1
|
Rehman H, Rehman ST, Zulfiqar S, Awan S, Abid S. Real-world comparison of terlipressin vs. octreotide as an adjuvant treatment in the management of variceal bleeding. Sci Rep 2024; 14:6692. [PMID: 38509184 PMCID: PMC10954665 DOI: 10.1038/s41598-024-56873-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Abstract
Variceal bleeding is a major complication and the leading cause of death in patients with cirrhosis and portal hypertension. This study aims to compare the efficacy and safety of terlipressin vs octreotide as an adjuvant to endoscopic management of patients with esophageal variceal bleeding in a real-time scenario. We reviewed the medical records of patients with esophageal variceal bleeding from January 2005 to December 2020 at our tertiary care Aga Khan University Hospital. Mortality was assessed after 6 weeks. A total of 842 patients with variceal bleed were evaluated. 624 patients (74.1%) and 218 patients (25.9%) received Terlipressin and Octreotide respectively. On multiple regression analysis, cardiac events during hospital stay (OR: 11.22), presence of Porto-systemic encephalopathy (OR: 3.79), and elevated bilirubin levels at the time of presentation were found to be independent risk factors for increased six weeks mortality. Moreover, cardiac events during hospital stay (OR: 3.26), Porto-systemic encephalopathy at presentation (OR: 3.06), and octreotide administration (OR: 1.80) were identified as independent risk factors for increased length of hospital stay. Terlipressin and Octreotide have similar outcomes in terms of control of bleeding, hospital stay, mortality, and side effects when used as adjuvant therapy for the management of variceal bleeding.
Collapse
Affiliation(s)
- H Rehman
- Section of Gastroenterology, Department of Medicine, Aga Khan University, National Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - S T Rehman
- Section of Gastroenterology, Department of Medicine, Aga Khan University, National Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - S Zulfiqar
- Section of Gastroenterology, Department of Medicine, Aga Khan University, National Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - S Awan
- Section of Gastroenterology, Department of Medicine, Aga Khan University, National Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - Shahab Abid
- Section of Gastroenterology, Department of Medicine, Aga Khan University, National Stadium Road, P.O Box 3500, Karachi, Pakistan.
| |
Collapse
|
2
|
Lim JW, Lindsay E, Rehman H, Tong EYH, Ammen bin Badekrizaman M, Withall A, Dalgleish S, Mitchell M, Boddie D. 941 The Effect of COVID-19 on Orthopaedic Trauma Theatre Efficiency and Surgical Training in the North and East of Scotland Major Trauma Centres – a Year On. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
To determine the orthopaedic trauma theatre efficiency in two large major trauma centres (MTCs) in Scotland before and after the outbreak of Coronavirus disease (COVID-19) pandemic.
Method
All trauma patients presented to the North and East of Scotland's MTCs prior to the outbreak of COVID-19 (7th May to 7th June 2019), during the first peak of COVID-19 (7th May to 7th June 2020), after Aerosol Generating Procedures updates (7th November to 7th December 2020) and the ‘new normal’ (7th May to 7th June 2021) were retrospectively reviewed. Training opportunities and theatre time were compared. The Kruskall-Wallis test was used.
Results
There were no significant differences in the length of hospital stay (p=0.117, 0.065) and time from injuries and surgery within groups in both MTCs (p=0.508, 0.384). The pandemic has negatively affected the anaesthetic and surgical preparation time, time between end of procedure and send for next case, and turnover time, with more profound effect on the North of Scotland's MTC. The trainee's involvement as main surgeon had decreased with the outbreak of the pandemic, with the junior trainees being affected most severely in North of Scotland. The time taken for patient to arrive to theatre after sending and total downtime were twice as long in the North of Scotland.
Conclusion
The COVID-19 pandemic has negatively impacted the orthopaedic trauma theatre efficiency and training opportunities. Actions should be taken to improve the turnover time to maximise theatre efficiency while prioritizing training opportunities.
Collapse
Affiliation(s)
- JW Lim
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - E Lindsay
- Ninewells Hospital and Medical School , Dundee , United Kingdom
| | - H Rehman
- Warrington Hospital , Warrington , United Kingdom
| | - EYH Tong
- University of Aberdeen , Aberdeen , United Kingdom
| | | | - A Withall
- Ninewells Hospital and Medical School , Dundee , United Kingdom
| | - S Dalgleish
- Ninewells Hospital and Medical School , Dundee , United Kingdom
| | - M Mitchell
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - D Boddie
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| |
Collapse
|
3
|
Lim JW, Rehman H. 947 COVID19 and Its Impact on the North and East of Scotland Orthopaedic Trainees. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim
We conducted a trainee survey at the first peak of the pandemic to investigate the impact of COVID-19 on the North of Scotland (NoS) and East of Scotland (EoS) orthopaedic trainees.
Method
An online survey was distributed to all NoS and EoS orthopaedic trainees. All data collection was anonymous.
Results
Across both Scottish deaneries, 28 trainees had responded: 39% from EoS and 61% from NoS. Trainees at all stages of training responded to the survey, with the most responses received from specialist trainees in third year of training (ST3) (25%). In response to the pandemic, 18% of trainees had been redeployed and they were from NoS. Since the reconfiguration of service, 18% of trainees had done >20 operations in a month and they were senior trainees. If COVID-19 outbreak is likely going to reduce operating opportunities for a long period, only 36% of trainees would be open to the idea of making standard surgical specialty training longer whereas 57% of trainees would be open to longer working hours to achieve certification in Trauma and Orthopaedic surgery within 96 months.
Conclusion
The outbreak of COVID-19 has impacted both deaneries orthopaedic training and urgent restoration of surgical training is essential for individual trainees. Changes in working practices necessitated by COVID-19 have known to impact theatre efficiency. Actions should be taken to improve the theatre efficiency while prioritizing training opportunities.
Collapse
Affiliation(s)
- JW Lim
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - H Rehman
- Warrington Hospital , Warrington , United Kingdom
| |
Collapse
|
4
|
Sadiq F, Shafi S, Khan M, Ain Q, Khan I, Rehman H, Šikonja J, Mlinarič M, Gidding S, Groselj U. Mapping of familial hypercholesterolemia basic infrastructure in Pakistan. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
|
6
|
Sohail MA, Rashid MA, Habib HF, Malik MI, Yousaf MS, Rehman H. Effects of physical form and wheat straw level in the diet on growth performance, nutrient digestibility, rumen papillae morphometry, and carcass characteristics in Lohi lambs. Anim Prod Sci 2022. [DOI: 10.1071/an21559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
7
|
Rehman H, Chandra N, Jammalamadaka SR. Competing risks survival data under middle censoring-An application to COVID-19 pandemic. Healthc Anal (N Y) 2021; 1:100006. [PMID: 38620911 PMCID: PMC8479409 DOI: 10.1016/j.health.2021.100006] [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] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/16/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
Abstract
Survival data is being analysed here under the middle censoring scheme, using specifically quantile function modelling under competing risks. The use of middle censoring scheme has been shown to be very appropriate under the COVID-19 pandemic scenario. Cause-specific quantile inference under middle censoring is employed. Such quantile inferences are obtained through cumulative incidence function based on cause-specific proportional hazards model. The baseline lifetime is assumed to follow a very general parametric model namely the Weibull distribution, and is independent of the censoring mechanism. We obtain estimates of the unknown parameters and cause specific quantile functions under classical as well as a Bayesian set-up. A Monte Carlo simulation study assesses the relative performance of the different estimators. Finally, a real life data analysis is given for illustration of the proposed methods.
Collapse
Affiliation(s)
- H Rehman
- Department of Statistics, Ramanujan School of Mathematical Sciences, Pondicherry University, Puducherry 605 014, India
| | - N Chandra
- Department of Statistics, Ramanujan School of Mathematical Sciences, Pondicherry University, Puducherry 605 014, India
| | - S Rao Jammalamadaka
- Department of Statistics and Applied Probability, University of California, Santa Barbara, CA, USA
| |
Collapse
|
8
|
Jamorabo DS, Deek MP, Yom SS, Rehman H, Zietman AL, Motwani SB, Briggs WM, Kim S, Chang DT, Jabbour SK. Can Sex and Seniority Predict the Quality of a Journal Reviewer's Manuscript Critique? Int J Radiat Oncol Biol Phys 2021; 111:312-316. [PMID: 34044095 PMCID: PMC10845841 DOI: 10.1016/j.ijrobp.2021.05.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate reviewers' timeliness and review quality for the International Journal of Radiation Oncology, Biology, Physics (IJROBP) by sex and seniority. METHODS AND MATERIALS The IJROBP editorial office provided data on 3962 individuals invited to review manuscripts from 2011 through 2014. We identified 1657 reviewers who had been invited to provide a review on at least 3 occasions during the study period and compared review timeliness and scoring between male and female reviewers. We confirmed the reviewers' sex after having unblinded their names based on our personal acquaintance with them and via an Internet search on their department websites. We then did a subset analysis of 124 US-based reviewers who had returned a "major revision" decision. We used the Review Quality Instrument (RQI) to rate their reviews. We used odds ratios and t tests to look for differences in mean RQI scores and factors that might be associated with quality-in particular, Hirsch indices (h indices) and year of first certification. RESULTS Of the 1657 reviewers of interest, 1245 (75.1%) were men and 412 (24.9%) were women. We found no statistically significant differences between men and women in the time to respond to invitations. There were no statistically significant differences in timeliness or review reminders based on sex. Our subset analysis showed no difference in quality (RQI scores) based on the reviewers' sex, h index, or year of first certification. CONCLUSIONS Women and men render reviews of equal quality regardless of seniority and h index, yet women have been invited less frequently to review. This is likely because of the underrepresentation of women in radiation oncology. A more balanced academic population is needed to address this continuing disparity of women's representation in academic publishing.
Collapse
Affiliation(s)
| | - Matthew P Deek
- Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sue S Yom
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, California
| | - Hasan Rehman
- Department of Medicine, North Shore University Hospital, Manhasset, New York
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sabin B Motwani
- Department of Radiation Oncology, St. Joseph's University Medical Center, Paterson, New Jersey
| | - William M Briggs
- Department of Biostatistics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Sinae Kim
- Rutgers School of Public Health, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| |
Collapse
|
9
|
Yasmin S, Yousaf M, Majeed K, Rashid M, Tahir S, Numan M, Mustafa R, Nagra S, Zaneb H, Rehman H. Dietary Catharanthus roseus modulates intestinal microarchitecture in broilers. S AFR J ANIM SCI 2021. [DOI: 10.4314/sajas.v51i4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study evaluated the efficacy of ethanolic extracts of Catharanthus roseus (C. roseus) in altering growth performance, viscera development and intestinal microarchitecture in broilers. Day-old broiler chicks (n = 175) were randomly divided into seven groups (n = 25/group) with 5 replicates (n = 5). The chicks in the control groups were fed a corn-soya-based basal diet, whereas groups 2 - 4 had the same basal diets supplemented with 0.05%, 0.1%, and 0.2% ethanolic leaf extracts (ELE), respectively. Chicks in groups 5 - 7 were fed the basal diet supplemented with 0.05%, 0.1%, and 0.2% ethanolic root extracts (ERE) of C. roseus, respectively. The growth performance and feed conversion ratio remained unchanged, but feed consumption of birds supplemented with 0.1% ERE increased in weeks 1 and 3. The relative length of the small intestine was lower in the 0.05% ERE group compared with the control. Villus height, width, surface area, and lamina propria thickness were higher in the 0.1% ERE group in all three segments of the small intestine than in the control. Broilers supplemented with 0.1% ERE performed better in terms of feed consumption and improved intestinal microarchitecture of the small intestine.
Collapse
|
10
|
Fujii T, Rehman H, Chung SY, Shen J, Newman J, Wu V, Hines A, Azimi-Nekoo E, Fayyaz F, Lee M, Raptis G, Egeblad M, Zhu X. Treatment with Granulocyte-colony Stimulating Factor (G-CSF) is not associated with Increased Risk of Brain Metastasis in Patients with De Novo Stage IV Breast Cancer. J Cancer 2021; 12:5687-5692. [PMID: 34405029 PMCID: PMC8364654 DOI: 10.7150/jca.63159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Survival outcome after developing brain metastasis is poor and there is an unmet need to identify factors that can promote brain metastasis. Granulocyte-colony stimulating factor (G-CSF) is given to support neutrophil recovery after myelosuppressive chemotherapy to some patients. However, there is emerging evidence that neutrophils can promote metastasis, including through the formation of neutrophil extracellular traps (NETs), scaffolds of chromatin with enzymes expelled from neutrophils to the extracellular space. In animal models, G-CSFs can induce NETs to promote liver and lung metastasis. The primary objective of this study was to test the association between G-CSF use and the later incidence of brain metastasis. Methods: Patients with de novo Stage IV breast cancer, without known brain metastasis at the time of initial diagnosis, were identified from electronic medical records covering the period from 1/1/2013 to 12/31/2020 at Northwell Health. Univariate and multivariate logistic regression models were used to test the association between variables of interest, including G-CSF use, and brain metastasis. Results: A total of 78 patients were included in the final analysis. Among those 78 patients, 24 patients (30.8%) had received G-CSF along with chemotherapy at least once. In logistic regression models, G-CSF use was not a significant factor to predict brain metastasis (OR 1.89 [95%CI 1.89-5.33]; P=0.23). Interestingly, in multivariate logistic models, pulmonary embolism (PE)/deep venous thrombosis (DVT) was a significant predictive factor of brain metastasis (OR 6.74 [95%CI 1.82-25.01]; P=0.004) (38.5% vs 21.5%). Conclusions: The use of G-CSF was not associated with increased risk of brain metastasis in patients with de novo Stage IV breast cancer. Interestingly, PE/DVT, which can be associated with elevated NETs, was associated with brain metastasis. Further studies are warranted to determine whether DVT/PE with or without elevated NETs levels in the blood, is predictive of developing brain metastasis in patients with de novo Stage IV breast cancer.
Collapse
Affiliation(s)
- Takeo Fujii
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA.,Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, USA
| | - Hasan Rehman
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - Su Yun Chung
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - Janice Shen
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - James Newman
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - Vernon Wu
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - Adam Hines
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - Elham Azimi-Nekoo
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - Fatima Fayyaz
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - Meeyoung Lee
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - George Raptis
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| | - Mikala Egeblad
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, USA
| | - Xinhua Zhu
- Division of Hematology and Medical Oncology, Northwell Health Cancer Institute, Northwell Health, Lake Success, New York, USA
| |
Collapse
|
11
|
Tea I, Rehman H, Patel A, Shah A. BACK TO THE FUTURE - SUCCESSFUL RETROGRADE NATIVE VESSEL CTO PCI VIA A SVG GRAFT BY USING CT CO-REGISTRATION AFTER PREVIOUS UNSUCCESSFUL ATTEMPTS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Lim JW, Rehman H, Gaba S, Sargeant H, Stevenson IM, Boddie DE. Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19). Ann R Coll Surg Engl 2021; 103:167-172. [PMID: 33645286 DOI: 10.1308/rcsann.2020.7069] [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: 11/22/2022] Open
Abstract
INTRODUCTION We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU. METHODS We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann-Whitney and Fisher Exact tests were used to test the statistical significance of data. RESULTS A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001). CONCLUSIONS Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.
Collapse
Affiliation(s)
- J W Lim
- Aberdeen Royal Infirmary, Aberdeen, UK
| | - H Rehman
- Aberdeen Royal Infirmary, Aberdeen, UK
| | - S Gaba
- Aberdeen Royal Infirmary, Aberdeen, UK
| | | | | | | |
Collapse
|
13
|
Rehman H, Stevenson I. Pneumatic high-speed burr as an adjunct to femoral preparation for fixation of bisphosphonate related fractures. Ann R Coll Surg Engl 2021; 103:1. [PMID: 33682432 DOI: 10.1308/rcsann.2020.7051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- H Rehman
- Aberdeen Royal Infirmary, Aberdeen, UK
| | | |
Collapse
|
14
|
Saif MW, Hakim N, Chi J, Rehman H, Goyal SP, Olazagasti C, Sheperd PF, Jose J. First Analysis of Same-day Pegfilgrastim Use with Concurrent Capecitabine-based Regimens in Patients with Gastrointestinal Malignancies. Cancer Med J 2021; 4:1-6. [PMID: 33655238 PMCID: PMC7903891] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pegfilgrastim is administered 24 hours. after chemotherapy to reduce risks of myelosuppression. This requires an additional clinic visit, which can be difficult for some patients (pts) due to work and transportation issues. In GI malignancies, patients receiving capecitabine-based regimens also require pegfilgrastim to reduce myelotoxicity. We present here the first study to analyze safety and efficacy of administering pegfilgrastim on the same day as capecitabine-based regimens in patients with GI malignancies. METHODS We evaluated 157 patients with GI malignancies who received a capecitabine-based chemotherapy regimen, including XELOX, EOX, ECX, XELIRI, MIXE, gemcitabine-capecitabine and same-day pegfilgrastim (6 mg) within 1 hr of completion of systemic agents. As per institutional guidelines, patients were counseled on risks of same-day pegfilgrastim prior to its administration. Patients were followed to determine the degree of neutropenia and toxicity. RESULTS A total of 914 chemotherapy cycles in 157 patients were analyzed. Median ANC nadir for all cycles was 5634/uL (range: 450 - 23800). Grade 1 and 2 neutropenia developed in 11 of 914 cycles. Bone pain reported in 9 pts. There was 1 episode of grade >3 neutropenia resulting in infection and antibiotic use. No other patient required dose reductions, chemotherapy delays, or hospitalizations. No increased toxicity of capecitabine was noticed. CONCLUSIONS We believe our study is the first in GI malignancies to report that same-day pegfilgrastim administration with capecitabine-based regimens may be as effective and safe as next-day administration. Additionally, given the absence of CD in human bone marrow, it appears capecitabine can be used concurrently with pegfilgrastim. Prospective studies should be done to further investigate, as this practice can benefit patients clinically, decrease office visits, increase patient's satisfaction and reduce healthcare costs.
Collapse
Affiliation(s)
- Muhammad Wasif Saif
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra, Feinstein Institute for Medical Research, Lake Success, NY
| | - Nausheen Hakim
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra, Feinstein Institute for Medical Research, Lake Success, NY
| | - Jeffrey Chi
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra, Feinstein Institute for Medical Research, Lake Success, NY
| | - Hasan Rehman
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra, Feinstein Institute for Medical Research, Lake Success, NY
| | - Shreya Prasad Goyal
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra, Feinstein Institute for Medical Research, Lake Success, NY
| | - Coral Olazagasti
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra, Feinstein Institute for Medical Research, Lake Success, NY
| | - Patnita Forde Sheperd
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra, Feinstein Institute for Medical Research, Lake Success, NY
| | - Jyothi Jose
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra, Feinstein Institute for Medical Research, Lake Success, NY
| |
Collapse
|
15
|
Rehman H, Chandra N, Hosseini-Baharanchi FS, Baghestani AR, Pourhoseingholi MA. Cause-specific hazard regression estimation for modified Weibull distribution under a class of non-informative priors. J Appl Stat 2021; 49:1784-1801. [DOI: 10.1080/02664763.2021.1882407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- H. Rehman
- Department of Statistics, Ramanujan School of Mathematical Sciences, Pondicherry University, Puducherry, India
| | - N. Chandra
- Department of Statistics, Ramanujan School of Mathematical Sciences, Pondicherry University, Puducherry, India
| | - Fatemeh Sadat Hosseini-Baharanchi
- Minimally Invasive Surgery Research Center and Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Baghestani
- Physiotherapy Research Center and Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Amin Pourhoseingholi
- Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Abbas S, Yousaf M, Ahmad I, Rehman H, Mahmood A, Ashraf S, Blouch R, Shahzad A, Nak Y, Nak D. Evaluation of serum analytes in pregnant and non-pregnant dairy cows as indicators of pregnancy. S AFR J ANIM SCI 2021. [DOI: 10.4314/sajas.v50i5.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to reveal the dynamics of haematological indicators in pregnant and non-pregnant dairy cows. Sixty multiparous healthy dairy cows were divided into four groups based on the length of time they had been pregnant, namely first, second and third trimesters, and non-pregnant (n=15 each). Blood was collected from each animal, and serum was harvested and stored at -20 °C for biochemical profiling. Concentrations of serum total oxidants (TOC), ceruloplasmin oxidase (CpO) and triiodothyronine (T3) were higher (P <0.05) during the third trimester compared with non-pregnant cows. Serum arylesterase (Ary) concentration was lower (P <0.05) during the second and the third trimesters compared with the non-pregnant cows. The concentration of serum total homocysteine (tHcy) was higher (P <0.05) the third trimester compared with the first and the second trimesters. The concentrations of serum total antioxidants (TAC), paraoxonase 1 (PON1), thyroxine (T4), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were not different in the pregnant and the non-pregnant cows. Thus, TOC, Ary, CpO, tHcy and T3 could be taken as biological markers to assess the progression of pregnancy and to develop management tools to improve health status during late gestation in dairy cows
Keywords: ceruloplasmin, hepatic enzymes, late gestation, triiodothyronine
Collapse
|
17
|
Nieto MJ, Li Z, Rehman H, Saif MW. Lower 24-Month Relative Survival among Black Patients with Non- Hodgkin's Lymphoma: An Analysis of the SEER Data 1997-2015. J Clin Haematol 2021; 2:5-13. [PMID: 33834180 PMCID: PMC8026162] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background Recent progress in the therapies used in patients with Non- Hodgkin's lymphoma has improved survival. The incidence has been reported to be decreasing in the last few years, accounting for 4% of all cancers. This study analyzed time trends for incidence, mortality, and prevalence of NHL. Methods We analyzed the SEER Cancer Database from 1997 to 2015. Join point regression analysis was used to determine age-adjusted incidence rates, 24-month relative survival rate, and to identify racial/ethnic groups with a lower survival. Results The trend in incidence of NHL decreased between 2008 and 2011 at an annual percentage change rate of 3.74%. The male predominance among NHL patients between 1997-2015 was 57%. The number of male patients affected with NHL has been similar in the last 20 years. Female predominance with NHL was higher in 1998 at 46 %, and lower in 2010 at 42.85%. The 24-month relative survival rate was higher among white patients as compared to black patients with NHL. Conclusions Our analysis demonstrated that the incidence of Non-Hodgkin's Lymphoma has decreased among minorities; however, the outcomes are inferior in terms of survival. This analysis showed an inferior 24-month relative survival rate among black patients compared with white patients. This analysis demonstrates the need for further research in NHL to determine the biological differences and social factors that influence the lower survival among black patients with NHL.
Collapse
Affiliation(s)
- Maria J Nieto
- Northwell Health Cancer Institute & Donald and Barbara
Zucker School of Medicine at Hofstra, Lake Success, NY, USA,Correspondence should be addressed to Maria J
Nieto;
| | - Zhen Li
- Wyckoff Medical Center, New York, NY, USA
| | - Hasan Rehman
- Northwell Health Cancer Institute & Donald and Barbara
Zucker School of Medicine at Hofstra, Lake Success, NY, USA
| | - Muhammad Wasif Saif
- Northwell Health Cancer Institute & Donald and Barbara
Zucker School of Medicine at Hofstra, Lake Success, NY, USA
| |
Collapse
|
18
|
Beg F, Rehman H, Chamsi-Pasha MA, Nabi F, Chang SM, Mahmarian JJ, Al-Mallah MH. Association Between FFR CT and Instantaneous Wave-Free Ratio (iFR) of Intermediate Lesions on Coronary Computed Tomography Angiography. Cardiovasc Revasc Med 2020; 31:57-60. [PMID: 33272881 DOI: 10.1016/j.carrev.2020.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/09/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND New data suggests long term outcomes of coronary revascularization based on instantaneous wave free ratio (iFR) are equivalent to invasive fractional flow reserve (FFR). We aimed to evaluate the correlation between non-invasive FFR derived from cardiac CT (FFRCT) and iFR. METHODS Data from 21 patients with 26 vessels, who underwent both FFRCT computation and invasive iFR measurement, were analysed. We evaluated diagnostic performance of FFRCT according to two cut-off values of ≤0.80 and ≤0.70 with iFR ≤0.89 as the reference standard. RESULTS In a per vessel analysis, the average diameter stenosis was 59%, mean FFRCT was 0.81 while mean iFR was 0.90. Using an FFRCT cut-off of 0.80, the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy for FFRCT were 86%, 84%, 67%, 94%, and 85% respectively. When the cut-off was lowered to 0.70, the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy for FFRCT were 57%, 100%, 100%, 86% and 88% respectively. CONCLUSION FFRCT correlates well with iFR in this small retrospective study. Larger studies are required to confirm this finding.
Collapse
Affiliation(s)
- Faheemullah Beg
- Section of Interventional & Structural Cardiology, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Hasan Rehman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States of America
| | - Mohammed A Chamsi-Pasha
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States of America
| | - Faisal Nabi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States of America
| | - Su-Min Chang
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States of America
| | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States of America
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States of America.
| |
Collapse
|
19
|
Rehman H, Chi J, Hakim N, Goyal SP, Olazagasti C, Jose J, Moriarty L, Saif MW. Attenuated regimen of biweekly gemcitabine/nab-paclitaxel in patients aged 65 years or older with advanced pancreatic cancer. Therap Adv Gastroenterol 2020; 13:1756284820974912. [PMID: 33281939 PMCID: PMC7692343 DOI: 10.1177/1756284820974912] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/29/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Treatment with gemcitabine/nab-paclitaxel confers a survival benefit over gemcitabine monotherapy in patients with advanced pancreatic cancer (APC). However, such treatment can be associated with significant toxicities especially in older patients and carries practical disadvantages related to a weekly schedule along with financial cost. We retrospectively analyzed patients >65 years of age with APC who received a modified biweekly regimen of gemcitabine/nab-paclitaxel to evaluate efficacy and toxicity. METHODS Patients aged >65 years with chemo-naïve APC with Eastern Cooperative Oncology Group performance status ⩽2 were studied. Patients were treated with a modified regimen of gemcitabine 1000 mg/m2 and nab-paclitaxel 125 mg/m2 every 2 weeks on days 1 and 15 of a 28-day cycle. Patients were evaluated for progression-free survival (PFS) and overall survival (OS) with analyses performed using the Kaplan-Meier method. Adverse events were recorded on the day of chemotherapy. Cancer antigen 19.9 was measured in every cycle and restaging scans were performed every two cycles. RESULTS A total of 73 patients (median age: 73 years; range: 66-93) were treated with biweekly gemcitabine/nab-paclitaxel as first-line treatment. The median OS and PFS were 9.1 months and 4.8 months, respectively. Around 66% of patients received growth-factor support based on American Society of Clinical Oncology guidelines and no patient developed neutropenic fever. The incidences of grade ⩾3 toxicity for neutropenia, anemia, thrombocytopenia, and neurotoxicity were 2%, 7%, 3%, and 5%, respectively. Dose reductions of gemcitabine/nab-paclitaxel were required in 10% and 4% patients, respectively. CONCLUSION In patients older than >65 years of age with APC, a modified regimen of biweekly gemcitabine/nab-paclitaxel was found to be effective when compared with the historical control from the MPACT study. This regimen allowed for fewer dose reductions, reduced healthcare costs from additional appointments, travel-related cost, as well as a favorable side-effect profile while maintaining efficacy. Though retrospective in nature, this study underlines the need for further investigation, particularly in elderly patients with poor performance status, such as those with pancreatic cancer, and in order to combine with a third agent, such as a targeted treatment or immunotherapy.
Collapse
Affiliation(s)
- Hasan Rehman
- Northwell Health Cancer Institute, and Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Jeffrey Chi
- Northwell Health Cancer Institute, and Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Nausheen Hakim
- Northwell Health Cancer Institute, and Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Shreya Prasad Goyal
- Northwell Health Cancer Institute, and Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Coral Olazagasti
- Northwell Health Cancer Institute, and Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Jyothi Jose
- Northwell Health Cancer Institute, and Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Linda Moriarty
- Northwell Health Cancer Institute, and Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | | |
Collapse
|
20
|
Rehman H, Ali Z, Qadir A, H. Farooq M, Shuaib A, Zahra A, Shahzady T, Hussain H. Synthesis of CuO-NPS by simple wet chemical method using various dicarboxylic acid salts as precursors: Spectral characterization and in-vitro biological evaluation. B CHEM SOC ETHIOPIA 2020. [DOI: 10.4314/bcse.v34i2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this study, a simple chemical reduction method was employed to synthesize CuO-NPs. Various dicarboxylic acids were converted into Cu(II) salt of dicarboxylic acid which were used as precursors. NPs were produced by reducing precursors with NaBH4. Characteristics of synthesized NPs were investigated by using important analytical techniques including Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), thermo gravimetric analysis (TGA) and scanning electron microscopy (SEM). Developed NPs were investigated for their antibacterial activity against a range of bacterial strains by employing agar well diffusion method. CuO-NPs exhibited good to moderate activity against E-Coli, B. Subtilis and poor activity against K. pneumonia and Methicillin-resistant Staphylococcus aureus (MRSA). It was found that amongst all experienced compounds sample 2 showed good activity with minimum inhibition concentration (MIC) 10 µg/mL (zone of inhibition: 22± 0.12 mm) while sample 3 showed poor activity with MIC 40 µg/mL (zone of inhibition: 8.0 ± 0.18 mm).
KEY WORDS: CuO-NPs, Dicarboxylic acids, Sodium borohydride, Antibacterial study
Bull. Chem. Soc. Ethiop. 2020, 34(2), 323-334
DOI: https://dx.doi.org/10.4314/bcse.v34i2.10
Collapse
|
21
|
Rehman H, Kalra A, Kochar A, Uberoi AS, Bhatt DL, Samad Z, Virani SS. Secondary prevention of cardiovascular diseases in India: Findings from registries and large cohorts. Indian Heart J 2020; 72:337-344. [PMID: 33189191 PMCID: PMC7670271 DOI: 10.1016/j.ihj.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022] Open
Abstract
Several registries and quality improvement initiatives have focused on assessing and improving secondary prevention of CVD in India. While the Treatment and Outcomes of Acute Coronary Syndromes in India (CREATE), Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF), and Trivandrum Heart Failure (THF) registries are limited to collecting data, the Tamil Nadu-ST-Segment Elevation Myocardial Infarction (TN-STEMI) program was aimed at examining and improving access to revascularization after an ST-elevation myocardial infarction (STEMI). The Acute Coronary Syndromes: Quality Improvement in Kerala (ACS-QUIK) study recruited hospitals from the Kerala ACS registry to assess a quality improvement kit for patients with ACS while the Practice Innovation and Clinical Excellence India Quality Improvement Program (PIQIP) provides valuable data on outpatient CVD quality of care. Collaborative efforts between health professionals are needed to assess further gaps in knowledge and policy makers to utilize new and existing data to drive policy-making.
Collapse
Affiliation(s)
- Hasan Rehman
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ajar Kochar
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Angad S Uberoi
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, New York, NY, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Zainab Samad
- Department of Medicine, Section of Cardiology, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
22
|
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality worldwide. Antiplatelet agents are considered to be the cornerstone for secondary prevention of stroke, but the role of using multiple antiplatelet agents early after stroke or transient ischaemic attack (TIA) to improve outcomes has not been established. OBJECTIVES To determine the effectiveness and safety of initiating, within 72 hours after an ischaemic stroke or TIA, multiple antiplatelet agents versus fewer antiplatelet agents to prevent stroke recurrence. The analysis explores the evidence for different drug combinations. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 6 July 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 7 of 12, 2020) (last searched 6 July 2020), MEDLINE Ovid (from 1946 to 6 July 2020), Embase (1980 to 6 July 2020), ClinicalTrials.gov, and the WHO ICTRP. We also searched the reference lists of identified studies and reviews and used the Science Citation Index Cited Reference search for forward tracking of included studies. SELECTION CRITERIA We selected all randomised controlled trials (RCTs) that compared the use of multiple versus fewer antiplatelet agents initiated within 72 hours after stroke or TIA. DATA COLLECTION AND ANALYSIS We extracted data from eligible studies for the primary outcomes of stroke recurrence and vascular death, and secondary outcomes of myocardial infarction; composite outcome of stroke, myocardial infarction, and vascular death; intracranial haemorrhage; extracranial haemorrhage; ischaemic stroke; death from all causes; and haemorrhagic stroke. We computed an estimate of treatment effect and performed a test for heterogeneity between trials. We analysed data on an intention-to-treat basis and assessed bias for all studies. We rated the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 15 RCTs with a total of 17,091 participants. Compared with fewer antiplatelet agents, multiple antiplatelet agents were associated with a significantly lower risk of stroke recurrence (5.78% versus 7.84%, risk ratio (RR) 0.73, 95% confidence interval (CI) 0.66 to 0.82; P < 0.001; moderate-certainty evidence) with no significant difference in vascular death (0.60% versus 0.66%, RR 0.98, 95% CI 0.66 to 1.45; P = 0.94; moderate-certainty evidence). There was a higher risk of intracranial haemorrhage (0.42% versus 0.21%, RR 1.92, 95% CI 1.05 to 3.50; P = 0.03; low-certainty evidence) and extracranial haemorrhage (6.38% versus 2.81%, RR 2.25, 95% CI 1.88 to 2.70; P < 0.001; high-certainty evidence) with multiple antiplatelet agents. On secondary analysis of dual versus single antiplatelet agent therapy, benefit for stroke recurrence (5.73% versus 8.06%, RR 0.71, 95% CI 0.62 to 0.80; P < 0.001; moderate-certainty evidence) was maintained as well as risk of extracranial haemorrhage (1.24% versus 0.40%, RR 3.08, 95% CI 1.74 to 5.46; P < 0.001; high-certainty evidence). The composite outcome of stroke, myocardial infarction, and vascular death (6.37% versus 8.77%, RR 0.72, 95% CI 0.64 to 0.82; P < 0.001; moderate-certainty evidence) and ischaemic stroke (6.30% versus 8.94%, RR 0.70, 95% CI 0.61 to 0.81; P < 0.001; high-certainty evidence) were significantly in favour of dual antiplatelet therapy, whilst the risk of intracranial haemorrhage became less significant (0.34% versus 0.21%, RR 1.53, 95% CI 0.76 to 3.06; P = 0.23; low-certainty evidence). AUTHORS' CONCLUSIONS Multiple antiplatelet agents are more effective in reducing stroke recurrence but increase the risk of haemorrhage compared to one antiplatelet agent. The benefit in reduction of stroke recurrence seems to outweigh the harm for dual antiplatelet agents initiated in the acute setting and continued for one month. There is lack of evidence regarding multiple versus multiple antiplatelet agents. Further studies are required in different populations to establish comprehensive safety profiles and long-term outcomes to establish duration of therapy.
Collapse
Affiliation(s)
- Imama A Naqvi
- Stroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University, New York, USA
| | - Ayeesha K Kamal
- Stroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Hasan Rehman
- Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
23
|
Gardner WT, Rehman H, Frost A. Spinal epidural abscesses - The role for non-operative management: A systematic review. Surgeon 2020; 19:226-237. [PMID: 32684428 DOI: 10.1016/j.surge.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal Epidural Abscesses (SEAs) are traditionally seen as a surgical emergency. However, SEAs can be discovered in entirely asymptomatic patients. This presents a dilemma for the attending clinician as to whether to subject these patients to significant surgery. This systematic review updates the evidence surrounding the efficacy of non-operative SEA management by means of intravenous antibiotics ± radiologically-guided aspiration. AIMS 1. To assess failure rates of medical therapy for SEA. The absolute definition of 'failure' used by the study was recorded, and comparisons made. 2. To review of risk factors for success/failure of medical treatment for SEA. METHODS A database search with the MESH term 'epidural abscess' and keywords ['treatment' OR 'management'] were used. RESULTS 14 studies were included. The number of SEA patients managed non-operatively ranged from 19 to 142. There was significant heterogeneity across the studies. Pooled Failure of Medical Therapy (FMT) (defined as any poor outcome) was 29.40%. When FMT = mortality the pooled rate was 11.49%. Commonly cited risk factors for FMT included acute neurological compromise, diabetes mellitus, increasing age and Staphylococcus aureus. CONCLUSION SEA will always be a condition mostly managed surgically. Despite this, there is growing evidence that non-operative management can be possible in the correct patients. The key is in patient selection - patients with any of the above-mentioned risk factors have the potential to deteriorate further on medical treatment and have a worse outcome than if they had undergone emergency surgery straight away. Ongoing research will hopefully further investigate this crucial step.
Collapse
Affiliation(s)
- W T Gardner
- Department of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
| | - H Rehman
- Department of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - A Frost
- Department of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| |
Collapse
|
24
|
Abbas S, Rashid M, Yousaf M, Ashraf S, Rabbani I, Zaneb H, Tahir S, Shahzad A, Rehman H. Effect of maternal yeast feeding on dam performance and serum health biomarkers of Beetal goat kids. S AFR J ANIM SCI 2020. [DOI: 10.4314/sajas.v50i2.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Supplementation with dietary yeast has improved digestibility and productive performance in ruminants. In this research the primary objective was to appraise the effects of dietary yeast supplementation of female goats during the transition period on milk composition and yield and on production and serum health biomarkers of their kids. Twenty-four Beetal goats (4 ± 1.2 years) were randomly assigned to three groups, which received 0, 5, and 10 grams/animal/day of live dried yeast Saccharomyces cerevisiae for 60 days (30 days pre- and post-partum). All goats were fed 500 grams of concentrate with water and green fodder ad libitum. Milk samples were collected at 7, 14, 21, and 28 days post kidding. Kids were weighed on days 0, 7, 15, 22, and 30, and blood samples were collected on days 15 and 30 for serum metabolites (glucose, urea, cholesterol, non-esterified fatty acids (NEFA), serum total proteins, albumin, globulin, albumin to globulin ratio, serum oxidant and antioxidant activity (malondialdehyde) (MDA) and catalase), and liver enzymes aspartate aminotransferase (AST) and alanine transaminase (ALT) assessment. Milk yield was significantly (P =0.02) higher during the post-partum period in yeast-fed goats. Yeast-fed goats also produced milk containing more fat (P <0.001) and protein (P <0.001) compared with control goats. Birth weight, average daily gain, and serum health biomarkers of the kids were not influenced by the treatments. In conclusion, dietary yeast supplementation resulted in increased production performance of the dams without significant impact on their offspring.Keywords: average daily gain, catalase activity, hepatic enzymes, milk production, Saccharomyces cerevisiae, transition period
Collapse
|
25
|
Rehman H, Chi J, Hakim N, Jose J, Moriarty L, Lamont C, Saif WM. FOLFIRINOX versus sequential 5-FU, oxaliplatin, and irinotecan-based regimens in patients with recurrent pancreatic cancer (rPDAC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16791 Background: There is a paucity of data to guide treatment for rPDAC after curative resection and gemcitabine-based adjuvant chemotherapy. Our aim was to investigate whether combination treatment upfront with all active agents is better than sequential administration of these drugs in patients with rPDAC following curative therapy. Methods: We retrospectively analyzed overall survival (OS), progression-free survival (PFS), response rate (RR), and adverse events (AEs) in patients treated for rPDAC. Patients received FOLFIRNOX upfront versus sequential therapy in the following order based on patient’s presence of toxicities (FOLFOX —> FOLFIRI, FOLFOX—> liposomal irinotecan/5FU, liposomal irinotecan/5FU —> FOLFOX). Each treatment was administered per NCCN guidelines with regulated staging scans, blood work, and office visits. Data was collected about chemotherapy dose, ECOG performance status (PS), RR, PFS, OS, and AEs. Results: 55 patients were identified with ECOG PS ≤ 2 and male:female ratio 35:20. Results for FOLFIRINOX, FOLFOX followed by FOLFIRI, FOLFOX followed by liposomal irinotecan/5FU, and vice versa are as follows respectively: PFS 4.0, 3.5, 3.5, and 3.0 months; OS 8.0, 7.5, 7.0, and 8.3 months; RR 10%, (8%, 3%), (9%, 4%), and (3%, 5%). One of the patients in the mFOLFIRINOX was able to undergo metastasectomy. The table summarizes the toxicities and dose modifications seen. Conclusions: Upfront FOLFIRINOX versus sequential regimens of oxaliplatin and irinotecan-containing regimens resulted in similar PFS and OS but higher AEs as expected. However, surgery was only possible in patients receiving FOLFIRINOX. Our findings support the use of sequential treatment in rPDAC who are not potential surgical candidates. Further investigative work is warranted to optimize sequencing of active agents in this setting where prognosis has historically been poor. [Table: see text]
Collapse
Affiliation(s)
- Hasan Rehman
- Northwell Health Cancer Institute, Lake Success, NY
| | - Jeffrey Chi
- Northwell Health Cancer Institute, Lake Success, NY
| | | | - Jyothi Jose
- Northwell Health Cancer Institute, Lake Success, NY
| | | | - Carol Lamont
- Northwell Health Cancer Institute, Lake Success, NY
| | | |
Collapse
|
26
|
Hakim N, Chi J, Rehman H, Nealon W, Deutsch GB, Newman E, Anantha S, Coppa G, Deperalta D, Rishi A, Maloney A, Moriarty L, Smith MH, Jose J, Saif WM. Safety and efficacy of biweekly gemcitabine in combination with capecitabine (GemCap) in elderly and frail patients (pts) with resected pancreatic cancer (PC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4628 Background: ESPAC-4 study showed that GemCap conferred a survival benefit over gemcitabine monotherapy in resected PC patients. ESPAC-4 included patients with median age of 65 years (37-81) and ECOG performance status (PS) of 0 (43%), 1 (54%) and 2 (2%) who received a median cumulative dose of gemcitabine of 15,000 mg/m2, capecitabine. Here we present our experience with an adopted biweekly regimen of GemCap in patients who were ≥ 75 years and those who were deemed not suitable for ESPAC-4 regimen. Methods: Patients ≥ 75 years with resected PC, ECOG PS of 0-2 and no prior treatments were included. Patients were treated with a modified regimen of gemcitabine (1000-2000 mg/m2) every 2 weeks and capecitabine (800-1000 mg/m2) day 1-7 every 2 weeks. Patients were evaluated for progression-free survival (PFS), overall survival (OS) and sites of recurrence. Toxicities were graded according to NCI CTCAE v5.0. Results: Thirty-five (22M, 13F) patients, ≥ 75 (median age 79) treated with biweekly Gem-Cap adjuvant treatment. 7 (28%) patients had ECOG PS of 1 and 28 (72%) had ECOG PS of 2. There were 5, 7 and 16 patients with stage I, II and III disease. Nine patients (25%) had R1 and 26 (75%) had R0 resection. The median PFS and OS were 8.0 months and 22.0 months. Nine (25%) had local recurrence, 21 (60%) had metastatic disease and 3 (8.6%) had NED. Two patients were lost to follow-up. The most frequent toxicities were grades 1-2 anemia (20%), thrombocytopenia (8%) and hand-foot syndrome (HFS) (10%). Grade ≥3 included diarrhea (4%) and HFS (1%) with no treatment-related discontinuations. Treatment compliance was 100%. Delays were necessary in 7% of cases and dose reduction was required in 4% of cases. There was no treatment related death. Conclusions: This schedule of biweekly GemCap regimen suggests an acceptable option in for elderly, frail patients with PC and warrants further exploration in patients not suitable for FOLFIRINOX, full dose GemCap or a clinical trial. This regimen required fewer dose reduction, omission or delays and allowed to administer pegylated-filgrastim. Previous studies have also shown decreased toxicity and equal efficacy of 7/7 schedule of capecitabine. Moreover, fewer visits to oncology and related expense do favor towards benefit. Additionally, this tolerable regimen is ideal to be combined with immunotherapy in clinical trials for this patient population.
Collapse
Affiliation(s)
| | - Jeffrey Chi
- Northwell Health Cancer Institute, Lake Success, NY
| | - Hasan Rehman
- Northwell Health Cancer Institute, Lake Success, NY
| | | | | | | | | | | | | | | | | | | | | | - Jyothi Jose
- Northwell Health Cancer Institute, Lake Success, NY
| | | |
Collapse
|
27
|
Chi J, Hakim N, Rehman H, Moriarty L, Maloney A, Smith MH, Jose J, Saif WM. A prospective pilot study of pharmacogenetic-based dosing of 5-fluouracil (5-FU) and irinotecan (IRI) in patients (pts) with gastrointestinal (GI) malignancies. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16138 Background: 5-FU and IRI are core components of chemotherapies for GI malignancies. Previous studies have shown that mutations in DPYP and TYMS predispose the pts to 5-FU toxicities. Mutations in UGT1A1 predispose pts to increased IRI toxicities. Retrospective data suggest that these mutations may have implications in selecting dosage and/or schedule of 5-FU and IRI. We present here a prospective study of upfront pharmacogenetic testing with tailored dose of respective drugs in pts with these mutations. Methods: Pts with GI malignancies were tested for DPYD, TYMS and UGT1A1 mutations before initiating 5-FU and/or IRI. Mutation analyses were performed at Quest Diagnostics Nichols Institute. Pts were dosed at 50% if DPYD was abnormal and 25% dose reduction if indicated by TYMS or UGT1A1 * 28 (homozygous) abnormality. Adverse events (AEs) were graded according to CTCAE v.5.0. We compared AEs to our previously collected data in DPYD, TYMS deficient pts who underwent genetic testing due to toxicity to 5-FU. Results: Of 226 pts screened, 5 pts had DPYP mutations with genotypes (3: c.1905+1G/A; 1: c.2846A/T; 1: c.557A/G). TYMS mutations were identified in 24 pts. For 3'-UTR, distributions were: intermediate expression genotype 4: INS/DEL, low expression genotype 5: DEL/DEL. For 5'TSER, distributions were: low expression genotypes (6:2R/2R; 3:2R/3RC; 4: 3RC/3RC) and high expression genotypes (2: 2R/3RG, 2: 3RG/3RC, 1: 3RG/3RG). UGT1A1*28 mutation was identified in 53 pts – 19 homozygous and 34 heterozygous. No grade ≥3 neutropenia was observed with reduced dose of IRI in UGT1A 1 variant pts compared to 33% reported in pts not tested. For TYMS and DPYD variants, no grade ≥3 AEs were seen. Comparison of AEs in pts with post treatment genetic testing is listed in Table. Conclusions: Pharmacogenetic based dosing of 5-FU and IRI led to less frequent, less severe toxicities and no death related to AEs was observed in our pts. This can improve pts’ quality of life and lessen economic burden of managing severe AEs. Currently, there are no formal guidelines regarding testing for DPYD, TYMS and UGT1A1. Although non-randomized, this study advocates for systemic screening of pharmacogenetic testing in pts with GI malignancies. [Table: see text]
Collapse
Affiliation(s)
- Jeffrey Chi
- Northwell Health Cancer Institute, Lake Success, NY
| | | | - Hasan Rehman
- Northwell Health Cancer Institute, Lake Success, NY
| | | | | | | | - Jyothi Jose
- Northwell Health Cancer Institute, Lake Success, NY
| | | |
Collapse
|
28
|
Rehman H, Jahan S, Ullah I, Thörnqvist PO, Jabbar M, Shoaib M, Aman F, John N. Effects of endocrine disruptor furan on reproductive physiology of Sprague Dawley rats: An F1 Extended One-Generation Reproductive Toxicity Study (EOGRTS). Hum Exp Toxicol 2020; 39:1079-1094. [PMID: 32174189 DOI: 10.1177/0960327120911416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present study investigated the reproductive toxicity of furan in an Extended One-Generation Reproductive Toxicity Study in rats. Sprague Dawley F0 weaning rats (30 per sex per group) were exposed to furan orally at 0, 1, 2.5, 5, and 10 mg kg-1 for 10 weeks (males) and 2 weeks (females) and then mated. Results of F0 indicated that in the furan-treated groups (5 mg kg-1 and 10 mg kg-1), body weight (bw) gain decreased during prebreed and gestational period while increased during lactation periods. F0 animals prebreeding exposure resulted in head tilt and foot splay at 10 mg kg-1. Number of live pups at birth were decreased (p < 0.001) at 10 mg kg-1. At postnatal day (PND) 70, a significant (p = 0.03) decrease in testosterone levels of male rats and estrogen levels of female rats (p = 0.05) was observed in 10 mg kg-1 furan-treated group in F1 generation. Luteinizing hormone, follicle-stimulating hormone, and progesterone levels were also reduced, but their reduction was not statistically significant in all groups. In higher dose furan group (10 mg kg-1), testicular and ovarian weights were reduced in F1 generation at PND 70, with decreased daily sperm production (p = 0.01) and disturbed estrous cyclicity (p < 0.01). Some histopathological changes were also observed in testis and ovaries in groups whose parents were previously exposed to 10 mg kg-1 bw of furan group. Based on the above results, it is suggested that exposure to food-based contaminant furan induced remarkable changes in the F0 (parental stage) and F1 (offspring, pubertal, and adult stage) generations of Sprague Dawley rats.
Collapse
Affiliation(s)
- H Rehman
- Reproductive Physiology Laboratory, Faculty of Biological Sciences, Department of Animal Sciences, Quaid-i-Azam University, Islamabad, Pakistan.,Division of Physiology, Department of Neuroscience, Uppsala Biomedical Centre (BMC), Uppsala University, Uppsala, Sweden
| | - S Jahan
- Reproductive Physiology Laboratory, Faculty of Biological Sciences, Department of Animal Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - I Ullah
- Division of Physiology, Department of Neuroscience, Uppsala Biomedical Centre (BMC), Uppsala University, Uppsala, Sweden
| | - P-O Thörnqvist
- Division of Physiology, Department of Neuroscience, Uppsala Biomedical Centre (BMC), Uppsala University, Uppsala, Sweden
| | - M Jabbar
- Department of Statistics, University of Gujrat, Gujrat, Pakistan
| | - M Shoaib
- Reproductive Physiology Laboratory, Faculty of Biological Sciences, Department of Animal Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - F Aman
- Reproductive Physiology Laboratory, Faculty of Biological Sciences, Department of Animal Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - N John
- Reproductive Physiology Laboratory, Faculty of Biological Sciences, Department of Animal Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| |
Collapse
|
29
|
Tahir S, Yousaf M, Rashid M, Khan A, Ahmad S, Zaneb H, Khan I, Rehman H. Supplemental chromium-loaded chitosan nanoparticles affect growth, serum metabolites and intestinal histology in broilers. S AFR J ANIM SCI 2020. [DOI: 10.4314/sajas.v49i6.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The goal of the present research was to evaluate the effects of chromium-loaded chitosan nanoparticles (Cr-CNPs) on production performance, viscera development, serum metabolites and intestinal histology in broilers. Two hundred (200) day-old broilers were randomly divided into five groups with five replicates (n = 8). Birds in the first group served as control and were fed a corn soybean-based diet, while the remaining four supplemented groups were offered 200, 400, 800, and 1200 μg Cr-CNPs/kg of feed, respectively, for 35 days. Weight gain, feed intake and feed conversion ratio (FCR) remained unaffected with Cr-CNP supplementation. No changes were observed in the relative weights of viscera. The relative length of the small intestine was decreased in birds supplemented with 200 and 800 μg Cr-CNPs/kg compared with the 1200 μg Cr-CNP-supplemented group and control. Serum metabolites remained unaffected with Cr-CNP supplementation except for serum HDL, which was increased. Cr-CNPs decreased the retention of chromium in the bone at higher concentrations. Jejunal villus height, villus surface area, and villus height to crypt depth ratio were increased in the 800 μg Cr-CNP-supplemented group. In conclusion, Cr-CNPs did not affect growth performance, viscera development, and most of the serum metabolites, but enhanced jejunal morphological attributes at 800 μg Cr-CNPs/kg of feed.
Keywords: blood biochemistry, health, nano-biotechnology, prebiotics, poultry, trace mineral
Collapse
|
30
|
Rehman H, Patel A, Aoun J, Faza NN, Little SH, Reardon M, Kleiman NS. CENTRAL AND PARAVALVULAR REGURGITATION IN A PATIENT WITH A HISTORY OF A BIOPROSTHETIC AORTIC VALVE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Ahmed ST, Mahtta D, Rehman H, Akeroyd J, Al Rifai M, Rodriguez F, Jneid H, Nasir K, Samad Z, Alam M, Petersen LA, Virani SS. Association between frequency of primary care provider visits and evidence-based statin prescribing and statin adherence: Findings from the Veterans Affairs system. Am Heart J 2020; 221:9-18. [PMID: 31896038 DOI: 10.1016/j.ahj.2019.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed if the frequency of visits with primary care providers (PCPs) is associated with higher use of evidence-based statin prescriptions and adherence among patients with ASCVD. METHODS We identified patients with ASCVD aged ≥18 years receiving care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into frequent PCP visitors (annual PCP visits ≥ median number of PCP visits for the entire cohort) and infrequent PCP visitors (annual PCP visits < median number of patient visits). We assessed any- and high-intensity statin prescription as well as statin adherence which was defined by proportion of days covered (PDC). RESULTS We included 1,249,061 patients with ASCVD (mean age was 71.9 years; 98.0% male). Median number of annual PCP visits was 3. Approximately 80.1% patients were on statins with 23.8% on high-intensity statins. Mean PDC was 0.715 ± 0.336 with 58.3% patients with PDC ≥0.8. Frequent PCP visitors had higher frequency of statin use (82.2% vs 77.4%), high-intensity statin use (26.4% vs 20.3%), and statin adherence (mean PDC 0.73 vs 0.68; P < .01) compared to infrequent PCP visitors. After adjusting for covariates, frequent PCP visits was associated with greater odds of being on any statin, high intensity statin, and higher statin adherence. CONCLUSION Frequent visits with PCPs is associated with a higher likelihood of any statin use, high intensity statin use, and statin adherence. Further research endeavors are needed to understand the reasons behind these associations.
Collapse
|
32
|
Rehman H, Hakim N, Sugarman R, Seetharamu N, Saif MW. Hyperpigmentation due to imatinib: A rare case of cutaneous involvement. J Oncol Pharm Pract 2020; 26:1511-1515. [DOI: 10.1177/1078155220903364] [Citation(s) in RCA: 4] [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: 12/19/2022]
Abstract
Case report Imatinib mesylate is a well-known tyrosine kinase inhibitor used to treat chronic myeloid leukemia, gastrointestinal stromal tumor, as well as a variety of other malignancies. Management and outcome: As use of this medication continues to grow, providers must be aware of potential side effects and management thereof. The toxicity profile of imatinib has been well characterized with most patients experiencing a grade 1 or 2 adverse event. These side effects are usually mild, and most patients can continue treatment without interruption. Around 30% of patients on imatinib experience skin toxicity, with 5% being high grade. This rash is typically hypopigmented, which is explained by imatinib’s effect on melanocytes. Discussion Although there have been several case reports describing hyperpigmentation of the oral mucosa or nails, very few have described skin hyperpigmentation. We previously reported the first two cases of imatinib-related squamous cell carcinoma in patients undergoing treatment for gastrointestinal stromal tumors. In this paper, we present a case of a patient on imatinib for management of gastrointestinal stromal tumor who experienced extensive skin hyperpigmentation and review the literature.
Collapse
Affiliation(s)
- Hasan Rehman
- Department of Hematology/Oncology, Northwell Cancer Institute, Lake Success, NY, USA
| | - Nausheen Hakim
- Department of Hematology/Oncology, Northwell Cancer Institute, Lake Success, NY, USA
| | - Ryan Sugarman
- Department of Hematology/Oncology, Northwell Cancer Institute, Lake Success, NY, USA
| | - Nagashree Seetharamu
- Department of Hematology/Oncology, Northwell Cancer Institute, Lake Success, NY, USA
| | - Muhammad W Saif
- Department of Hematology/Oncology, Northwell Cancer Institute, Lake Success, NY, USA
| |
Collapse
|
33
|
Hakim N, Chi J, Rehman H, Goyal SP, Olazagasti C, Moriarty L, Jose J, Lamont C, Saif WM. First analysis of same-day pegfilgrastim use with concurrent capecitabine-based regimens in pts with GI malignancies. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.817] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Abstract
817 Background: Pegfilgastrim is administered 24 hrs after chemotherapy to reduce risks of myelosuppression. This requires an additional clinic visit, which can be difficult for some patients (pts) due to work and transportation issues. In GI malignancies, pts receiving capecitabine-based regimens also require pegfilgastrim to reduce myelotoxicity. Capecitabine is converted to active 5-FU by cytidine deaminase which is present in humans in low levels and generally does not cause severe myelosupression. Therefore, administering pefilgastrim concurrently with chemotherapy may be an option. We present here the first study to analyze safety and efficacy of administering pegfilgrastim on the same day as capecitabine-based regimens in patients with GI malignancies. Methods: We evaluated 157 pts with GI malignancies who received a capecitabine-based chemotherapy regimens, including XELOX, EOX, ECX, XELIRI, MIXE, gemcitabine-capecitabine and same-day pegfilgrastim (6 mg) within 1 hr of completion of systemic agents. As per institutional guidelines, pts were counseled on risks of same-day pegfilgrastim prior to its administration. Pts were followed to determine the degree of neutropenia and toxicity. Results: A total of 914 chemotherapy cycles in 157 pts were analyzed. Median ANC nadir for all cycles was 5634/uL (range: 450-23800). Grade 1 and 2 neutropenia developed in 11 of 914 cycles. Bone pain reported in 9 pts. There was 1 episode of grade >3 neutropenia resulting in infection and antibiotic use. No other pt required dose reductions, chemotherapy delays, or hospitalizations. No increased toxicity of capecitabine was noticed. Conclusions: We believe our study is the first in GI malignancies to report that same-day pegfilgrastim administration with capecitabine-based regimens may be as effective and safe as next-day administration. Additionally, given the absence of CD in human bone marrow, it appears capecitabine can be used concurrently with pegfilgastrim. Prospective studies should be done to further investigate, as this practice can benefit pts clinically, decrease office visits, increase pt satisfaction and reduce healthcare costs.
Collapse
Affiliation(s)
| | - Jeffrey Chi
- Northwell Health Cancer Institute, Lake Success, NY
| | - Hasan Rehman
- Northwell Health Cancer Institute, Lake Success, NY
| | | | | | | | - Jyothi Jose
- Northwell Health Cancer Institute, Lake Success, NY
| | - Carol Lamont
- Northwell Health Cancer Institute, Lake Success, NY
| | | |
Collapse
|
34
|
Rehman H, Chi J, Hakim N, Goyal SP, Olazagasti C, Jose J, Moriarty L, Saif WM. Attenuated regimen of biweekly gemcitabine/nab-paclitaxel in patients aged > 65 years with advanced pancreatic cancer (APC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
705 Background: Treatment with gemcitabine/nab-paclitaxel confers a survival benefit over gemcitabine monotherapy in APC. However, such treatment can be associated with significant toxicities especially in older patients and carries practical disadvantages related to a weekly schedule along with financial cost. We retrospectively analyzed patients > 65 years of age with APC who received a modified biweekly regimen of gemcitabine/nab-paclitaxel to evaluate efficacy and toxicity. Methods: Patients aged > 65 years with chemo-naive APC and ECOG PS < 2 were studied. Patients were treated with a modified regimen of gemcitabine 1000 mg/m2 and nab-paclitaxel 125 mg/m2 every 2 weeks on days 1 and 15 of a 28-day cycle. Patients were evaluated for progression-free survival (PFS) and overall survival (OS) with analyses performed using Kaplan-Meier method. Adverse events were recorded on the day of chemotherapy. CA19-9 was measured every cycle and restaging scans were performed every two cycles. Results: Seventy-three patients (median age: 73; range: 66 - 93) were treated with biweekly gemcitabine/nab-paclitaxel as first-line treatment. The median OS and PFS were 9.1 months and 4.8 months respectively. 66% of patients received growth factor support based on ASCO guidelines and no patients developed neutropenic fever. The incidence of grade > 3 toxicity for neutropenia, anemia, thrombocytopenia, and neurotoxicity were 2%, 7%, 3%, and 5% respectively. Dose reductions of gemcitabine/nab-paclitaxel were required in 10% and 4% patients respectively. Conclusions: In patients > 65 years of age with APC, a modified regimen of biweekly gemcitabine/nab-paclitaxel was found to be effective when compared with historical control from the MPACT study. This regimen allowed for less dose reductions, reduced healthcare costs from additional appointments, travel-related cost, as well as favorable side effect profile while maintaining efficacy. Though retrospective in nature, this study underlines the need for further investigation, particularly in elderly patients with APC and poor performance status. Better tolerability may allow for combination with a third agent, such as a targeted or immunotherapy.
Collapse
Affiliation(s)
- Hasan Rehman
- Northwell Health Cancer Institute, Lake Success, NY
| | - Jeffrey Chi
- Northwell Health Cancer Institute, Lake Success, NY
| | | | | | | | - Jyothi Jose
- Northwell Health Cancer Institute, Lake Success, NY
| | | | | |
Collapse
|
35
|
Rehman H, Ali Z, G. Shahzady T, A. Abid M, Nazir S, Hussain H, Zahra A, Hussain I. Synthesis, X-ray analysis and antibacterial study of silver complex with ethyl-5-hydroxy- 2-oxo-2H-chromene-3-carboxylate. B CHEM SOC ETHIOPIA 2019. [DOI: 10.4314/bcse.v33i3.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
36
|
Rehman H, Ahmed ST, Akeroyd J, Mahtta D, Jia X, Rifai MA, Nasir K, Jneid H, Khalid MU, Alam M, Toth PP, Virani SS. Relation Between Cardiology Follow-Up Visits, Evidence-Based Statin Prescribing, and Statin Adherence (from the Veterans Affairs Health Care System). Am J Cardiol 2019; 124:1165-1170. [PMID: 31405545 DOI: 10.1016/j.amjcard.2019.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/14/2019] [Revised: 07/07/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed whether outpatient care with a cardiology provider is associated with evidence-based statin prescription and statin adherence. We identified patients with ASCVD aged ≥18 years receiving primary care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into: (1) patients with at least 1 outpatient cardiology visit and (2) patients with no outpatient cardiology visits in the year before the index primary care visit. We assessed any- and high-intensity statin prescription adjusting for several patient- and facility-level covariates, and statin adherence using proportion of days covered (PDC). We included 1,249,061 patients with ASCVD (mean age: 71.9 years; 98.0% male). After adjusting for covariates, patients who visited a cardiology provider had greater odds of being on a statin (87.4% vs 78.4%; Odds ratio [OR] 1.25, 95% Confidence interval [CI] 1.24 to 1.26), high-intensity statin (34.5% vs 21.2%; OR: 1.21, 95% CI 1.21 to 1.22), and higher statin adherence (mean PDC 0.76 ± 0.29 vs 0.70 ± 0.34, PDC ≥0.8: 62.0% vs 57.3%; OR 1.09, 95% CI 1.09 to 1.11). A dose response relation was seen with a higher number of cardiology visits associated with a higher statin use and statin adherence. In conclusion, compared with outpatient care delivered by primary care providers alone, care delivered by a cardiology provider for patients with ASCVD is associated with a higher likelihood of guideline-based statin use and statin adherence.
Collapse
Affiliation(s)
- Hasan Rehman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Sarah T Ahmed
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Julia Akeroyd
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Dhruv Mahtta
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Xiaoming Jia
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mahmoud Al Rifai
- Department of Medicine, University of Kansas School of Medicine, Wichita, Kankas
| | - Khurram Nasir
- Division of Cardiovascular Medicine, Center for Outcomes & Research Evaluation (CORE), Yale University School of Medicine & Yale New Haven Health, New Haven, Connecticut
| | - Hani Jneid
- Department of Medicine, Division of Cardiology, Baylor College of Medicine Houston, Texas
| | - Mirza U Khalid
- Department of Medicine, Division of Cardiology, Baylor College of Medicine Houston, Texas
| | - Mahboob Alam
- Department of Medicine, Division of Cardiology, Baylor College of Medicine Houston, Texas
| | - Peter P Toth
- Clinical Family and Community Medicine, University of Illinois College of Medicine, Peoria, Illinois; Department of Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
| |
Collapse
|
37
|
Sattar H, Firyal S, Awan AR, Rehman H, Wasim M, Tayyab M, Anjum AA. Bacteriological and biochemical analysis of raw milk samples from mastitic sahiwal cows of the Punjab province. J BIOL REG HOMEOS AG 2019; 33:1545-1549. [PMID: 31588718 DOI: 10.23812/19-153-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- H Sattar
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - S Firyal
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - A R Awan
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - H Rehman
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - M Wasim
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - M Tayyab
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - A A Anjum
- Department of Microbiology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| |
Collapse
|
38
|
Lacey MJ, Raza S, Rehman H, Puri R, Bhatt DL, Kalra A. Coronary Embolism: A Systematic Review. Cardiovasc Revasc Med 2019; 21:367-374. [PMID: 31178350 DOI: 10.1016/j.carrev.2019.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coronary embolism is a rare and potentially fatal phenomenon that occurs primarily in patients with valvular heart disease and atrial fibrillation. There is a lack of consensus regarding the diagnosis, treatment, and management of coronary embolism, leaving management at the discretion of the treating physician. Through this review, we aim to establish a better understanding of coronary embolism, and to identify treatment options - invasive and non-invasive - that may be used to manage coronary embolism. METHODS AND RESULTS Our systematic review included 147 documented cases of coronary embolism from case reports and case series. The average age of our population was 54.2 ± 17.6 years. The most common causes of coronary embolism included infective endocarditis (22.4%), atrial fibrillation (17.0%), and prosthetic heart valve thrombosis (16.3%). Initial presentation was indistinguishable from an acute coronary syndrome (ACS) due to coronary atherosclerosis, and the diagnosis required a high level of suspicion and evaluation with angiography. Treatment strategies included, but were not limited to, thrombectomy, thrombolysis, balloon angioplasty and stent placement. Myocardial dysfunction on echocardiography was observed in over 80% of patients following coronary embolism. "Good outcomes" were reported in 68.7% of case reports and case series, with a mortality rate of 12.9%. CONCLUSION Coronary embolism is an under-recognized etiology of myocardial infarction with the potential for significant morbidity and mortality. To improve outcomes, physicians should strive for early diagnosis and intervention based on the underlying etiology. Thrombectomy may be considered with the goal of rapid restoration of coronary flow.
Collapse
Affiliation(s)
- Matthew J Lacey
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Sajjad Raza
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Hasan Rehman
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, United States
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States.
| |
Collapse
|
39
|
Rehman H, Ahmed S, Akeroyd J, Nasir K, Alam M, Mahtta D, Virani S. ASSOCIATION BETWEEN CARDIOLOGY VISIT AND EVIDENCE-BASED STATIN PRESCRIPTION AND STATIN ADHERENCE PATTERNS: FINDINGS FROM THE VETERANS AFFAIRS NATIONAL DATABASE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
40
|
Aman W, Rehman H, Barker C. MITRACLIP INTERVENTION FOR SEVERE TRICUSPID REGURGITATION: A CASE SERIES AT A TERTIARY CARE CENTER. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
41
|
Ahmed S, Rehman H, Akeroyd J, Nasir K, Alam M, Mahtta D, Virani S. ASSOCIATION BETWEEN FREQUENCY OF PCP VISITS AND EVIDENCE-BASED STATIN PRESCRIBING AND STATIN ADHERENCE: FINDINGS FROM THE VETERANS AFFAIRS NATIONAL DATABASE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
42
|
Malahfji M, Chang SM, Faza N, Chinnadurai P, Rehman H, Neill J, Kleiman N, Little S, Barker C. CLINICAL UTILITY OF CT FUSION IMAGING IN GUIDING TRANS-CATHETER PARAVALVULAR LEAK CLOSURE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31803-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
43
|
Shah M, Zaneb H, Masood S, Khan I, Sikandar A, Ashraf S, Rehman H, Usman M, Khan F, Amanullah H, Rehman H. Effect of zinc and probiotics supplementation on performance and immune organs morphology in heat stressed broilers. S AFR J ANIM SCI 2019. [DOI: 10.4314/sajas.v48i6.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
44
|
Khan A, Rehman H. Case report; mycobacterium chimaera associated pulmonary disease in two members of the same household. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.054] [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: 10/27/2022] Open
|
45
|
|
46
|
Rehman HF, Zaneb H, Masood S, Yousaf MS, Ashraf S, Khan I, Shah M, Khilji MS, Rehman H. Effect of Moringa Oleifera Leaf Powder Supplementation on Pectoral Muscle Quality and Morphometric Characteristics of Tibia Bone in Broiler Chickens. Braz J Poult Sci 2018. [DOI: 10.1590/1806-9061-2017-0609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- HF Rehman
- University of Veterinary and Animal Sciences, Pakistan
| | - H Zaneb
- University of Veterinary and Animal Sciences, Pakistan
| | - S Masood
- University of Veterinary and Animal Sciences, Pakistan
| | - MS Yousaf
- University of Veterinary and Animal Sciences, Pakistan
| | - S Ashraf
- University of Veterinary and Animal Sciences, Pakistan
| | - I Khan
- University of Veterinary and Animal Sciences, Pakistan
| | - M Shah
- University of Veterinary and Animal Sciences, Pakistan
| | - MS Khilji
- University of Veterinary and Animal Sciences, Pakistan
| | - H Rehman
- University of Veterinary and Animal Sciences, Pakistan
| |
Collapse
|
47
|
Jamorabo D, Deek M, Rehman H, Motwani S, Yom S, Zietman A, Jabbour S, Chang D. Can Demographic Factors or Academic Metrics of Red Journal Reviewers Predict the Quality of their Reviews? Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1157] [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]
|
48
|
Dadu RT, Xu J, Rehman H, von Ballmoos MW, Barker CM, Reyes M, Ramchandani M, Reul RM, Reardon MJ, Kleiman NS. Optimal positioning of self-expanding valves before deployment decreases paravalvular regurgitation following transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2018; 93:149-155. [DOI: 10.1002/ccd.27829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 02/23/2018] [Accepted: 07/18/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Razvan T. Dadu
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| | - Jiaqiong Xu
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| | - Hasan Rehman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| | - Moritz Wyler von Ballmoos
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| | - Colin M. Barker
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| | - Manuel Reyes
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| | - Mahesh Ramchandani
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| | - Ross M. Reul
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| | - Neal S. Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center; Houston Texas
| |
Collapse
|
49
|
Rehman H, Samad Z, Mishra SR, Merchant AT, Narula JP, Mishra S, Virani SS. Epidemiologic studies targeting primary cardiovascular disease prevention in South Asia. Indian Heart J 2018; 70:721-730. [PMID: 30392513 PMCID: PMC6204454 DOI: 10.1016/j.ihj.2018.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 12/12/2017] [Accepted: 01/16/2018] [Indexed: 01/02/2023] Open
Abstract
South Asia has experienced a 73% increase in healthy life years lost due to ischemic heart disease between 1990 and 2010. There is a lack of quality data relating to cardiovascular risk factors and disease from this region. Several observational and prospective cohorts in South Asia have been established in recent times to evaluate the burden of cardiovascular disease and their risk factors. The Prospective Rural Urban Epidemiology (PURE) study is the largest of these studies that has provided data on social, environmental, behavioral and biologic risk factors that influence heart disease and diabetes. Some studies have also borrowed data from large datasets to provide meaningful insights. These studies have allowed a better understanding of cardiovascular disease risk factors indigenous to the South Asian population along with conventional risk factors. Culturally sensitive interventions geared towards treating risk factors identified in these studies are needed to fully realize the true potential of these epidemiologic studies.
Collapse
Affiliation(s)
| | - Zainab Samad
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shiva Raj Mishra
- Nepal Development Society, Bharatpur-10, Chitwan, Nepal; Center for Longitudinal and Lifecourse Research, Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Jagat P Narula
- Marie-Josée and Henry R. Kravis Center for Cardiovascular Health Mount Sinai School of Medicine, USA
| | - Sundeep Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
50
|
Murtaza M, Dadu R, Rehman H, Barker C, Reardon M, Kleiman N. TCT-593 Predicting Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Replacement: Testing the Mehran Contrast Induced Nephropathy Score. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|