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Hussain MR, Abdelgadir O, Polychronopoulou E, Tsilidis KK, Alzweri L, Villasante-Tezanos A, Baillargeon J, Canfield S, Kuo YF, Lopez DS. Evaluating the impact of pre-diagnostic use of statins and testosterone replacement therapy on mortality outcomes in older men with hormone-related cancers: Surveillance, Epidemiology, and End Results-Medicare 2007-2015. Andrology 2024. [PMID: 38421134 DOI: 10.1111/andr.13616] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/11/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The link between the pre-diagnostic use of statins and testosterone replacement therapy and their impact on hormone-related cancers, prostate cancer, colorectal cancer, and male breast cancer survival remains a topic of controversy. Further, there is a knowledge gap concerning the joint effects of statins and testosterone replacement therapy on hormone-related cancer survival outcomes. OBJECTIVE To examine the independent and joint effects of pre-diagnostic use of statins and testosterone replacement therapy on the risk of all-cause and cause-specific mortality among older men diagnosed with hormone-related cancers, including prostate cancer, colorectal cancer, and male breast cancer. METHODS In 41,707 men (≥65 years) of Surveillance, Epidemiology, and End Results-Medicare 2007-2015, we identified 31,097 prostate cancer, 10,315 colorectal cancer, and 295 male breast cancer cases. Pre-diagnostic prescription of statins and testosterone replacement therapy was ascertained and categorized into four groups (Neither users, statins alone, testosterone replacement therapy alone, and Dual users). Multivariable-adjusted Cox proportional hazards and competing-risks (Fine-Gray subdistribution hazard) models were conducted. RESULTS No significant associations were found in Cox-proportional hazard models for hormone-related cancers. However, in the Fine-Gray competing risk models among high-grade hormone-related cancers, statins alone had an 11% reduced risk of hormone-related cancer-specific death (hazard ratio: 0.89; 95% confidence interval: 0.81-0.99; p 0.0451). In the prostate cancer cohort with both statistical models, the use of testosterone replacement therapy alone had a 24% lower risk of all-cause death (hazard ratio: 0.76; 95% confidence interval: 0.59-0.97; p 0.0325) and a 57% lower risk of prostate cancer-specific death (hazard ratio: 0.43; 95% confidence interval: 0.24-0.75; p 0.0029). Similar inverse associations were found among aggressive prostate cancer cases with testosterone replacement therapy alone and statins alone. No significant associations were found in the colorectal cancer and male breast cancer sub-groups. CONCLUSION Pre-diagnostic use of statins and testosterone replacement therapy showed a survival benefit with reduced mortality in high-grade hormone-related cancer patients (only statins) and aggressive prostate cancer patients in both statistical models. Findings of testosterone replacement therapy use in aggressive prostate cancer settings could facilitate clinical trials. Further studies with extended follow-up periods are needed to substantiate these findings.
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Affiliation(s)
- Maryam R Hussain
- School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Omer Abdelgadir
- Graduate School of Biomedical Science, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Laith Alzweri
- Department of Surgery, Division of Urology, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Jacques Baillargeon
- School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Steven Canfield
- Department of Surgery, Division of Urology, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Yong-Fang Kuo
- School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - David S Lopez
- School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
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Hussain MR, Ali FS, Tangri A, Rashtak S, Joseph-Talreja M, Mutha PR, Wadhwa V, Guha S, DaVee RT, Thosani N. Correction to: The incremental yield of adenoma detection with I-Scan versus high-definition white light colonoscopy-a systematic review and meta-analysis of randomized studies. Int J Colorectal Dis 2023; 38:251. [PMID: 37815632 DOI: 10.1007/s00384-023-04545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Maryam R Hussain
- Department of Population Health and Health Disparities/School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Faisal S Ali
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas Health Science Center, Houston, TX, USA.
| | - Apoorva Tangri
- Department of Internal Medicine, Woodhull Hospital, New York, NY, USA
| | - Shahrooz Rashtak
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Mairin Joseph-Talreja
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Pritesh R Mutha
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Vaibhav Wadhwa
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Sushovan Guha
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Roy Tomas DaVee
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA.
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Hussain MR, Ali FS, Tangri A, Rashtak S, Joseph-Talreja M, Mutha PR, Wadhwa V, Guha S, DaVee RT, Thosani N. The incremental yield of adenoma detection with I-Scan versus high-definition white light colonoscopy-a systematic review and meta-analysis of randomized studies. Int J Colorectal Dis 2023; 38:240. [PMID: 37755588 DOI: 10.1007/s00384-023-04533-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION The incremental yield of I-Scan virtual chromoendoscopy compared to high-definition white light endoscopy (HD-WLE) in detection of colorectal adenomas has not been thoroughly elucidated. METHODS A systematic search from inception to April 2023 was conducted to identify randomized controlled trials (RCTs) comparing I-Scan to HD-WLE for detection of adenomas. A random effects model was used to compute risk difference (RD) with corresponding 95% confidence intervals in adenoma detection rate (ADR). Influence analysis was done to assess robustness of findings. The number needed to diagnose was computed. Heterogeneity was assessed using the I2 statistic and explored further by subgroup analyses defined a priori. Certainty in effect estimates was assessed using the GRADE approach. RESULTS We identified four studies (I-Scan n = 730, HD-WLE n = 765). I-Scan increased adenoma detection by 9% (risk difference (RD), 0.09; 0.04, 0.14; I2 02%; certainty, low). Influence analysis revealed that the gain in yield remained statistically significant with exclusion of all but one study. The number needed to capture one additional adenomatous polyp with I-Scan use was 11.2. I-Scan 1 use was associated with a statistically significant gain in ADR, whereas no significant difference in ADR was noted with I-Scan use on subgroup analysis. DISCUSSION In conclusion, I-Scan increases the yield of adenoma detection by 9% compared to HD-WLE, with low certainty in the estimate of this effect. Data on the gain in yield of detecting large polyps, sessile serrated lesions, and on the impact of formally training endoscopists and trainees in I-Scan use and similar technology on adenoma detection rate are needed.
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Affiliation(s)
- Maryam R Hussain
- Department of Population Health and Health Disparities/School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Faisal S Ali
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas Health Science Center, Houston, TX, USA.
| | - Apoorva Tangri
- Department of Internal Medicine, Woodhull Hospital, New York, NY, USA
| | - Shahrooz Rashtak
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Mairin Joseph-Talreja
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Pritesh R Mutha
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Vaibhav Wadhwa
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Sushovan Guha
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Roy Tomas DaVee
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA.
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Ali FS, Gandam MR, Hussain MR, Mualla N, Khuwaja S, Sundararajan N, Siddiqui SI, Naqvi S, DaVee RT, Thosani N. Self-expanding metal stents for the treatment of malignant colon obstruction from extra-colonic malignancy versus intra-colonic malignancy: a systematic review and meta-analysis. Surg Endosc 2023:10.1007/s00464-023-09943-6. [PMID: 36947223 DOI: 10.1007/s00464-023-09943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/12/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIMS The relative utility of self-expanding metal stent (SEMS) insertion for malignant colon obstruction (MCO) due to extra-colonic malignancy (ECM) versus intra-colonic malignancy (ICM) is understudied. METHODS A systematic search was done from inception-April 2021 to identify reports of safety and efficacy of SEMS insertion for the treatment of MCO-ECM versus MCO-ICM. A meta-analysis of proportions, comparative meta-analysis to compute relative risks (RR), and mean differences (MD) was performed. Subgroup analyses and influence analyses were conducted. The certainty in estimates of effect(s) was assessed using the GRADE approach. RESULTS Eight non-randomized studies were identified; 46% (39-53%) and 63% (59-67%) of patients in the ECM and ICM groups were male. Most obstructions were in the rectosigmoid colon in both ECM and ICM groups. SEMS insertion in MCO-ECM was associated with an increased risk of technical failure compared to MCO-ICM (RR 2.92; 1.13-7.54; Certainty: Very Low). Risk of clinical failure of SEMS was higher in MCO-ECM compared to MCO-ICM (RR 2.88; 1.58-2.52; Certainty: Very Low). The risk of clinical failure remained significant throughout the influence analysis, as well as on subgroup analysis. There was no significant difference in the risk of adverse events or luminal perforation with SEMS insertion among patients with MCO-ECM and MCO-ICM. On influence analysis, removal of one study unveiled a significant increase in the risk of luminal perforation in MCO-ECM (RR 3.22; 1.44-7.19; p = 0.004). CONCLUSION SEMS for MCO-ECM may have a technical success rate comparable to or questionably worse than MCO-ICM, with low certainty in estimate of effects. SEMS deployment in MCO-ECM carries a higher risk of clinical failure, with a questionably higher risk of luminal perforation.
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Affiliation(s)
- Faisal S Ali
- Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, Houston, TX, USA
| | - Mohammed R Gandam
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA
| | - Maryam R Hussain
- Department of Population Health Sciences, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, TX, USA
| | - Noor Mualla
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA
| | - Samreen Khuwaja
- Department of Internal Medicine, Christus St. Elizabeth Hospital, Beaumont, TX, USA
| | | | - Samrah I Siddiqui
- School of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syeda Naqvi
- Department of Endocrinology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Roy Tomas DaVee
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, Houston, TX, USA.
- Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA.
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Ali FS, DaVee T, Bernstam EV, Kao LS, Wandling M, Hussain MR, Rashtak S, Ramireddy S, Guha S, Thosani N. Cost-effectiveness analysis of optimal diagnostic strategy for patients with symptomatic cholelithiasis with intermediate probability for choledocholithiasis. Gastrointest Endosc 2022; 95:327-338. [PMID: 34499905 DOI: 10.1016/j.gie.2021.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/14/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS, MRCP, and intraoperative cholangiogram (IOC) are the recommended diagnostic modalities for patients with intermediate probability for choledocholithiasis (IPC). The relative cost-effectiveness of these modalities in patients with cholelithiasis and IPC is understudied. METHODS We developed a decision tree for diagnosing IPC (base-case probability, 50%; range, 10%-70%); patients with a positive test were modeled to undergo therapeutic ERCP. The strategies tested were laparoscopic cholecystectomy with IOC (LC-IOC), MRCP, single-session EUS + ERCP, and separate-session EUS + ERCP. Costs and probabilities were extracted from the published literature. Effectiveness was assessed by assigning utility scores to health states, average proportion of true-positive diagnosis of IPC, and the mean length of stay (LOS) per strategy. Cost-effectiveness was assessed by extrapolating a net-monetary benefit (NMB) and average cost per true-positive diagnosis. RESULTS LC-IOC was the most cost-effective strategy to diagnose IPC (base-case probability of 50%) among patients with cholelithiasis in health state-based effectiveness analysis (NMB of $34,612), diagnostic test accuracy-based effectiveness analysis (average cost of $13,260 per true-positive diagnosis), and LOS-based effectiveness analysis (mean LOS of 4.13) compared with strategies 2 (MRCP), 3 (single-session EUS + ERCP), and 4 (separate-session EUS + ERCP). These findings were robust on deterministic and probabilistic sensitivity analyses. CONCLUSIONS For patients with cholelithiasis with IPC, LC-IOC is a cost-effective approach that should limit preoperative testing and may shorten hospital LOS. Our findings may be used to design institutional and organizational management protocols.
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Affiliation(s)
- Faisal S Ali
- Center for interventional Gastroenterology at UTHealth (iGUT), University of Texas Health Science Center at Houston, Houston, Texas, USA; Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Tomas DaVee
- Center for interventional Gastroenterology at UTHealth (iGUT), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elmer V Bernstam
- Department of General Internal Medicine, McGovern Medical School, and School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lillian S Kao
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA
| | - Mike Wandling
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA
| | - Maryam R Hussain
- Department of Public Health, Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Shahrooz Rashtak
- Center for interventional Gastroenterology at UTHealth (iGUT), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Srinivas Ramireddy
- Center for interventional Gastroenterology at UTHealth (iGUT), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sushovan Guha
- Center for interventional Gastroenterology at UTHealth (iGUT), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nirav Thosani
- Center for interventional Gastroenterology at UTHealth (iGUT), University of Texas Health Science Center at Houston, Houston, Texas, USA
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Hussain MR, Ali FS, Verghese D, Myint PT, Ahmed M, Gong Z, Gerais Y, Siddiqui M, Lin JJ, Troy K. Factor Xa inhibitors versus low molecular weight heparin for the treatment of cancer associated venous thromboembolism; A meta-analysis of randomized controlled trials and non-randomized studies. Crit Rev Oncol Hematol 2021; 169:103526. [PMID: 34838704 DOI: 10.1016/j.critrevonc.2021.103526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/18/2021] [Accepted: 11/01/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION We compared the safety and efficacy of Xa-inhibitors to LMWH for treatment of venous thromboembolism in mixed and gastrointestinal cancer cohorts (CA-VTE). METHODS A systematic search identified RCTs and non-randomized studies (NRS) comparing Xa-inhibitors to LMWH for treating CA-VTE. Relative risks were computed. Certainty was assessed using the GRADE approach. RESULTS Xa-inhibitors reduced the risk of recurrent VTE (RR0.64;0.49-0.84) and NRS (RR0.74;0.60-0.92;Moderate-Low Certainty). There was no significant difference in recurrent PE in RCTs (RR0.72;0.50-1.02) and NRS (1.43;0.65-3.12;Low-Very Low Certainty). Xa-inhibitors increased the risk of overall bleeding events in RCTs (RR1.45;1.05-2.01) and NRS (RR1.72;1.42-2.08;Moderate-Low Certainty), and the risk of major bleeding events in NRS (RR1.56;1.17-2.07), but not in RCTs (RR1.33;0.94-1.89; Low-Very Low Certainty). Similar results were detected in gastrointestinal cancer patients. CONCLUSION Xa-inhibitors may reduce the risk of recurrent VTE, but not recurrent PE compared to LMWH. A higher overall bleeding risk, and a questionably higher major bleeding risk was found with Xa-inhibitor use.
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Affiliation(s)
- Maryam R Hussain
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Faisal S Ali
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA; Division of Gastroenterology, Hepatology, and Nutrition, The University of Texas Health Science Center at Houston, TX, USA
| | - Dhiran Verghese
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA
| | - Phyo Thazin Myint
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA
| | - Mubashir Ahmed
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA
| | - Zimu Gong
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA
| | - Yasmin Gerais
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA
| | - Mahrukh Siddiqui
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Troy
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mualla NM, Hussain MR, Akrmah M, Malik P, Bashir S, Lin JJ. The Impact of Postoperative Complications on Long-Term Oncological Outcomes Following Curative Resection of Colorectal Cancer (Stage I-III): A Systematic Review and Meta-Analysis. Cureus 2021; 13:e12837. [PMID: 33628695 PMCID: PMC7896484 DOI: 10.7759/cureus.12837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background and objective The incidence of post-surgical complications (PSCs) after curative resection of non-metastatic colorectal cancer (CRC) is very widespread and evident. Some studies suggest that PSCs often predict poor long-term oncological outcomes. However, the available data on the topic is often controversial. The aim of this systematic review and meta-analysis was to study the effect of postoperative complications (POCs) on long-term oncological outcomes following curative resection of non-metastatic (stage I-III) CRC. Methods A comprehensive search of MEDLINE® and Excerpta Medica dataBASE (EMBASE) databases was performed via the Ovid platform, by using controlled vocabulary as well as natural language terms for POCs, outcomes, and CRC. Two authors independently screened the studies and extracted data. Conflicts were resolved by discussion among authors and also independently with the help of a third author. Meta-analysis was performed using a random-effects model (REM) to calculate pooled estimates for overall survival (OS), disease-free survival (DFS), and overall recurrence. Results Overall, 3,836 studies were initially screened, and 16 studies involving 37,192 patients were ultimately selected for final inclusion in the analysis. Meta-analysis of these studies showed that PSCs following non-metastatic CRC surgery predicted worse OS rates [hazard ratio (HR): 1.36; 95% CI: 1.15-1.61; p<0.00001], DFS (HR: 1.41; 95% CI: 1.11-1.80; p<0.00001), and overall recurrence (HR: 1.19; 95% CI: 1.04-1.37; p=0.01). Conclusion Based on our findings, PSCs predict poor OS rates, DFS, and overall recurrence following curative resection of non-metastatic CRC.
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Affiliation(s)
- Noor M Mualla
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Maryam R Hussain
- Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Preeti Malik
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA.,Neurology, Massachusetts General Hospital, Andover, USA
| | - Sadia Bashir
- Internal Medicine, Pakistan Medical and Dental Council and University of Health Sciences, Lahore, PAK
| | - Jenny J Lin
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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Farukhuddin FNU, Akrmah M, Hussain MR, Iqbal A, Alam M. When the Heart Cries Wolf: Myocardial Bridging Presenting as Angina-like Chest Pain. Cureus 2019; 11:e5392. [PMID: 31620318 PMCID: PMC6791395 DOI: 10.7759/cureus.5392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ali F, Hussain MR, Deep A, Abu-Sbeih H, Alrifai T, Myint PT, Gong Z, Kozma KE. Gastrointestinal, pancreatic, and hepatic toxicity profile of CTLA-4 immune checkpoint inhibitors alone and in combination with PD-1/PD-L1 inhibitors: A meta-analysis of clinical trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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
e14117 Background: Cytotoxic T-lymphocyte activator-4 immune checkpoint inhibitors (CTLA-4-ICPI) is believed to cause more toxicity than programmed cell death/Ligand-1 (PD-1/PD-L1) ICPIs. We conducted a meta-analysis to outline the gastrointestinal (GI), pancreatic, and hepatic toxicity of CTLA-4 ICPIs when used alone and in combination with PD-1/PD-L1 ICPIs (C-ICPI). Methods: Ovid MEDLINE, EMBASE, Cochrane Library, SCOPUS, Web of Science, ClinicalTrials.gov, and WHO ICTRP were queried from January 2007-October 2018. Clinical trials reporting ICPI associated adverse events (AEs) were included. Colitis was defined as the development of diarrhea or documented colitis of any grade. Pancreatitis was defined as an elevation of amylase or lipase. Hepatitis was defined as elevation of ALT, AST, or transaminitis of any grade. A meta-analysis of proportions was conducted to report pooled AEs rate with 95% confidence intervals (CI) using a random effects model. Results: Overall, 30 study arms (20 CTLA-4, 10 C-ICPI) enrolling 3721 patients were included. There were a total of 3944 and 3317 AEs with CTLA-4 and C-ICPI use, respectively, with a pooled incidence of high grade AEs (grade 3-5; HAEs) of 23% (95% CI 16-33%) with CTLA-4 use and 52% (95% CI 37-67%) with C-ICPI use ( Table). The incidence of high-grade colitis was higher among patients treated with CTLA-4 ICPI. The proportion of high-grade pancreatitis was higher among patient who received C-ICPI. Two GI perforations were reported with CTLA-4 use. Pooled incidence of treatment related mortality was 1% in both groups. Conclusions: Though the overall GI, hepatic and pancreatic safety profile of CTLA-4 is comparable to C-ICPI, a higher incidence of high-grade colitis was found with CTLA-4. Two GI perforations were reported with CTLA-4 and warrant further investigation. No difference in treatment related mortality was found among the two groups. [Table: see text]
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Affiliation(s)
- Faisal Ali
- AMITA Health St. Joseph Hospital, Chicago, IL
| | | | - Aman Deep
- Steward Carney Hospital, Dorchester, MA
| | | | | | | | - Zimu Gong
- AMITA Health St. Joseph Hospital, Chicago, IL
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Abstract
Cognitive dysfunction is common among patients with intracranial tumors. Most cognitive deficits are subtle, lack specificity, may mimic depression or other neurological disorders and may be recognized in retrospect by the physician. In certain cases, distinguishing between tumor recurrence and cognitive deficits that arise as a consequence of the treatment becomes challenging. Late treatment effects have also become an area of focus as the overall survival and prognosis of patients with brain tumors increases. New data has highlighted the importance of less toxic adjuvant therapies owing to their positive impact on prognosis and quality of life. Various experimental therapies and genetic influences on individual sensitivity towards injury are promising steps towards a better management strategy for cognitive dysfunction. In this literature review, we discuss cognitive dysfunction as a manifestation of intracranial tumors, treatment modalities such as radiotherapy, chemotherapy, surgery and their impact on cognition and patients' quality of life. We also discuss management options for cognitive dysfunction and emerging therapies.
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Affiliation(s)
- Faisal S Ali
- The University of Texas Health Science Center at Houston, Vivian L. Smith Department of Neurosurgery and Mischer Neuroscience Institute, Houston, TX, United States
| | - Maryam R Hussain
- Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Carolina Gutiérrez
- Department of Physical Medicine and Rehabilitation, Memorial Hermann, Houston, TX, United States
| | - Petya Demireva
- Department of Psychology/Neuropsychology, TIRR Memorial Hermann, Houston, TX, United States
| | - Leomar Y Ballester
- Department of Pathology, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jiguang-Jay Zhu
- The University of Texas Health Science Center at Houston, Vivian L. Smith Department of Neurosurgery and Mischer Neuroscience Institute, Houston, TX, United States
| | - Angel Blanco
- The University of Texas Health Science Center at Houston, Vivian L. Smith Department of Neurosurgery and Mischer Neuroscience Institute, Houston, TX, United States
| | - Yoshua Esquenazi
- The University of Texas Health Science Center at Houston, Vivian L. Smith Department of Neurosurgery and Mischer Neuroscience Institute, Houston, TX, United States.
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Maji TK, Baruah I, Dube S, Hussain MR. Microencapsulation of Zanthoxylum limonella oil (ZLO) in glutaraldehyde crosslinked gelatin for mosquito repellent application. Bioresour Technol 2007; 98:840-4. [PMID: 16697181 DOI: 10.1016/j.biortech.2006.03.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 03/07/2006] [Accepted: 03/19/2006] [Indexed: 05/09/2023]
Abstract
Glutaraldehyde (GA) crosslinked gelatin (G) microcapsules containing Zanthoxylum limonella oil (ZLO) were prepared by coacervation technique. The effect of various parameters such as variation of oil-loading, gelatin concentration and degree of crosslinking on release rate of oil were studied. Scanning electron microscopy (SEM) was used to understand the surface characteristics of microcapsules. FTIR-results indicated the absence of any significant interaction between polymer and oil.
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Affiliation(s)
- T K Maji
- Department of Chemical Sciences, Tezpur University, Napaam 784 028, India.
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Abstract
UNLABELLED The purpose of this pilot study was to examine four groups of primary care physicians' knowledge of sleep apnea. METHODS Using a 36-item questionnaire, we investigated how cognizant primary care physicians in Ontario, Canada, were of sleep apnea and its different symptoms. The questions covered incidence, diagnosis, treatment, and medical and social ramifications of sleep apnea. Sleep apnea surveys were administered to small groups of primary care physicians attending educational conferences or were distributed by mail to physicians who had previously referred patients to the sleep clinic. RESULTS A total of 151 physicians responded to the survey. An overall average score of 69% was obtained on the questionnaire. CONCLUSIONS This score suggests that the physicians sampled in this pilot study are relatively under-informed about the clinical features and medical and social ramifications associated with sleep apnea.
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Affiliation(s)
- S A Chung
- Sleep Research Laboratory, Department of Psychiatry, Toronto Western Hospital, The University Health Network, Toronto, Ontario, Canada.
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13
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Affiliation(s)
- C M Shapiro
- Toronto Hospital, University of Toronto, Ontario
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