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Khafagy R, Paterson AD, Dash S. Erythritol as a Potential Causal Contributor to Cardiometabolic Disease: A Mendelian Randomization Study. Diabetes 2024; 73:325-331. [PMID: 37939167 DOI: 10.2337/db23-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
People with type 2 diabetes frequently use low-calorie sweeteners to manage glycemia and reduce caloric intake. Use of erythritol, a low-calorie sweetener, has increased recently. Higher circulating concentration associates with major cardiac events and metabolic disease in observational data, prompting some concern. As observational data may be prone to confounding and reverse causality, we undertook bidirectional Mendelian randomization (MR) to investigate potential causal associations between erythritol and coronary artery disease (CAD), BMI, waist-hip-ratio (WHR), and glycemic and renal traits in cohorts of European ancestry. Analyses were undertaken using instruments comprising genome-wide significant variants from three cohorts with erythritol measurement. Across instruments, we did not find supportive evidence that increased erythritol increases CAD (b = -0.033 ± 0.02, P = 0.14; b = 0.46 ± 0.37, P = 0.23). MR indicates erythritol may decrease BMI (b = -0.04 ± 0.018, P = 0.03; b = -0.04 ± 0.0085, P = 1.23 × 10-5; b = -0.083 ± 0.092, P = 0.036), with potential evidence from one instrument of increased BMI adjusted for WHR (b = 0.046 ± 0.022, P = 0.035). No evidence of causal association was found with other traits. In conclusion, we did not find supportive evidence from MR that erythritol increases cardiometabolic disease. These findings await confirmation in well-designed prospective studies. ARTICLE HIGHLIGHTS
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Affiliation(s)
- Rana Khafagy
- Department of Medicine, University Health Network, and Banting & Best Diabetes Centre, University of Toronto, Toronto, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Andrew D Paterson
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Satya Dash
- Department of Medicine, University Health Network, and Banting & Best Diabetes Centre, University of Toronto, Toronto, Canada
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Nguyen A, Khafagy R, Gao Y, Meerasa A, Roshandel D, Anvari M, Lin B, Cherney DZI, Farkouh ME, Shah BR, Paterson AD, Dash S. Erratum. Association Between Obesity and Chronic Kidney Disease: Multivariable Mendelian Randomization Analysis and Observational Data From a Bariatric Surgery Cohort. Diabetes 2023;72:496-510. Diabetes 2023:148944. [PMID: 37200064 PMCID: PMC10382645 DOI: 10.2337/db23-er08a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
In Table 2 of the article cited above, the univariable MR analyses for microalbuminuria were erroneously cited as inverse variance weighted analyses. The row headings in Table 2 have been revised to show the correct analyses performed: MR-Egger, weighted median and mode, and simple mode analyses. In Fig. 3, the confidence intervals were erroneously plotted as error bars. Fig. 3 has been updated with the correct confidence intervals from the text. The revised online version of the article can be accessed at https://doi.org/10.2337/db22-0696.
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Nguyen A, Khafagy R, Gao Y, Meerasa A, Roshandel D, Anvari M, Lin B, Cherney DZI, Farkouh ME, Shah BR, Paterson AD, Dash S. Association Between Obesity and Chronic Kidney Disease: Multivariable Mendelian Randomization Analysis and Observational Data From a Bariatric Surgery Cohort. Diabetes 2023; 72:496-510. [PMID: 36657976 DOI: 10.2337/db22-0696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
Obesity is postulated to independently increase chronic kidney disease (CKD), even after adjusting for type 2 diabetes (T2D) and hypertension. Dysglycemia below T2D thresholds, frequently seen with obesity, also increases CKD risk. Whether obesity increases CKD independent of dysglycemia and hypertension is unknown and likely influences the optimal weight loss (WL) needed to reduce CKD. T2D remission rates plateau with 20-25% WL after bariatric surgery (BS), but further WL increases normoglycemia and normotension. We undertook bidirectional inverse variance weighted Mendelian randomization (IVWMR) to investigate potential independent causal associations between increased BMI and estimated glomerular filtration rate (eGFR) in CKD (CKDeGFR) (<60 mL/min/1.73 m2) and microalbuminuria (MA). In 5,337 BS patients, we assessed whether WL influences >50% decline in eGFR (primary outcome) or CKD hospitalization (secondary outcome), using <20% WL as a comparator. IVWMR results suggest that increased BMI increases CKDeGFR (b = 0.13, P = 1.64 × 10-4; odds ratio [OR] 1.14 [95% CI 1.07, 1.23]) and MA (b = 0.25; P = 2.14 × 10-4; OR 1.29 [1.13, 1.48]). After adjusting for hypertension and fasting glucose, increased BMI did not significantly increase CKDeGFR (b = -0.02; P = 0.72; OR 0.98 [0.87, 1.1]) or MA (b = 0.19; P = 0.08; OR 1.21 [0.98, 1.51]). Post-BS WL significantly reduced the primary outcome with 30 to <40% WL (hazard ratio [HR] 0.53 [95% CI 0.32, 0.87]) but not 20 to <30% WL (HR 0.72 [0.44, 1.2]) and ≥40% WL (HR 0.73 [0.41, 1.30]). For CKD hospitalization, progressive reduction was seen with increased WL, which was significant for 30 to <40% WL (HR 0.37 [0.17, 0.82]) and ≥40% WL (HR 0.24 [0.07, 0.89]) but not 20 to <30% WL (HR 0.60 [0.29, 1.23]). The data suggest that obesity is likely not an independent cause of CKD. WL thresholds previously associated with normotension and normoglycemia, likely causal mediators, may reduce CKD after BS.
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Affiliation(s)
- Anthony Nguyen
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Rana Khafagy
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yiding Gao
- Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ameena Meerasa
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Delnaz Roshandel
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mehran Anvari
- Department of Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Boxi Lin
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Z I Cherney
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Andrew D Paterson
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Satya Dash
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Nguyen A, Khafagy R, Hashemy H, Kuo KHM, Roshandel D, Paterson AD, Dash S. Investigating the association between fasting insulin, erythrocytosis and HbA1c through Mendelian randomization and observational analyses. Front Endocrinol (Lausanne) 2023; 14:1146099. [PMID: 37008938 PMCID: PMC10064082 DOI: 10.3389/fendo.2023.1146099] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Insulin resistance (IR) with associated compensatory hyperinsulinemia (HI) are early abnormalities in the etiology of prediabetes (preT2D) and type 2 diabetes (T2D). IR and HI also associate with increased erythrocytosis. Hemoglobin A1c (HbA1c) is commonly used to diagnose and monitor preT2D and T2D, but can be influenced by erythrocytosis independent of glycemia. METHODS We undertook bidirectional Mendelian randomization (MR) in individuals of European ancestry to investigate potential causal associations between increased fasting insulin adjusted for BMI (FI), erythrocytosis and its non-glycemic impact on HbA1c. We investigated the association between the triglyceride-glucose index (TGI), a surrogate measure of IR and HI, and glycation gap (difference between measured HbA1c and predicted HbA1c derived from linear regression of fasting glucose) in people with normoglycemia and preT2D. RESULTS Inverse variance weighted MR (IVWMR) suggested that increased FI increases hemoglobin (Hb, b=0.54 ± 0.09, p=2.7 x 10-10), red cell count (RCC, b=0.54 ± 0.12, p=5.38x10-6) and reticulocyte (RETIC, b=0.70 ± 0.15, p=2.18x10-6). Multivariable MR indicated that increased FI did not impact HbA1c (b=0.23 ± 0.16, p=0.162) but reduced HbA1c after adjustment for T2D (b=0.31 ± 0.13, p=0.016). Increased Hb (b=0.03 ± 0.01, p=0.02), RCC (b=0.02 ± 0.01, p=0.04) and RETIC (b=0.03 ± 0.01, p=0.002) might modestly increase FI. In the observational cohort, increased TGI associated with decreased glycation gap, (i.e., measured HbA1c was lower than expected based on fasting glucose, (b=-0.09 ± 0.009, p<0.0001)) in people with preT2D but not in those with normoglycemia (b=0.02 ± 0.007, p<0.0001). CONCLUSIONS MR suggests increased FI increases erythrocytosis and might potentially decrease HbA1c by non-glycemic effects. Increased TGI, a surrogate measure of increased FI, associates with lower-than-expected HbA1c in people with preT2D. These findings merit confirmatory studies to evaluate their clinical significance.
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Affiliation(s)
- Anthony Nguyen
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Rana Khafagy
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Habiba Hashemy
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kevin H. M. Kuo
- Division of Medical Oncology and Haematology, Department of Medicine, University Health Network, Toronto, ON, Canada
- Division of Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Delnaz Roshandel
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrew D. Paterson
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Satya Dash
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
- *Correspondence: Satya Dash,
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Nguyen A, Khafagy R, Meerasa A, Roshandel D, Paterson A, Dash S. Insulin Response to Oral Glucose and Cardiometabolic Disease: A Mendelian Randomization Study to Assess Potential Causality. Can J Diabetes 2022. [DOI: 10.1016/j.jcjd.2022.09.068] [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: 11/13/2022]
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Nguyen A, Khafagy R, Meerasa A, Roshandel D, Paterson AD, Dash S. Insulin Response to Oral Glucose and Cardiometabolic Disease: A Mendelian Randomization Study to Assess Potential Causality. Diabetes 2022; 71:1880-1890. [PMID: 35748295 DOI: 10.2337/db22-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022]
Abstract
Mendelian randomization (MR) suggests that postprandial hyperinsulinemia (unadjusted for plasma glucose) increases BMI, but its impact on cardiometabolic disease, a leading cause for mortality and morbidity in people with obesity, is not established. Fat distribution i.e., increased centripetal and/or reduced femoro-gluteal adiposity, is causally associated with and better predicts cardiometabolic disease than BMI. We therefore undertook bidirectional MR to assess the effect of corrected insulin response (CIR) (insulin 30 min after a glucose challenge adjusted for plasma glucose) on BMI, waist-to-hip ratio (WHR), leg fat, type 2 diabetes (T2D), triglyceride (TG), HDL, liver fat, hypertension (HTN), and coronary artery disease (CAD) in people of European descent. Inverse variance-weighted MR suggests a potential causal association between increased CIR and increased BMI (b = 0.048 ± 0.02, P = 0.03), increased leg fat (b = 0.029 ± 0.012, P = 0.01), reduced T2D (b = -0.73 ± 0.15, P = 6 × 10-7, odds ratio [OR] 0.48 [95% CI 0.36-0.64]), reduced TG (b = -0.07 ± 0.02, P = 0.003), and increased HDL (b = 0.04 ± 0.01, P = 0.006) with some evidence of horizontal pleiotropy. CIR had neutral effects on WHR (b = 0.009 ± 0.02, P = 0.69), liver fat (b = -0.08 ± 0.04, P = 0.06), HTN (b = -0.001 ± 0.004, P = 0.7, OR 1.00 [95% CI 0.99-1.01]), and CAD (b = -0.002 ± 0.002, P = 0.48, OR 0.99 [95% CI 0.81-1.21]). T2D decreased CIR (b -0.22 ± 0.04, P = 1.3 × 10-7), with no evidence that BMI, TG, HDL, liver fat, HTN, and CAD modulate CIR. In conclusion, we did not find evidence that increased CIR increases cardiometabolic disease. It might increase BMI with favorable fat distribution, reduce T2D, and improve lipids.
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Affiliation(s)
- Anthony Nguyen
- Department of Medicine, University Health Network, and University of Toronto, Toronto, Canada
| | - Rana Khafagy
- Department of Medicine, University Health Network, and University of Toronto, Toronto, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ameena Meerasa
- Department of Medicine, University Health Network, and University of Toronto, Toronto, Canada
| | - Delnaz Roshandel
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Andrew D Paterson
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Satya Dash
- Department of Medicine, University Health Network, and University of Toronto, Toronto, Canada
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Abstract
Obesity is a growing public health challenge across the globe. It is associated with increased morbidity and mortality. Cardiovascular disease (CVD) is the leading cause of mortality for people with obesity. Current strategies to reduce CVD are largely focused on addressing traditional risk factors such as dyslipidemia, type 2 diabetes (T2D) and hypertension. Although this approach is proven to reduce CVD, substantial residual risk remains for people with obesity. This necessitates a better understanding of the etiology of CVD in people with obesity and alternate therapeutic approaches. Reducing inflammation may be one such strategy. A wealth of animal and human data indicates that obesity is associated with adipose tissue and systemic inflammation. Inflammation is a known contributor to CVD in humans and can be successfully targeted to reduce CVD. Here we will review the etiology and pathogenesis of inflammation in obesity associated metabolic disease as well as CVD. We will review to what extent these associations are causal based on human genetic studies and pharmacological studies. The available data suggests that anti-inflammatory treatments can be used to reduce CVD, but off-target effects such as increased infection have precluded its broad therapeutic application to date. The role of anti-inflammatory therapies in improving glycaemia and metabolic parameters is less established. A number of clinical trials are currently ongoing which are evaluating anti-inflammatory agents to lower CVD. These studies will further clarify whether anti-inflammatory agents can safely reduce CVD.
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Affiliation(s)
- Rana Khafagy
- Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada.,Banting & Best Diabetes Centre, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Satya Dash
- Banting & Best Diabetes Centre, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
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Abd El Tawab K, Abdo Salem A, Khafagy R. New Technique of Embolization of the Hemorrhoidal Arteries Using Embolization Particles Alone: Retrospective Results in 33 Patients. The Arab Journal of Interventional Radiology 2021. [DOI: 10.4103/ajir.ajir_21_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: The purpose of this study was to assess the safety and efficacy of using particles only in the embolization of the hemorrhoidal arteries for the management of hemorrhoids. Subjects and Methods: This is a retrospective study for patients treated between March 2015 and December 2018. We treated 33 patients, 13 men and 20 women with a mean age of 37 years (range: 18–70 years), in which 11 patients had Grade II hemorrhoids and 22 had Grade III hemorrhoids. Technical and clinical successes together with procedural complications were assessed. Results: The technical success rate was 100%. No minor or major complications have been reported. No cases of anorectal ischemia, anal incontinence, hemorrhoidal thrombosis, or complications related to femoral arterial puncture have occurred. Follow-up was at 3 months and 12 months postembolization. Clinical success was observed in 32 patients (96.9%) with improvement by at least 2 points of the French bleeding score at 3 months postembolization. Conclusion: The use of particles alone in the embolization of hemorrhoidal arteries whether from the superior rectal artery and/or from the middle and inferior rectal arteries can offer a safe and effective treatment option.
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Affiliation(s)
| | - Amr Abdo Salem
- Department of Radiology, IR Unit, Ain Shams University Hospitals, Cairo
| | - Rana Khafagy
- Department of Radiology, IR Unit, Ain Shams University Hospitals, Cairo
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Khafagy R, Gupta S, Campisi P, Waters V. Treatment of localized mucormycosis using nasal amphotericin B irrigation in pediatric oncology. Pediatr Blood Cancer 2020; 67:e28175. [PMID: 31925929 DOI: 10.1002/pbc.28175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/21/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Rana Khafagy
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paolo Campisi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Valerie Waters
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
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Salama A, Soliman A, Khafagy R, Elmogy AA, Nabil SH, Shaaban M, Gibreel M, Elkafrawy F, Tantawy S, Labib DO, Elmozy W, Romeih S. 225Neglected unrepaired TGA with VSD, does CMR has a role? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez107.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Salama
- Aswan Heart Centre, Aswan, Egypt
| | | | | | | | | | | | | | | | | | | | - W Elmozy
- Aswan Heart Centre, Aswan, Egypt
| | - S Romeih
- Aswan Heart Centre, Aswan, Egypt
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Soliman A, Elmozy W, Romeih S, Khafagy R, Elmogy A, Nabil SH, Shaaban M, Gibreel M, Salama A, Elkafrawy F. P574Diagnosis of uhl anomaly in infancy, role of CMR. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez108.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - W Elmozy
- Aswan Heart Centre, Aswan, Egypt
| | - S Romeih
- Aswan Heart Centre, Aswan, Egypt
| | | | - A Elmogy
- Aswan Heart Centre, Aswan, Egypt
| | | | | | | | - A Salama
- Aswan Heart Centre, Aswan, Egypt
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Tantawy S, Shaaban M, Elkafrawy F, Khafagy R, Elmogy A, Salama A, Gibreel M, Soliman A, Nabil SH, Kharabeesh A, Labib D, Romeih S, Elmozy W. P161Longitudinal RV and LV strain in pulmonary hypertension patients using CMR feature tracking. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Tantawy
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | - M Shaaban
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | | | - R Khafagy
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | - A Elmogy
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | - A Salama
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | - M Gibreel
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | - A Soliman
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | - S H Nabil
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | | | - D Labib
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | - S Romeih
- Aswan Heart Centre, Radiology, Aswan, Egypt
| | - W Elmozy
- Aswan Heart Centre, Radiology, Aswan, Egypt
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Shaaban M, Tantawy S, Elkafrawy F, Salama A, Gibreel M, Elmogy A, Khafagy R, Soliman A, Nabil SH, Kharabesh A, Romeih S, Labib D, Elmozy W. P609Feature tracking cardiac magnetic resonance as a prognostic tool in successfully revascularized patients with acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez116.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - A Salama
- Aswan Heart Centre, Aswan, Egypt
| | | | - A Elmogy
- Aswan Heart Centre, Aswan, Egypt
| | | | | | | | | | - S Romeih
- Aswan Heart Centre, Aswan, Egypt
| | - D Labib
- Aswan Heart Centre, Aswan, Egypt
| | - W Elmozy
- Aswan Heart Centre, Aswan, Egypt
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Brown A, Khafagy R, Kabir S, Kimuli M, Urwin G. UP-2.11: A comparative analysis of MiniArc™ and Monarc™ sub-urethral slings for female stress urinary incontinence. Urology 2010. [DOI: 10.1016/j.urology.2010.07.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Abstract
Consider alcohol related pathology in women who present with lower abdominal pain
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Affiliation(s)
- M D Dooldeniya
- Pinderfields Hospitals, Wakefield, West Yorkshire WF1 4EE.
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Khafagy R, Stephens T, Hart C, Ramani V, Brown M, Clarke N. In vitro effects of the prenyl transferase inhibitor AZD3409 on prostate cancer epithelial cells. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Khafagy
- Paterson Institute, Manchester, United Kingdom; AstraZeneca, Alderley Park, Cheshire, United Kingdom; Christie Hospital NHS Trust, Manchester, United Kingdom
| | - T. Stephens
- Paterson Institute, Manchester, United Kingdom; AstraZeneca, Alderley Park, Cheshire, United Kingdom; Christie Hospital NHS Trust, Manchester, United Kingdom
| | - C. Hart
- Paterson Institute, Manchester, United Kingdom; AstraZeneca, Alderley Park, Cheshire, United Kingdom; Christie Hospital NHS Trust, Manchester, United Kingdom
| | - V. Ramani
- Paterson Institute, Manchester, United Kingdom; AstraZeneca, Alderley Park, Cheshire, United Kingdom; Christie Hospital NHS Trust, Manchester, United Kingdom
| | - M. Brown
- Paterson Institute, Manchester, United Kingdom; AstraZeneca, Alderley Park, Cheshire, United Kingdom; Christie Hospital NHS Trust, Manchester, United Kingdom
| | - N. Clarke
- Paterson Institute, Manchester, United Kingdom; AstraZeneca, Alderley Park, Cheshire, United Kingdom; Christie Hospital NHS Trust, Manchester, United Kingdom
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Aziz T, Burgess M, Khafagy R, Wynn Hann A, Campbell C, Rahman A, Deiraniya A, Yonan N. Bicaval and standard techniques in orthotopic heart transplantation: medium-term experience in cardiac performance and survival. J Thorac Cardiovasc Surg 1999; 118:115-22. [PMID: 10384194 DOI: 10.1016/s0022-5223(99)70150-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to compare the medium-term results of right heart pressures, tricuspid valve dysfunction, overall cardiac performance, and survival between the bicaval and standard techniques. METHOD Between 1991 and 1997, 201 heart transplantations were performed in our center. Right heart catheterization was performed up to 12 months after transplantation. Echocardiography was used to assess left ventricular and tricuspid valve function. RESULT The standard technique was used in 105 cases, and the bicaval technique was used in 96 cases. There was no difference in the age, preoperative parameters, pulmonary hemodynamics, or ischemic time between the 2 groups. Right atrial pressure (4.3 +/- 4.0 mm Hg for the bicaval vs 10.9 +/- 4.8 mm Hg for standard technique) and mean pulmonary artery pressure (17.5 +/- 5.3 mm Hg and 22.5 +/- 5.2 mm Hg, respectively) were lower for the bicaval recipients up to 12 months after the operation (P =.001 and. 01, respectively). Left ventricular ejection fraction was higher for the recipients of the bicaval technique up to the most recent measurement (P =.005). The prevalence of moderate or severe tricuspid regurgitation was higher in the recipients of the standard technique up to the most recent measurement (28% vs 7%; P =.02). The actuarial survival at 1, 3, and 5 years was 74%, 70%, and 62% for the recipients of the standard technique versus 87%, 82%, and 81% for the recipients of the bicaval technique (P <.03, <.04, and <.02, respectively). CONCLUSION The bicaval technique maintains good left ventricular function, lower incidence and severity of tricuspid valve dysfunction, and improved survival compared with the standard technique.
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Affiliation(s)
- T Aziz
- Cardiac Transplant Unit, Wythenshawe Hospital, and the University Department of Statistics, Manchester University, Manchester, United Kingdom
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