Medicine Division , Boston , United States of America
| | - L Hobohm
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | - B J Hunt
- Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital Thrombosis and Haemophilia Centre and Thrombosis and Vascular Biology Group , London , United Kingdom
| | - K Keller
- University Medical Center Mainz, Department of Cardiology , Mainz , Germany
| | - F A Klok
- Leiden University Medical Center, Department of Medicine - Thrombosis and Hemostasis , Leiden , The Netherlands
| | - A C Spyropoulos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell , Hempstead , United States of America
| | - N Kucher
- University Hospital Zurich, Department of Angiology , Zurich , Switzerland
| | | | - S Barco
- University Hospital Zurich, Department of Angiology , Zurich , Switzerland
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Abstract
BACKGROUND Sarcopenia is associated with adverse outcomes in cancer, chemotherapy, solid organ transplants, intensive care and medical patients. It has also been proven to increase perioperative mortality, hospital length of stay and complications in patients of various age groups. However, a limited number of studies have examined the association of post-surgical outcomes and sarcopenia inclusively in patients aged 65 years and older. OBJECTIVE This scoping review aimed to examine the relationship between adverse post-surgical outcomes and sarcopenia in patients aged 65 years and older. METHODOLOGY EMBASE and Medline databases were searched for sarcopenia, perioperative period and post-surgical outcomes. The articles were screened based on exclusion and inclusion criteria and were reviewed systematically as per the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. RESULTS After duplicates removal and application of the inclusion and exclusion criteria, eight articles were included for this study from a total of nine hundred initially identified articles. All studies defined sarcopenia as low muscle mass but did not include physical function or muscle strength as the parameter of sarcopenia. Low muscle mass was associated with higher mortality in emergency surgeries, reduced long term survival in open elective surgeries, and increased length of hospital stay in endoscopic surgeries. CONCLUSION The current review suggests that low muscle mass is associated with higher mortality and various adverse post-surgical outcomes in the elderly. It remains to be determined if applying the definition of sarcopenia as per the international consensus/guidelines will affect the association of adverse post-surgical outcomes and sarcopenia.
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Affiliation(s)
- M Hossain
- Monowar Hossain, Aged and Extended Care Services, The Queen Elizabeth Hospital. Central Adelaide Local Health Network, South Australia,
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Quezada A, Aguilar MP, Jiménez D, Bikdeli B, Moores L, Aramberri M, Lima J, Ballaz A, Yusen R, Monreal M. P9. Abstract Title: Systolic Blood Pressure and Mortality in Acute Symptomatic Pulmonary Embolism. Thromb Res 2019. [DOI: 10.1016/j.thromres.2019.09.020] [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: 10/25/2022]
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Bikdeli B, Visvanathan R, Jimenez D, Monreal M, Goldhaber SZ, Bikdeli B. Use of Prophylaxis for Prevention of Venous Thromboembolism in Patients with Isolated Foot or Ankle Surgery: A Systematic Review and Meta-Analysis. Thromb Haemost 2019; 119:1686-1694. [PMID: 31430799 DOI: 10.1055/s-0039-1693464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although prophylaxis for venous thromboembolism (VTE) is recommended after many surgeries, evidence base for use of VTE prophylaxis after foot or ankle surgery has been elusive, leading into varying guidelines recommendations and notable practice variations. We conducted a systematic review of the literature to determine if use of VTE prophylaxis decreased the frequency of subsequent VTE, including deep vein thrombosis (DVT) or pulmonary embolism (PE), compared with control. We searched PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through May 2018, for randomized controlled trials (RCTs) or prospective controlled observational studies of VTE prophylaxis in patients undergoing foot and ankle surgery. Our search retrieved 263 studies, of which 6 were finally included comprising 1,600 patients. Patients receiving VTE prophylaxis had lower risk for subsequent DVT (risk ratio [RR]: 0.72; 95% confidence interval [CI]: 0.55-0.94) and subsequent VTE (RR: 0.72; 95% CI: 0.55-0.94). There was only one case of nonfatal PE, no cases of fatal PE, and no change in all-cause mortality (RR: 3.51; 95% CI: 0.14-84.84). There was no significant difference in the risk for bleeding (RR: 2.12; 95% CI: 0.53-8.56). Very few RCTs exist regarding the efficacy and safety of VTE prophylaxis in foot and ankle surgery. Prophylaxis appears to reduce the risk of subsequent VTE, but the event rates are low and symptomatic events are rare. Future studies should determine the subgroups of patients undergoing foot or ankle surgery in whom prophylaxis may be most useful.
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Affiliation(s)
- Bavand Bikdeli
- Aged & Extended Care Services, The Queen Elizabeth Hospital, Adelaide, Australia.,Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia.,Division of Medical Sub-specialties, Lyell McEwin Hospital, Adelaide, Australia
| | - Renuka Visvanathan
- Aged & Extended Care Services, The Queen Elizabeth Hospital, Adelaide, Australia.,Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
| | - David Jimenez
- Respiratory and Medicine Department, Hospital Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona.,Universidad Católica de Murcia, Murcia, Spain
| | - Samuel Z Goldhaber
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Behnood Bikdeli
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona.,Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States.,Center for Outcomes Research & Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States
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Bikdeli B, Lobo JL, Jimenez D, Green P, Fernandez-Capitan C, Bura-Riviere A, Otero R, Ditullio M, Galindo S, Ellis M, Parikh S, Monreal M. P1627Early use of echocardiography in patients with acute pulmonary embolism: findings from the RIETE registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Affiliation(s)
- B Bikdeli
- Columbia University Medical Center, Division of Cardiology; Center for Outcomes Research and Evaluation, Yale School of Medicine; CRF, New York, United States of America
| | - J L Lobo
- University Hospital of Araba, Alava, Spain
| | - D Jimenez
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - P Green
- Columbia University Medical Center, New York, United States of America
| | | | - A Bura-Riviere
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - R Otero
- University Hospital of Virgen del Rocio, Seville, Spain
| | - M Ditullio
- Columbia University Medical Center, New York, United States of America
| | - S Galindo
- S&H Medical Sciences Services, Madrid, Spain
| | - M Ellis
- Meir Medical Center, Kfar Saba, Israel
| | - S Parikh
- Columbia University Medical Center, New York, United States of America
| | - M Monreal
- Germans Trias i Pujol Hospital, Badalona (Barcelona), Spain
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6
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Rosenblum H, Wessler J, Gupta A, Bikdeli B. Zinc Deficiency and Heart Failure: A Systematic Review of the Literature. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.821] [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] Open
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Bikdeli B, Sharif-Kashani B, Bikdeli B, Valle R, Falga C, Riera-Mestre A, Mazzolai L, Verhamme P, Wells PS, Torrero JFSM, Lopez-Jiménez L, Monreal M. Impact of Thrombus Sidedness on Presentation and Outcomes of Patients with Proximal Lower Extremity Deep Vein Thrombosis. Semin Thromb Hemost 2018; 44:341-347. [PMID: 29329472 DOI: 10.1055/s-0037-1621716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Small studies have suggested differences in demographics and outcomes between left- and right-sided deep vein thrombosis (DVT), and also unilateral versus bilateral DVT. We investigated the clinical presentation and outcomes of patients with DVT based on thrombus sidedness. The authors used the data from the Registro Informatizado Enfermedad TromboEmbólica (RIETE) database (2001-2016) to identify patients with symptomatic proximal lower-extremity DVT. Main outcomes included cumulative 90-day symptomatic pulmonary embolism (PE) and 1-year mortality. Overall, 30,445 patients were included. The majority of DVTs occurred in the left leg (16,421 left-sided, 12,643 right-sided, and 1,390 bilateral; p < 0.001 for chi-squared test comparing all three groups). Comorbidities were relatively similar in those with left-sided and right-sided DVT. Compared with those with left-sided DVT, patients with right-sided DVT had higher relative frequency of PE (26% versus 23%, p < 0.001) and 1-year mortality (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.00-1.18). This difference in mortality did not persist after multivariable adjustment (OR: 1.01; 95% CI: 0.93-1.1). Patients with bilateral DVT had a greater burden of comorbidities such as heart failure, and recent surgery compared with those with unilateral DVT (p < 0.001), and higher relative frequency of PE (48%), and 1-year mortality (24.1%). Worse outcomes in patients with bilateral DVT were attenuated but persisted after multivariable adjustment for demographics and risk factors (OR: 1.64; 95% CI: 1.43-1.87). Patients with bilateral DVT had worse outcomes during and after discontinuation of anticoagulation. There is a left-sided preponderance for proximal lower-extremity DVT. Compared with those with left-sided DVT, patients with right-sided DVT have slightly higher rates of PE. Bilateral DVT is associated with markedly worse short-term and 1-year outcomes.
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Affiliation(s)
- Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York-Presbyterian Hospital, New York, New York.,Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, Connecticut.,Cardiovascular Research Foundation, New York, New York
| | - Babak Sharif-Kashani
- Division of Cardiology, Masih-Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bavand Bikdeli
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Reina Valle
- Department of Internal Medicine, Hospital Sierrallana, Santander, Spain
| | - Conxita Falga
- Department of Internal Medicine, Consorci Hospitalari de Mataró, Barcelona, Spain
| | - Antoni Riera-Mestre
- Department of Internal Medicine, Hospital Universitarie de Bellvitge - IDIBELL and Universitat de Barcelona, Barcelona, Spain
| | - Lucia Mazzolai
- Division of Angiology, Department of Heart and Vessel, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Peter Verhamme
- Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
| | - Philip S Wells
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Manuel Monreal
- Department of Internal Medicine, Universidad Católica de Murcia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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8
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Bikdeli B, Heggodu Devappa S, Beare C, Taylor C. Improving quality of medical admission clerking and validation of medical assessment proforma, complete audit cycle 1. Intern Med J 2017. [DOI: 10.1111/imj.3_13461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- B Bikdeli
- Northern Adelaide Local Health Network; Adelaide South Australia Australia
- University of Adelaide; Discipline of Medicine; Adelaide South Australia Australia
| | - S Heggodu Devappa
- Northern Adelaide Local Health Network; Adelaide South Australia Australia
| | - C Beare
- Northern Adelaide Local Health Network; Adelaide South Australia Australia
| | - C Taylor
- Northern Adelaide Local Health Network; Adelaide South Australia Australia
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9
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Affiliation(s)
- Sudheer Ahamed Puthiyaveetil
- Department of General Medicine, Modbury Hospital, Modbury Department of General Medicine Modbury Hospital, Modbury, Adelaide
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10
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Bikdeli B, Sharif-Kashani B, Chitsaz E, Bikdeli B, Chitsazan M, Kermani-Randjbar S, Behzadnia N, Yazdani S, Saliminejad L, Masjedi MR. Dexter versus sinister deep vein thrombosis: which is the more sinister? Findings from the NRITLD DVT registry. Semin Thromb Hemost 2011; 37:298-304. [PMID: 21455863 DOI: 10.1055/s-0031-1273093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Deep vein thrombosis (DVT) is a major health problem. Despite the wealth of studies on its epidemiology, few have described the thrombus sidedness and particularly the association of thrombus sidedness with clinical presentation and subsequent complications. This article reviews current knowledge regarding this topic and in light of recent data from a large prospective study. This is the first report from the prospective National Research Institute of Tuberculosis and Lung Disease DVT registry. Patients with ultrasound-confirmed symptomatic DVT were enrolled, and thrombus sidedness was investigated in each case. Computed tomography pulmonary angiography was used to diagnose coexisting pulmonary embolism (PE) in DVT patients with suggestive symptoms. Embolic burden score was calculated for those with PE. From the total of 100 patients, 45 had left-sided DVT, 41 had right-sided DVT, and 14 had bilateral DVT. Presenting symptoms and comorbidities were comparable, except for cancer, which was more common in those with right-sided involvement (either right-sided or bilateral DVT; P = 0.004). Compared with those with left-sided DVT, PE happened more frequently in right-sided DVT patients. Right-sided DVT patients also had a higher rate of massive PE ( P = 0.03) and a greater mean embolic burden (13.32 ± 1.63 versus 6.05 ± 1.06; P = 0.001). These findings support raised awareness for global reconsideration of the assumption of complete identicalness of right-sided and left-sided DVT. Although future studies are needed to better elucidate epidemiological and prognostic differences based on the thrombus sidedness, our preliminary findings suggest that the two are not completely identical and right-sided DVT might be more ominous.
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Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Department, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran.
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Sharif-Kashani B, Ahmadi ZH, Bikdeli B, Tabarsi P, Dorudinia A, Shahabi P, Raeissi S, Shadafza B, Estahbanati G, Naji A, Saliminejad L, Bakhshayesh-Karam M, Karimi S, Khodadad K, Masjedi MR, Gavazzi A. Bilateral diffuse pulmonary infiltration in a heart transplant recipient. Transpl Infect Dis 2009; 12:258-60. [PMID: 20015115 DOI: 10.1111/j.1399-3062.2009.00483.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pulmonary complications are not infrequent after heart transplantation. Kaposi sarcoma is a vascular tumor that can involve the skin as well as visceral organs. We describe a case of visceral and cutaneous Kaposi sarcoma that presented with diffuse bilateral pulmonary infiltration and breathlessness 6 month after heart transplantation. Following modulation of the immunosuppressive regimen and addition of chemotherapy, the patient had an excellent response and has had an uneventful 1-year follow-up.
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Affiliation(s)
- B Sharif-Kashani
- Cardiovascular Department, Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran
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13
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Hashemi MR, Rahnavardi M, Bikdeli B, Dehghani Zahedani M, Iranmanesh F. Touch cytology in diagnosing Helicobacter pylori: comparison of four staining methods. Cytopathology 2008; 19:179-84. [PMID: 18495002 DOI: 10.1111/j.1365-2303.2007.00417.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Helicobacter pylori (Hp), a major cause of peptic ulcer disease and an important risk factor for gastric malignancy, can be diagnosed by several methods. Touch cytology (TC) of the gastric mucosa has been noted to give good results and has been found to be very simple, inexpensive and rapid. However, evidence regarding the accuracy of different staining methods of TC is lacking. The present study aims at defining the diagnostic accuracy of four different staining methods of TC. METHODS Biopsy specimens were taken from the antral mucosa of one hundred consecutive patients referred for upper gastrointestinal endoscopy (UGIE) for various indications. TC slides were processed by four staining methods: Wright, Giemsa, Papanicolaou and Gram. Rapid urease test (RUT) and histological examination of specimens were also performed. The same experienced pathologist evaluated the coded samples. A patient's Hp status was established by minimum concordance of the three tests, including histology, RUT, and 'Touch mean'. The latter was defined positive when at least three of the four TC staining methods were positive. RESULTS Forty-six patients (46%) were positive for Hp according to Hp status. TC stained by Wright had excellent agreement with both histology (kappa = 0.80, P < 0.001) and RUT (kappa = 0.84, P < 0.001). Regarding Hp status, histology was 100% sensitive and RUT was 100% specific. Wright-stained TC (88.89%) was significantly more specific than both Giemsa- (74.07%; P < 0.05) and Papanicolaou-stained (70.37%; P < 0.05) TC. CONCLUSIONS RUT should still be acknowledged as the primary test in diagnosing Hp following UGIE. If RUT is negative and Hp detection is intended only, Wright-stained TC can safely substitute for histology. However, when assessment for severity of mucosal damage or cell atypias is meant, histology cannot be neglected.
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Affiliation(s)
- M R Hashemi
- Department of Gastroenterology, Artesh University of Medical Sciences, Tehran, Iran
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Rahnavardi M, Bikdeli B, Vahedi H, Alaei F, Pourmalek F, Amini A, Rahnavardi A. Morning report: a survey of Iranian senior faculty attitudes. Intern Emerg Med 2008; 3:17-24. [PMID: 18256889 DOI: 10.1007/s11739-008-0091-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 07/19/2007] [Indexed: 11/28/2022]
Abstract
Morning report (MR) is a universal component of internal medicine training. Despite its omnipresence, little is known about senior faculty attitudes toward MR. We aimed to survey expert attitudes towards MR. Using an 85-item self-administered questionnaire, we made a survey of medical education-trained faculty members (FMs) who participated in and presented articles at the Seventh National Iranian Congress on Medical Education, 12-15 November 2005, Tabriz, Iran, on the processes of teaching and learning during MR (n=175). Among the 111 FMs (63.4%) who completed the survey, education was the most frequently cited goal of the MR. Clinical wisdom and the ability to expand a resident's differential diagnosis skills were the attributes most often proposed as essential for the FMs. Respondents believed the FM in cooperation with the senior resident of the last duty (41%) or the senior resident of the last duty alone (40%) should select the presenting cases. The study participants stated that 41% of the MR should be spent discussing common cases, 33% in the area of expertise of the FM and 26% in discussing rare or interesting cases. A common opinion was that treatment recommendations should be based on the medical literature. In terms of the educational impact of activities during the MR, listing differential diagnoses and bedside visits to examine unique findings scored the highest. Education as the main goal of the MR can best be achieved by expanding residents' skills in differential diagnosis and in making decisions using an evidence-based, self-directed method.
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Affiliation(s)
- Mohammad Rahnavardi
- Educational Development Center, Artesh University of Medical Sciences, West Dr Fatemi Boulevard, Tehran, Iran.
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15
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Abstract
AIM: To describe the frequency of H pylori infection among 1000 southern Iranian dyspeptic patients.
METHODS: A prospective study was performed in a referral hospital in south of Iran from 1999 to 2005. One thousand dyspeptic patients (518 males, mean ± SD age of 49.12 ± 12.82 years) consecutively underwent upper gastrointestinal endoscopy. Multiple gastric antral biopsy samples were taken from all patients for rapid urease test and histopathologic examination (96.9% satisfactory samples). Patients were considered H pylori-infected if one or both tests were positive.
RESULTS: Six hundred and seventy-one patients (67.1%, 95% confidence interval [CI]: 64.2%-70.0%) were H pylori-infected. H pylori positivity was significantly more frequent in patients with peptic ulcer disease (PUD) than in those with non-ulcer dyspepsia (P < 0.001). Male-to-female ratio for duodenal and gastric ulcers was 2.7:1 and 1.5:1, respectively. Moreover, the duodenal-to-gastric ulcer ratio was 1.95:1. The frequency of H pylori infection among those with endoscopic diagnosis of gastritis, duodenal ulcer, gastric ulcer, and normal mucosa was 70.1% (398/568), 86.2% (150/174), 71.9% (64/89), and 33.5% (54/161), respectively. H pylori infection, male sex, and older age were independently associated with PUD in multivariate analysis. H pylori positivity was associated with chronic gastritis, and chronic active gastritis with odds ratios of 34.21 (95% CI: 12.19%-96.03%) and 81.21 (95% CI: 28.85%-228.55%), respectively.
CONCLUSION: H pylori and PUD are highly frequent in dyspeptic patients from south of Iran. H pylori is a cardinal risk factor for chronic active or inactive gastritis.
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Affiliation(s)
- Mahmood Reza Hashemi
- Department of Gastroenterology, Hormozgan University of Medical Sciences, Bandarabbas, Artesh University of Medical Sciences, Tehran, Iran
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