1
|
Lam S, Kumar B, Loke YK, Orme SE, Dhatariya K. Glycated haemoglobin and the risk of postoperative complications in people without diabetes: a prospective population-based study in UK Biobank. Anaesthesia 2022; 77:659-667. [PMID: 35238399 PMCID: PMC9314702 DOI: 10.1111/anae.15684] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/13/2022]
Abstract
Summary The aim of our study was to clarify the association between glycated haemoglobin (HbA1c) and postoperative outcomes in people without an existing diagnosis of diabetes. Half a million adults were recruited into the UK Biobank prospective cohort study between March 2006 and October 2010. We divided participants into three groups: no diagnosis of diabetes and HbA1c < 42 mmol.mol−1; no diagnosis of diabetes and elevated HbA1c (≥ 42 mmol.mol−1 with no upper limit); and prevalent diabetes (regardless of HbA1c concentration) at recruitment. We followed up participants by linkage with routinely collected hospital data to determine any surgical procedures undertaken after recruitment and the associated postoperative outcomes. Our main outcome measure was a composite primary outcome of 30‐day major postoperative complications and 90‐day all‐cause mortality. We used logistic regression to estimate the odds of the primary outcome by group. We limited analyses to those who underwent surgery within one year of recruitment (n = 26,653). In a combined effects logistic regression model, participants not known to have diabetes with HbA1c ≥ 42 mmol.mol−1 had increased odds of the primary outcome (OR [95% CI] 1.43 [1.02–2.02]; p = 0.04), when compared with those without diabetes and HbA1c < 42 mmol.mol−1. This effect was attenuated and no longer statistically significant in a direct effects model with adjustment for hyperglycaemia‐related comorbidity (OR [95% CI] 1.37 [0.97–1.93]; p = 0.07). Elevated pre‐operative HbA1c in people without diabetes may be associated with an increased risk of complications, but the association is likely confounded by end‐organ comorbidity. In contrast to previous evidence, our findings suggest that to prevent adverse postoperative outcomes, optimisation of pre‐existing morbidity should take precedence over reducing HbA1c in people without diabetes.
Collapse
Affiliation(s)
- S Lam
- Norwich Medical School, University of East Anglia, Norwich, UK.,Department of General Surgery, Norfolk and Norwich University Hospital NHS Trust, UK
| | - B Kumar
- Norwich Medical School, University of East Anglia, Norwich, UK.,Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital NHS Trust, UK
| | - Y K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - S E Orme
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Dhatariya
- Norwich Medical School, University of East Anglia, Norwich, UK.,Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Trust, UK
| |
Collapse
|
2
|
Alexandre L, Clark AB, Walton S, Lewis MP, Kumar B, Cheong EC, Warren H, Kadirkamanathan SS, Parsons SL, Dresner SM, Sims E, Jones M, Hammond M, Flather M, Loke YK, Swart AM, Hart AR. Adjuvant statin therapy for oesophageal adenocarcinoma: the STAT-ROC feasibility study. BJS Open 2019; 4:59-70. [PMID: 32011825 PMCID: PMC6996637 DOI: 10.1002/bjs5.50239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/22/2019] [Indexed: 01/14/2023] Open
Abstract
Background Statins inhibit proliferative signalling in oesophageal adenocarcinoma (OAC) and their use is associated with better survival in observational studies. The present study was undertaken to examine the feasibility of assessing adjuvant statin therapy in patients with operable OAC in a phase III RCT. Methods For this multicentre, double‐blind, parallel‐group, randomized, placebo‐controlled feasibility trial, adults with OAC (including Siewert I–II lesions) who had undergone oesophagectomy were centrally allocated (1 : 1) to simvastatin 40 mg or matching placebo by block randomization, stratified by centre. Participants, clinicians and investigators were blinded to treatment allocation. Patients received treatment for up to 1 year. Feasibility outcomes were recruitment, retention, drug absorption, adherence, safety, quality of life, generalizability and survival. Results A total of 120 patients were assessed for eligibility at four centres, of whom 32 (26·7 per cent) were randomized, 16 in each group. Seven patients withdrew. Participants allocated to simvastatin had lower low‐density lipoprotein cholesterol levels by 3 months (adjusted mean difference −0·83 (95 per cent c.i. −1·4 to −0·22) mmol/l; P = 0·009). Median adherence to medication was greater than 90 per cent between 3 and 12 months' follow‐up. Adverse events were similar between the groups. Quality‐of‐life data were complete for 98·3 per cent of questionnaire items. Cardiovascular disease, diabetes and aspirin use were more prevalent in the non‐randomized group, whereas tumour site, stage and grade were similar between groups. Survival estimates were imprecise. Conclusion This RCT supports the conduct and informs the design considerations for a future phase III trial of adjuvant statin therapy in patients with OAC. Registration number: ISRCTN98060456 (http://www.isrctn/com).
Collapse
Affiliation(s)
- L Alexandre
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - A B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - S Walton
- Cancer Research Team and, Norwich, UK
| | - M P Lewis
- Department of General Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - B Kumar
- Department of General Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - E C Cheong
- Department of General Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - H Warren
- Department of General Surgery, Queen Elizabeth Hospital, King's Lynn, UK
| | - S S Kadirkamanathan
- Department of General Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
| | - S L Parsons
- Department of Surgery, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S M Dresner
- Department of General Surgery, James Cook University Hospital, Middlesbrough, UK
| | - E Sims
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Jones
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Hammond
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Y K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - A M Swart
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - A R Hart
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
3
|
Mattishent K, Loke YK. Detection of asymptomatic drug-induced hypoglycemia using continuous glucose monitoring in older people - Systematic review. J Diabetes Complications 2018; 32:805-812. [PMID: 29887300 DOI: 10.1016/j.jdiacomp.2018.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Received: 03/04/2018] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 02/03/2023]
Abstract
AIM We conducted a systematic review of the use of continuous glucose monitoring (CGM) in older patients, in order to consolidate the growing evidence base in this area. METHODS Our protocol was registered on PROSPERO (CRD42017068523). We searched SCI Web of Science, Ovid SP MEDLINE and EMBASE from January 2010 to June 2017 for observational studies and randomized controlled trial of CGM in older patients (mean age 65 or older) with diabetes. We excluded studies that involved only hospitalized patients. Two reviewers independently extracted data blood sugar values (in particular, hypoglycemic episodes) captured with the use of CGM. We also assessed adverse events and acceptability of CGM. RESULTS After screening 901 abstracts, we included nine studies with a total of 989 older patients with diabetes. The CGM studies reveal that hypoglycemic episodes were occurring in a sizeable proportion (28-65%) of participants. Most (80-100%) of these episodes were asymptomatic, with some patients spending nearly 2 h per day in the hypoglycemic range. Older people with diabetes found CGM acceptable and experienced improved health-related well-being. CONCLUSION CGM frequently picks up asymptomatic hypoglycemic episodes in older patients with diabetes. Users of CGM report improved well-being, and reduction of diabetes-related stress.
Collapse
Affiliation(s)
- K Mattishent
- Norwich Medical School, University of East Anglia, NR4 7UY, United Kingdom.
| | - Y K Loke
- Norwich Medical School, University of East Anglia, NR4 7UY, United Kingdom
| |
Collapse
|
4
|
Peel AM, Crossman-Barnes CJ, Tang J, Fowler SJ, Davies GA, Wilson AM, Loke YK. S1 Biomarkers in adult asthma: a systematic review of 8-isoprostane in exhaled breath condensate. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.7] [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: 11/04/2022]
|
5
|
Kwok CS, Loke YK, Welch AA, Luben RN, Lentjes MAH, Boekholdt SM, Pfister R, Mamas MA, Wareham NJ, Khaw KT, Myint PK. Habitual chocolate consumption and the risk of incident heart failure among healthy men and women. Nutr Metab Cardiovasc Dis 2016; 26:722-734. [PMID: 27052923 PMCID: PMC4987462 DOI: 10.1016/j.numecd.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND We aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association. METHODS AND RESULTS We used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993-1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66-0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71-1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66-1.01). CONCLUSIONS Our results suggest that higher chocolate intake is not associated with subsequent incident heart failure.
Collapse
Affiliation(s)
- C S Kwok
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Keele Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
| | - Y K Loke
- Department of Population Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - A A Welch
- Department of Population Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - R N Luben
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - M A H Lentjes
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - S M Boekholdt
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - R Pfister
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany
| | - M A Mamas
- Keele Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
| | - N J Wareham
- Medical Research Council Epidemiology Unit, Cambridge, United Kingdom
| | - K-T Khaw
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - P K Myint
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
| |
Collapse
|
6
|
Mattishent K, Loke YK. 43BI-DIRECTIONAL INTERACTION BETWEEN HYPOGLYCEMIA AND COGNITIVE IMPAIRMENT IN ELDERLY PATIENTS WITH DIABETES MELLITUS: SYSTEMATIC REVIEW AND META-ANALYSIS. Age Ageing 2016. [DOI: 10.1093/ageing/afw028] [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: 11/14/2022] Open
|
7
|
Mattishent K, Loke YK. Bi-directional interaction between hypoglycaemia and cognitive impairment in elderly patients treated with glucose-lowering agents: a systematic review and meta-analysis. Diabetes Obes Metab 2016; 18:135-41. [PMID: 26446922 DOI: 10.1111/dom.12587] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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] [Received: 09/09/2015] [Revised: 09/12/2015] [Accepted: 10/01/2015] [Indexed: 01/17/2023]
Abstract
AIMS To examine the bi-directional relationship, whereby hypoglycaemia is a risk factor for dementia, and where dementia increases risk of hypoglycaemia in older patients with diabetes mellitus treated with glucose-lowering agents. METHODS We searched MEDLINE and EMBASE over a 10-year span from 2005 to 2015 (with automated PubMed updates to August 2015) for observational studies of the association between hypoglycaemia and cognitive impairment or dementia in participants aged >55 years. Assessment of study validity was based on ascertainment of hypoglycaemia, dementia and risk of confounding. We conducted random effects inverse variance meta-analyses, and assessed heterogeneity using the I(2) statistic. RESULTS We screened 1177 citations, and selected 12 studies, of which nine were suitable for meta-analysis. There were a total of 1,439,818 participants, with a mean age of 75 years. Meta-analysis of five studies showed a significantly increased risk of dementia in patients who had hypoglycaemic episodes: pooled odds ratio 1.68 [95% confidence interval (CI) 1.45, 1.95]. We also found a significantly increased risk of hypoglycaemia in patients with dementia: pooled odds ratio from five studies 1.61 (95% CI 1.25, 2.06). Limitations of the study were heterogeneity in the meta-analysis, and uncertain ascertainment of dementia and hypoglycaemic outcomes and temporal relationships. Publication bias may have favoured the reporting of more significant findings. CONCLUSIONS Our meta-analysis shows a bi-directional relationship between cognitive impairment and hypoglycaemia in older patients. Glucose-lowering therapy should be carefully tailored and monitored in older patients who are susceptible to cognitive decline.
Collapse
Affiliation(s)
- K Mattishent
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Y K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
8
|
Mattishent K, Kwok CS, Mahtani A, Pelpola K, Myint PK, Loke YK. Prognostic indices for early mortality in ischaemic stroke - meta-analysis. Acta Neurol Scand 2016; 133:41-8. [PMID: 25968234 DOI: 10.1111/ane.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Several models have been developed to predict mortality in ischaemic stroke. We aimed to evaluate systematically the performance of published stroke prognostic scores. METHODS We searched MEDLINE and EMBASE in February 2014 for prognostic models (published between 2003 and 2014) used in predicting early mortality (<6 months) after ischaemic stroke. We evaluated discriminant ability of the tools through meta-analysis of the area under the curve receiver operating characteristic curve (AUROC) or c-statistic. We evaluated the following components of study validity: collection of prognostic variables, neuroimaging, treatment pathways and missing data. RESULTS We identified 18 articles (involving 163 240 patients) reporting on the performance of prognostic models for mortality in ischaemic stroke, with 15 articles providing AUC for meta-analysis. Most studies were either retrospective, or post hoc analyses of prospectively collected data; all but three reported validation data. The iSCORE had the largest number of validation cohorts (five) within our systematic review and showed good performance in four different countries, pooled AUC 0.84 (95% CI 0.82-0.87). We identified other potentially useful prognostic tools that have yet to be as extensively validated as iSCORE - these include SOAR (2 studies, pooled AUC 0.79, 95% CI 0.78-0.80), GWTG (2 studies, pooled AUC 0.72, 95% CI 0.72-0.72) and PLAN (1 study, pooled AUC 0.85, 95% CI 0.84-0.87). CONCLUSIONS Our meta-analysis has identified and summarized the performance of several prognostic scores with modest to good predictive accuracy for early mortality in ischaemic stroke, with the iSCORE having the broadest evidence base.
Collapse
Affiliation(s)
- K. Mattishent
- Norwich Medical School; University of East Anglia; Norwich UK
| | - C. S. Kwok
- Norwich Medical School; University of East Anglia; Norwich UK
| | - A. Mahtani
- Norwich Medical School; University of East Anglia; Norwich UK
| | - K. Pelpola
- Southend University Hospital Trust; Westcliff-on-Sea UK
| | - P. K. Myint
- Epidemiology Group; Institute of Applied Health Sciences; School of Medicine & Dentistry; University of Aberdeen; Aberdeen UK
| | - Y. K. Loke
- Norwich Medical School; University of East Anglia; Norwich UK
| |
Collapse
|
9
|
Kwok CS, Aslam S, Kontopantelis E, Myint PK, Zaman MJS, Buchan I, Loke YK, Mamas MA. Influenza, influenza-like symptoms and their association with cardiovascular risks: a systematic review and meta-analysis of observational studies. Int J Clin Pract 2015; 69:928-37. [PMID: 25940136 PMCID: PMC7165588 DOI: 10.1111/ijcp.12646] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS To synthesise the evidence relating influenza and influenza-like symptoms to the risks of myocardial infarction (MI), heart failure (HF) and stroke. METHODS We conducted a systematic review and meta-analysis of the evidence relating influenza and influenza-like symptoms to the risks of MI, HF and stroke. We systematically searched all MEDLINE and EMBASE entries up to August 2014 for studies of influenza vs. the cardiovascular outcomes above. We conducted random effects meta-analysis using inverse variance method for pooled odds ratios (OR) and evaluated statistical heterogeneity using the I(2) statistic. RESULTS We identified 12 studies with a total of 84,003 participants. The pooled OR for risk of MI vs. influenza (serologically confirmed) was 1.27 (95% CI, confidence interval 0.54-2.95), I(2) = 47%, which was significant for the only study that adjusted for confounders (OR 5.50, 95% CI 1.31-23.13). The pooled OR for risk of MI vs. influenza-like symptoms was 2.17 (95% CI 1.68-2.80), I(2) = 0%, which was significant for both unadjusted (OR 2.23, 95% CI 1.65-3.01, five studies) and adjusted studies (OR 2.01, 95% CI 1.24-3.27, two studies). We found one study that evaluated stroke risk, one study in patients with HF, and one that evaluated mortality from MI - all of these studies suggested increased risks of events with influenza-like symptoms. CONCLUSIONS There is an association between influenza-like illness and cardiovascular events, but the relationship is less clear with serologically diagnosed influenza. We recommend renewed efforts to apply current clinical guidelines and maximise the uptake of annual influenza immunisation among patients with cardiovascular diseases, to decrease their risks of MI and stroke.
Collapse
Affiliation(s)
- C S Kwok
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - S Aslam
- Central Manchester Foundation Trust, Manchester, UK
| | - E Kontopantelis
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
| | - P K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M J S Zaman
- Department of Cardiology, James Paget University Hospital, Gorleston-on-Sea, UK
| | - I Buchan
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Y K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - M A Mamas
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
- Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK
| |
Collapse
|
10
|
Mannu GS, Kyu MM, Bettencourt-Silva JH, Loke YK, Clark AB, Metcalf AK, Potter JF, Myint PK. Age but not ABCD(2) score predicts any level of carotid stenosis in either symptomatic or asymptomatic side in transient ischaemic attack. Int J Clin Pract 2015; 69:948-56. [PMID: 25832133 DOI: 10.1111/ijcp.12637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The ABCD(2) score is routinely used in assessment of transient ischaemic attack (TIA) to assess the risk of developing stroke. There remains uncertainty regarding whether the ABCD(2) score could be used to help predict extent of carotid artery stenosis (CAS). OBJECTIVES We aimed to (i) collate and analyse all available published literature on this topic and (ii) compare the data from our local population to the existing evidence base. MATERIALS AND METHODS We conducted a retrospective-observational study over a 6-month period using our East of England hospital-based TIA clinic data with a catchment population of ~750,000. We also searched the literature on studies reporting the association between ABCD(2) score and CAS. RESULTS We included 341 patients in our observational study. The mean age in our cohort was 72.86 years (SD 10.91) with 52% male participants. ABCD(2) score was not significantly associated with CAS (p = 0.78). Only age > 60 years was significantly associated with ipsilateral (> 50%) and contralateral CAS (> 50% and > 70%) (p < 0.01) after controlling for other confounders. The systematic review identified four studies for inclusion and no significant association between ABCD(2) score and CAS was reported, confirming our findings. CONCLUSION Our systematic review and observational study confirm that the ABCD(2) score does not predict CAS. However, our observational study has examined a larger number of possible predictors and demonstrates that age appears to be the single best predictor of CAS in patients presenting with a TIA. Selection of urgent carotid ultrasound scan thus should be based on individual patient's age and potential benefit of carotid intervention rather than ABCD(2) score.
Collapse
Affiliation(s)
- G S Mannu
- Oxford University Hospitals NHS Trust, Oxford, UK
- Norfolk and Norwich University Hospital, Norfolk, UK
| | - M M Kyu
- Norfolk and Norwich University Hospital, Norfolk, UK
- Huddersfield Royal Infirmary, West Yorkshire, UK
| | - J H Bettencourt-Silva
- Norfolk and Norwich University Hospital, Norfolk, UK
- University of East Anglia, Norwich, UK
| | - Y K Loke
- Norfolk and Norwich University Hospital, Norfolk, UK
- University of East Anglia, Norwich, UK
| | - A B Clark
- University of East Anglia, Norwich, UK
| | - A K Metcalf
- Norfolk and Norwich University Hospital, Norfolk, UK
- University of East Anglia, Norwich, UK
| | - J F Potter
- Norfolk and Norwich University Hospital, Norfolk, UK
- University of East Anglia, Norwich, UK
| | - P K Myint
- University of Aberdeen, Aberdeen, UK
| |
Collapse
|
11
|
Brainard JS, Loke YK, Salter CS. International Variations in Targeting of Vulnerable Groups: A Systematic Survey of Health Literacy Interventions. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.010] [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: 11/12/2022] Open
|
12
|
Bellis JR, Pirmohamed M, Nunn AJ, Loke YK, De S, Golder S, Kirkham JJ. Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2014; 113:23-42. [PMID: 24942713 DOI: 10.1093/bja/aeu152] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Summary In children undergoing tonsillectomy, dexamethasone is recommended to reduce the risk of postoperative nausea and vomiting while non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain relief. We aimed to determine whether children who receive dexamethasone or dexamethasone with NSAID are more likely to experience haemorrhage post-tonsillectomy. Randomized and non-randomized studies in which children undergoing tonsillectomy received dexamethasone or dexamethasone and NSAID were sought within bibliographic databases and selected tertiary sources. The risk of bias assessment and evaluation of haemorrhage rate data collection and reporting were assessed using the Cochrane Risk of Bias Tool and McHarm tool. Synthesis methods comprised pooled estimate of the effect of dexamethasone on the risk of haemorrhage rate using the Peto odds ratio (OR) method. The pooled estimate for haemorrhage rate in children who received dexamethasone was 6.2%, OR 1.41 (95% confidence interval 0.89-2.25, P=0.15). There was risk of bias and inconsistent data collection and reporting rates of haemorrhage in many of the included studies. Clinical heterogeneity was observed between studies. The pooled analysis did not demonstrate a statistically significant increase in the risk of post-tonsillectomy haemorrhage with dexamethasone with/without NSAID use in children. However, the majority of the included studies were not designed to investigate this endpoint, and thus large studies which are specifically designed to collect data on haemorrhage rate are needed.
Collapse
Affiliation(s)
- J R Bellis
- Research and Development, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - M Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, UK
| | - A J Nunn
- Department of Women's and Children's Health, Institute of Translational Medicine (Child Health), University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - Y K Loke
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - S De
- Department of Paediatric Otolaryngology, Head and Neck Surgery, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - S Golder
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
| | - J J Kirkham
- Department of Biostatistics, University of Liverpool, Shelley's Cottage, Brownlow Street, Liverpool L69 3GS, UK
| |
Collapse
|
13
|
Wilson H, Loke YK, Hamilton EJ, Green AQ, Southgate JL, Markham E, Chomicki P. Readmission rates of older patients (age >75 years) discharged within 48 hours of admission to the Acute Medical Unit, Norwich: observational study. Future Hosp J 2014; 1:23-25. [DOI: 10.7861/futurehosp.14.008] [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: 11/27/2022]
|
14
|
Atkins CP, Loke YK, Wilson AM. S16 Outcomes in idiopathic pulmonary fibrosis: a meta-analysis from placebo controlled trials: Abstract S16 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.23] [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: 11/04/2022]
|
15
|
Loke YK, Ho R, Smith M, Wong O, Sandhu M, Sage W, Singh S. Systematic review evaluating cardiovascular events of the 5-alpha reductase inhibitor - Dutasteride. J Clin Pharm Ther 2013; 38:405-15. [DOI: 10.1111/jcpt.12080] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 06/05/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Y. K. Loke
- Norwich Medical School; University of East Anglia; Norwich UK
| | - R. Ho
- Norwich Medical School; University of East Anglia; Norwich UK
| | - M. Smith
- Norwich Medical School; University of East Anglia; Norwich UK
| | - O. Wong
- Norwich Medical School; University of East Anglia; Norwich UK
| | - M. Sandhu
- Norwich Medical School; University of East Anglia; Norwich UK
| | - W. Sage
- Norwich Medical School; University of East Anglia; Norwich UK
| | - S. Singh
- Centre for Public Health and Human Rights; Johns Hopkins School of Medicine and Public Health; Baltimore MD USA
| |
Collapse
|
16
|
Loke YK, Kwok CS, Wong JM, Sankaran P, Myint PK. Chronic obstructive pulmonary disease and mortality from pneumonia: meta-analysis. Int J Clin Pract 2013; 67:477-87. [PMID: 23574107 DOI: 10.1111/ijcp.12120] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 09/27/2012] [Accepted: 12/27/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND We aimed to determine whether patients with concomitant community-acquired pneumonia (CAP) and chronic obstructive pulmonary disease (COPD) are at greater risk of death when compared with those with CAP or acute COPD exacerbation alone. We also assessed the effect of inhaled corticosteroids (ICS) on pneumonia mortality in COPD. METHODS We searched MEDLINE and EMBASE from inception to March 2012 for studies reporting on mortality in patients with COPD and CAP. We assessed ascertainment of disease, mortality, drug exposure and adjustment for confounders. Data were pooled using random effects meta-analysis, and heterogeneity was estimated using I². RESULTS We identified 24 eligible articles overall. Evaluation of 13 studies revealed considerable heterogeneity and a non-significant mortality risk associated with concomitant COPD and CAP as compared with CAP in five studies that reported adjusted or severity-matched data, pooled RR 1.44 (95% CI 0.97-2.16, I² = 50%). There was also considerable inconsistency amongst the effect estimates from five studies that reported on the associated mortality with concomitant CAP and COPD as compared with acute COPD exacerbations alone. Evaluation of six datasets found that ICS use in COPD was not consistently associated with lower mortality in CAP. Reports of reduced mortality with prior ICS use stemmed from three studies that enrolled participants from the same healthcare database. CONCLUSIONS Evidence on associated mortality risk with concomitant CAP and COPD (as opposed to CAP alone, or COPD exacerbation alone) is weak and heterogeneous. ICS use was not consistently associated with reduced mortality from pneumonia.
Collapse
Affiliation(s)
- Y K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | | | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVES Despite many interventions that have been tried, controversy remains regarding the efficacy of interventions for contrast-induced nephropathy (CIN), so we aimed to evaluate the best evidence from recent meta-analyses. METHODS We searched MEDLINE, EMBASE and the Cochrane library for interventions which have been used for CIN. We included only the most recent meta-analysis of each intervention. We extracted data on the methodology, quality and results of each meta-analysis. We performed narrative synthesis and adjusted indirect comparison of interventions that were shown to be statistically significant compared with a placebo. RESULTS We included 7 systematic reviews and meta-analyses involving 9 different interventions for CIN, with a total of 15 976 participants. A significantly decreased risk of CIN was reported in meta-analysis of the following interventions: N-acetylcysteine [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.48-0.88, I(2)=64%], theophylline [relative risk (RR) 0.48, 95% CI 0.26-0.89, I(2)=44%], statins (RR 0.51, 95% CI 0.34-0.77, I(2)=0%) and sodium bicarbonate (RR 0.62, 95% CI 0.45-0.86, I(2)=49%). Furosemide was shown to increase the risk of CIN (RR 3.27, 95% CI 1.48-7.26, I(2)=0%). Other interventions such as renal replacement therapy, angiotensin-converting enzyme inhibitors, dopamine and fenoldapam failed to show any significant difference from the control group. CONCLUSION Although there is some evidence to suggest that N-acetylcysteine, theophylline, sodium bicarbonate and statins may reduce incidence of CIN, limitations in the study quality and heterogeneity preclude any firm recommendations. ADVANCES IN KNOWLEDGE N-acetylcysteine, theophylline, sodium bicarbonate and statins show some promise as potentially efficacious agents for preventing CIN, but more high-quality studies are needed before they can be recommended for use in routine practice.
Collapse
Affiliation(s)
- C S Kwok
- Norfolk and Norwich University Hospital, Norwich, UK.
| | | | | | | |
Collapse
|
18
|
Loke YK. Lack of clarity in reports of adverse events: Is there any harm? Pain 2013; 154:183-184. [DOI: 10.1016/j.pain.2012.10.019] [Citation(s) in RCA: 2] [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] [Received: 09/10/2012] [Revised: 10/17/2012] [Accepted: 10/26/2012] [Indexed: 11/29/2022]
|
19
|
Singh S, Loke YK, Spangler JG, Furberg CD. Authors' response. CMAJ 2011. [DOI: 10.1503/cmaj.111-2074] [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: 11/01/2022] Open
|
20
|
Singh S, Loke YK, Spangler JG, Furberg CD. Authors' response. CMAJ 2011. [DOI: 10.1503/cmaj.111-2072] [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: 11/01/2022] Open
|
21
|
Abstract
WHAT IS KNOWN AND OBJECTIVE Dabigatran and rivaroxaban are new oral anticoagulants for thromboprophylaxis after elective orthopaedic surgery. We aimed to systematically compare their relative benefits and harms through meta-analysis, and adjusted indirect comparison. METHODS We searched PubMed, EMBASE, trial registries and regulatory documents through May 2009 for randomized controlled trials (RCTs) of dabigatran (150 and 220 mg daily) and rivaroxaban (10 mg daily) compared with enoxaparin (40-60 mg daily) in elective orthopaedic surgery. We used random effects meta-analysis to calculate pooled relative risks (RRs) and 95% confidence intervals (95% CI) for the outcomes of total venous thromboembolism, VTE (deep venous thrombosis, non-fatal pulmonary embolism and all-cause mortality), and haemorrhagic adverse events (major and clinically relevant non-major bleeds). Adjusted indirect comparison was used for the pooled RRs of dabigatran and rivaroxaban with enoxaparin as the common control. RESULTS Rivaroxaban was superior to enoxaparin for the prevention of venous thromoboembolism (RR 0.56, 95% CI 0.43-0.73, P<0.0001), with a trend for increased haemorrhage (RR 1.26, 95% CI 0.94-1.69, P=0.13). Dabigatran was not superior to enoxaparin for prevention of VTE (RR 1.12, 95% 0.97-1.29, P=0.12), and did not reduce haemorrhage risk (RR 1.10, 95% 0.90-1.35, P=0.32). Adjusted indirect comparison showed that rivaroxaban was superior to dabigatran in preventing VTE, RR 0.50 (95% CI 0.37-0.68), but with a slight trend towards increased haemorrhage RR 1.14 (95% CI 0.80-1.64). WHAT IS NEW AND CONCLUSION Rivaroxaban may be more effective than dabigatran for prevention of VTE after elective orthopaedic surgery but might also slightly increase the risk of haemorrhage.
Collapse
Affiliation(s)
- Y K Loke
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.
| | | |
Collapse
|
22
|
Loke YK, Kwok CS, Singh S. Authors' reply. West J Med 2011. [DOI: 10.1136/bmj.d2573] [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: 11/04/2022]
|
23
|
Loke YK. Drug-drug interactions - bridging the gulf between the bench and the bedside? Br J Clin Pharmacol 2011; 71:485-6. [DOI: 10.1111/j.1365-2125.2011.03951.x] [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: 11/29/2022] Open
|
24
|
Kwok CS, Loke YK, Hale R, Potter JF, Myint PK. Atrial fibrillation and incidence of dementia: A systematic review and meta-analysis. Neurology 2011; 76:914-22. [DOI: 10.1212/wnl.0b013e31820f2e38] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
25
|
Singh S, Loke YK. From the authors:. Eur Respir J 2010. [DOI: 10.1183/09031936.00089310] [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: 11/05/2022]
|
26
|
Loke YK, Kwok CS, Niruban A, Myint PK. Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis. Thorax 2010; 65:884-90. [DOI: 10.1136/thx.2009.134072] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
27
|
|
28
|
Song F, Parekh S, Hooper L, Loke YK, Ryder J, Sutton AJ, Hing C, Kwok CS, Pang C, Harvey I. Dissemination and publication of research findings: an updated review of related biases. Health Technol Assess 2010; 14:iii, ix-xi, 1-193. [PMID: 20181324 DOI: 10.3310/hta14080] [Citation(s) in RCA: 538] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To identify and appraise empirical studies on publication and related biases published since 1998; to assess methods to deal with publication and related biases; and to examine, in a random sample of published systematic reviews, measures taken to prevent, reduce and detect dissemination bias. DATA SOURCES The main literature search, in August 2008, covered the Cochrane Methodology Register Database, MEDLINE, EMBASE, AMED and CINAHL. In May 2009, PubMed, PsycINFO and OpenSIGLE were also searched. Reference lists of retrieved studies were also examined. REVIEW METHODS In Part I, studies were classified as evidence or method studies and data were extracted according to types of dissemination bias or methods for dealing with it. Evidence from empirical studies was summarised narratively. In Part II, 300 systematic reviews were randomly selected from MEDLINE and the methods used to deal with publication and related biases were assessed. RESULTS Studies with significant or positive results were more likely to be published than those with non-significant or negative results, thereby confirming findings from a previous HTA report. There was convincing evidence that outcome reporting bias exists and has an impact on the pooled summary in systematic reviews. Studies with significant results tended to be published earlier than studies with non-significant results, and empirical evidence suggests that published studies tended to report a greater treatment effect than those from the grey literature. Exclusion of non-English-language studies appeared to result in a high risk of bias in some areas of research such as complementary and alternative medicine. In a few cases, publication and related biases had a potentially detrimental impact on patients or resource use. Publication bias can be prevented before a literature review (e.g. by prospective registration of trials), or detected during a literature review (e.g. by locating unpublished studies, funnel plot and related tests, sensitivity analysis modelling), or its impact can be minimised after a literature review (e.g. by confirmatory large-scale trials, updating the systematic review). The interpretation of funnel plot and related statistical tests, often used to assess publication bias, was often too simplistic and likely misleading. More sophisticated modelling methods have not been widely used. Compared with systematic reviews published in 1996, recent reviews of health-care interventions were more likely to locate and include non-English-language studies and grey literature or unpublished studies, and to test for publication bias. CONCLUSIONS Dissemination of research findings is likely to be a biased process, although the actual impact of such bias depends on specific circumstances. The prospective registration of clinical trials and the endorsement of reporting guidelines may reduce research dissemination bias in clinical research. In systematic reviews, measures can be taken to minimise the impact of dissemination bias by systematically searching for and including relevant studies that are difficult to access. Statistical methods can be useful for sensitivity analyses. Further research is needed to develop methods for qualitatively assessing the risk of publication bias in systematic reviews, and to evaluate the effect of prospective registration of studies, open access policy and improved publication guidelines.
Collapse
Affiliation(s)
- F Song
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
BACKGROUND Recent studies have suggested an adverse interaction between proton pump inhibitors (PPI) and clopidogrel. AIM To perform a meta-analysis of cardiovascular outcomes and mortality in patients taking clopidogrel, with and without concomitant PPI. METHODS We searched MEDLINE, EMBASE, Cochrane Controlled Trials Register in October 2009, and checked conference abstracts for randomized and nonrandomized studies that reported the risk of cardiovascular events and mortality with PPI exposure in patients taking clopidogrel. We performed random effects meta-analysis, stratified by study design and assessed heterogeneity using the I2 statistic. RESULTS Our review included 23 studies covering 93,278 patients. There was substantial heterogeneity in the meta-analyses of major cardiovascular events (19 studies, I2 = 79%) or myocardial infarction (12 studies, I2 = 77%). Analysis of propensity-matched or randomized trial participants showed no associated cardiovascular risk with PPIs, whereas other observational studies generally showed a significant association. Meta-analysis of 13 studies showed no significant association between PPI use and overall mortality (RR 1.09, 95% CI: 0.94-1.26, P = 0.23, I2 = 60%). CONCLUSION As there are conflicting and inconsistent data regarding the adverse clopidogrel-PPI interaction, clinicians should focus on potential harm from ulcers/haemorrhage before deciding to omit PPIs in patients taking clopidogrel.
Collapse
Affiliation(s)
- C S Kwok
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk, UK
| | | |
Collapse
|
30
|
Somogyi A, Loke YK, Ferro A, Lewis LD, Cohen AF, Ritter JM. Editors' pick 2009. Br J Clin Pharmacol 2010; 69:107-10. [DOI: 10.1111/j.1365-2125.2009.03606.x] [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: 12/01/2022] Open
|
31
|
Loke YK, Cohen AF, Ferro A, Lewis LD, Ritter JM, Somogyi A. Editors' Report, November 2009. Br J Clin Pharmacol 2010. [DOI: 10.1111/j.1365-2125.2009.03603.x] [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: 11/29/2022] Open
|
32
|
Loke YK, Kwok CS, Singh S. Risk of myocardial infarction and cardiovascular death associated with inhaled corticosteroids in COPD. Eur Respir J 2009; 35:1003-21. [DOI: 10.1183/09031936.00095909] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
33
|
|
34
|
Loke YK, Singh S. Two of the authors respond:. CMAJ 2009. [DOI: 10.1503/cmaj.1090004] [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: 11/01/2022] Open
|
35
|
Cohen AF, Loke YK, Lewis LD, Schachter M, Somogyi A, Ritter JM. Editors’ Report, December 2008. Br J Clin Pharmacol 2009; 67:151-2. [DOI: 10.1111/j.1365-2125.2009.03387.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
36
|
|
37
|
Loke YK, Trivedi AN, Singh S. Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 2008; 27:31-40. [PMID: 17919277 DOI: 10.1111/j.1365-2036.2007.03541.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) have been associated with upper gastrointestinal haemorrhage (UGIH) but the magnitude and characteristics of this reaction and possible interaction with concurrent Non-Steroidal Anti-Inflammatory Drug (NSAID) therapy are unknown. AIM To evaluate systematically the risk of UGIH with SSRIs, including interaction with NSAIDs. METHODS We searched PubMED, Science Citation Index, and trial registries for data on SSRIs, NSAIDs and UGIH. We evaluated spontaneous case reports from pharmacovigilance databases. RESULTS Random effects meta-analysis of four observational studies involving 153 000 patients showed an odds ratio of 2.36 (95% CI: 1.44-3.85; P = 0.0006) for SSRI associated UGIH. The odds ratio increased to 6.33 (95% CI: 3.40-11.8; P < 0.00001) with concomitant NSAIDs. In patients aged above 50 years with no UGIH risk factors, the Number-Needed-to-Harm per year is 411 for SSRIs alone, and 106 with concomitant NSAIDs. Analysis of 101 spontaneous reports showed that UGIH occurred after a median of 25 weeks with SSRIs. Around 67% of these patients were on NSAIDs. CONCLUSIONS Selective serotonin reuptake inhibitor use, alone and in combination with NSAIDs, substantially increases the risk of UGIH. Clinicians should consider this when managing patients at risk of, or presenting with UGIH.
Collapse
Affiliation(s)
- Y K Loke
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.
| | | | | |
Collapse
|
38
|
Abstract
OBJECTIVES To assess the incidence of gastrointestinal haemorrhage associated with long term aspirin therapy and to determine the effect of dose reduction and formulation on the incidence of such haemorrhage. DESIGN Meta-analysis of 24 randomised controlled trials (almost 66 000 participants). INTERVENTION Aspirin compared with placebo or no treatment, for a minimum of one year. MAIN OUTCOME MEASURES Incidence of gastrointestinal haemorrhage. RESULTS Gastrointestinal haemorrhage occurred in 2.47% of patients taking aspirin compared with 1.42% taking placebo (odds ratio 1.68; 95% confidence interval 1.51 to 1.88); the number needed to harm was 106 (82 to 140) based on an average of 28 months' therapy. At doses below 163 mg/day, gastrointestinal haemorrhage occurred in 2.30% of patients taking aspirin compared with 1.45% taking placebo (1.59; 1.40 to 1.81). Meta-regression showed no relation between gastrointestinal haemorrhage and dose. For modified release formulations of aspirin the odds ratio was 1.93 (1.15 to 3.23). CONCLUSIONS Long term therapy with aspirin is associated with a significant increase in the incidence of gastrointestinal haemorrhage. No evidence exists that reducing the dose or using modified release formulations would reduce the incidence of gastrointestinal haemorrhage.
Collapse
Affiliation(s)
- S Derry
- Department of Clinical Pharmacology, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE
| | | |
Collapse
|
39
|
Abstract
OBJECTIVES To assess the incidence of gastrointestinal haemorrhage associated with long term aspirin therapy and to determine the effect of dose reduction and formulation on the incidence of such haemorrhage. DESIGN Meta-analysis of 24 randomised controlled trials (almost 66 000 participants). INTERVENTION Aspirin compared with placebo or no treatment, for a minimum of one year. MAIN OUTCOME MEASURES Incidence of gastrointestinal haemorrhage. RESULTS Gastrointestinal haemorrhage occurred in 2.47% of patients taking aspirin compared with 1.42% taking placebo (odds ratio 1.68; 95% confidence interval 1.51 to 1.88); the number needed to harm was 106 (82 to 140) based on an average of 28 months' therapy. At doses below 163 mg/day, gastrointestinal haemorrhage occurred in 2.30% of patients taking aspirin compared with 1.45% taking placebo (1.59; 1.40 to 1.81). Meta-regression showed no relation between gastrointestinal haemorrhage and dose. For modified release formulations of aspirin the odds ratio was 1.93 (1.15 to 3.23). CONCLUSIONS Long term therapy with aspirin is associated with a significant increase in the incidence of gastrointestinal haemorrhage. No evidence exists that reducing the dose or using modified release formulations would reduce the incidence of gastrointestinal haemorrhage.
Collapse
Affiliation(s)
- S Derry
- Department of Clinical Pharmacology, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE
| | | |
Collapse
|
40
|
Abstract
BACKGROUND Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) with analgesic properties, and is used mainly for treating rheumatic disorders. Some drugs have been directly compared against each other within a trial setting to determine their relative efficacies, whereas other have not. It is possible, however, to compare analgesics indirectly by examining the effectiveness of each drug against placebo when used in similar clinical situations. OBJECTIVES To determine the analgesic efficacy and adverse effects of single-dose piroxicam compared with placebo in moderate to severe postoperative pain. To compare the effects of piroxicam with other analgesics. SEARCH STRATEGY Published reports were identified from systematic searching of Medline, Biological Abstracts, Embase, The Cochrane Library and the Oxford Pain Relief Database. Additional studies were identified from the reference lists of retrieved reports. SELECTION CRITERIA The following inclusion criteria were used: full journal publication, randomised placebo controlled trial, double-blind design, adult patients, postoperative pain of moderate to severe intensity at the baseline assessment, postoperative administration of oral or intramuscular piroxicam. DATA COLLECTION AND ANALYSIS Summed pain intensity and pain relief data were extracted and converted into dichotomous information to yield the number of patients obtaining at least 50% pain relief. This was used to calculate estimates of relative benefit and number-needed-to-treat for one patient to obtain at least 50% pain relief. Information was collected on adverse effects and estimates of relative risk and number-needed-to-harm were calculated. MAIN RESULTS Three trials (141 patients) compared oral piroxicam 20 mg with placebo and one (15 patients) compared oral piroxicam 40 mg with placebo. For single doses of piroxicam 20 mg and 40 mg the respective numbers-needed-to-treat for at least 50% pain relief were 2.7 (2.1 to 3.8) [95% confidence interval] and 1.9 (1.2 to 4.3) [95% confidence interval] compared with placebo over 4-6 hours in moderate to severe postoperative pain. The reported incidence of adverse effects was no higher with piroxicam (20 mg or 40 mg) than with placebo. REVIEWER'S CONCLUSIONS Piroxicam appears to be of similar efficacy to other non-steroidal anti-inflammatory drugs (NSAIDs) and intramuscular morphine 10 mg when used as a single oral dose in the treatment of moderate to severe postoperative pain.
Collapse
Affiliation(s)
- J E Edwards
- Pain Research Unit, Nuffield Department of Anaesthetics, Churchill Hospital, Old Road, Oxford, UK, OX3 7LJ.
| | | | | | | |
Collapse
|
41
|
Loke YK, Tee MH, Tan MH. Decompression illness associated with underwater logging: 6 case reports from Kenyir Lake, Malaysia. Med J Malaysia 1998; 53:100-3. [PMID: 10968146] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The formation of Kenyir Lake as part of a hydroelectric project in the 1980s caused much forest area to be submerged. From 1991, underwater divers were employed to log these sunken trees at depths of up to 100 meters. At least 6 mishaps involving underwater logging personnel were recorded from March 1994 to August 1996. We retrospectively reviewed 5 cases who were managed in Hospital Kuala Terengganu. The patients presented with marked cardiorespiratory and neurological disturbances. One diver died in the Hospital while another died at the recompression chamber. Three divers were treated with recompression and improved. Average delay before the start of recompression was 14 hours. Underwater logging has definite dangers and steps must be taken to ensure that both the divers and the equipment are appropriate for the task. Availability of a nearby recompression facility would greatly enhance the management of diving accidents, not only for commercial divers but also for recreational divers who frequent the islands nearby.
Collapse
Affiliation(s)
- Y K Loke
- Department of Medicine, Hospital Kuala Terengganu, Malaysia
| | | | | |
Collapse
|
42
|
Loke YK, Murugesan E, Suryati A, Tan MH. An outbreak of rabies in dogs in the state of Terengganu 1995-1996. Med J Malaysia 1998; 53:97-100. [PMID: 10968145] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The presence of rabies in dogs has been well recognized in areas of Malaysia close to the Thai border but it has rarely ever been reported in Terengganu which is a state on the East Coast of Malaysia. From November 1995 to June 1996 six different rabid stray dogs were found to have been involved in dog bite attacks on 9 members of the public. We report these cases to highlight that rabid dog bites may occur even in areas where the disease is thought to be rate. Medical and veterinary staff must keep the possibility of the risk of rabies in mind when faced with patients who have been bitten by dogs.
Collapse
Affiliation(s)
- Y K Loke
- Hospital Kuala Terengganu, Jalan Sultan Mahmud
| | | | | | | |
Collapse
|
43
|
Loke YK, Tan MH. An unusual case of Wegener's granulomatosis. Med J Malaysia 1998; 53:107-9. [PMID: 10968148] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A 35-year-old Malay man underwent treatment for uveitis of the right eye in 1992 but developed marked visual impairment in the affected eye after he failed to attend follow-up. Two years later, he complained of difficulty swallowing and was found to have left sided X and XI cranial nerve palsies. Chest radiograph showed a cavitating lesion in the lower zone of the right lung field. Inflammation and perforation of the nasal septum was found on examination of his upper respiratory tract. Punch biopsies taken from that area showed chronic inflammatory change and necrotizing vasculities. The patient was diagnosed as having Wegener's granulomatosis and made a very good recovery with immunosuppressive therapy.
Collapse
Affiliation(s)
- Y K Loke
- Department of Medicine, Hospital Kuala Terengganu, Malaysia
| | | |
Collapse
|
44
|
Loke YK, Tan MH. A unique case of tetrodotoxin poisoning. Med J Malaysia 1997; 52:172-4. [PMID: 10968077] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A 69-year-old lady who was referred by her general practitioner with a diagnosis of food poisoning developed cardiorespiratory arrest shortly after arriving at the Casualty Department. Cardiac output was successfully restored with resuscitation but she had to be mechanically ventilated due to the absence of any spontaneous respiratory effort. Assessment 24 hours after admission, showed fixed and dilated pupils with brain stem areflexia. Her family was told that the prognosis was hopeless. Surprisingly, her condition rapidly improved a day later and she eventually had a good recovery. Her condition was actually due to severe tetrodotoxin poisoning after eating roe of the puffer fish and it was fortunate that appropriate aggressive resuscitation was instituted to revive the patient from her critical state.
Collapse
Affiliation(s)
- Y K Loke
- Department of Medicine, Hospital Kuala Terengganu
| | | |
Collapse
|
45
|
Loke YK, Hwang SL, Tan MH. Delays in thrombolytic therapy in acute myocardial infarction: an audit from the east coast of peninsular Malaysia. Ann Acad Med Singap 1997; 26:285-9. [PMID: 9285018] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objectives of this study were to evaluate the time delays between the onset of symptoms and admission to hospital and provision of thrombolytic therapy in patients with suspected acute myocardial infarction; and to examine the accuracy of the clinical diagnosis and the therapeutic decision on thrombolysis in these patients. An observational study of 96 patients with suspected myocardial infarction was undertaken over a period of 15 months in the Coronary Care Unit of Hospital Kuala Terengganu. Seventy per cent of the patients arrived in the hospital within 6 hours of the onset of symptoms. After arrival in the emergency room, it took a median time of 85 minutes before the administration of thrombolytic therapy. Of the 67 patients who were given thrombolysis, 46 were treated within 6 hours of the onset of symptoms. About a quarter of patients said that they had delayed seeking treatment at the hospital. Treatment delays occurring in the hospital were mainly due to admission procedures as well as late diagnosis. Eighty-one patients had confirmed myocardial infarction of whom 59 received thrombolytic therapy. Eight patients receiving thrombolytic therapy had no confirmation of myocardial infarctions. Improvements in diagnostic accuracy and reduction of delays in the provision of thrombolytic therapy could be achieved by better training of health care staff as well as by further streamlining of admission procedures.
Collapse
Affiliation(s)
- Y K Loke
- Department of Medicine, Hospital Kuala Terengganu, Malaysia
| | | | | |
Collapse
|
46
|
Loke YK, Lai VM, Tan MH, Gunn A. Bizarre ECG in head injury mimicking ventricular tachycardia. Singapore Med J 1997; 38:166-8. [PMID: 9269397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Bizarre electrocardiographic (ECG) changes were found in an 18-year-old girl who had a subdural haematoma following head trauma. The initial diagnosis was of ventricular tachycardia (VT) and she was treated with intravenous anti-arrhythmic drugs and electrical cardioversion, but to no effect. It was later concluded that the ECG appearances were not of a ventricular arrhythmia but were the result of the intracranial pathology. ECG abnormalities related to head injuries have been reported on many occasions, and our case report illustrates how this can create difficulties for the attending clinicians.
Collapse
Affiliation(s)
- Y K Loke
- Medical Unit, Hospital Kuala Terengganu, Jin Sultan Mahmud, Malaysia
| | | | | | | |
Collapse
|