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Mallat J, Fischer MO, Granier M, Vinsonneau C, Jonard M, Mahjoub Y, Baghdadi FA, Préau S, Poher F, Rebet O, Bouhemad B, Lemyze M, Marzouk M, Besnier E, Hamed F, Rahman N, Abou-Arab O, Guinot PG. Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study. Br J Anaesth 2022; 129:308-316. [PMID: 35842352 DOI: 10.1016/j.bja.2022.04.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Passive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (ΔPPVPLR) can also predict fluid responsiveness in mechanically ventilated patients. METHODS In this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of >15% defined fluid responsiveness. To investigate whether ΔPPVPLR can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and grey zones for relative and absolute ΔPPVPLR. RESULTS Of the 270 patients, 238 (88%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6-7.6) ml kg-1 ideal body weight. One hundred sixty-four patients (61%) were fluid responders. Relative and absolute ΔPPVPLR predicted fluid responsiveness with an AUROC of 0.92 (95% confidence interval [95% CI], 0.88-0.95; P<0.001) each. The grey zone for relative and absolute ΔPPVPLR included 4.8% and 22.6% of patients, respectively. These results were not affected by ventilatory mode and baseline characteristics (type of shock, centre, vasoactive treatment). CONCLUSIONS Passive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation. CLINICAL TRIAL REGISTRATION NCT03225378.
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Affiliation(s)
- Jihad Mallat
- Department of Critical Care Medicine, Arras Hospital, Arras, France; Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Normandy University, UNICAEN, Ecole Doctorale NBISE 497, Caen, France.
| | - Marc-Olivier Fischer
- Normandy University, UNICAEN, CHU de Caen Normandie, Ecole Doctorale NBISE 497, Service d'Anesthésie Réanimation, Caen, France
| | - Maxime Granier
- Department of Critical Care Medicine, Arras Hospital, Arras, France
| | | | - Marie Jonard
- Department of Critical Care Medicine, Amiens University Medical Centre, Amiens, France
| | - Yazine Mahjoub
- Cardiac Vascular Thoracic and Respiratory Intensive Care Unit, Department of Anesthesia and Intensive Care, Amiens University Medical Centre, Amiens, France
| | - Fawzi Ali Baghdadi
- Department of Critical Care Medicine, Intensive Care Unit, Centre Hospitalier de Cambrai, Cambrai, France
| | - Sébastien Préau
- Division of Intensive Care, Inserm, Institut Pasteur de Lille, U1167, University of Lille, CHU Lille, Lille, France
| | - Fabien Poher
- Intensive Care Unit, Centre Hospitalier de Boulogne Sur Mer, Boulogne Sur Mer, France
| | - Olivier Rebet
- Cardiac Vascular Intensive Care Unit, Schaffner Hospital, Lens, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
| | - Malcolm Lemyze
- Department of Critical Care Medicine, Arras Hospital, Arras, France
| | - Mehdi Marzouk
- Intensive Care Unit, Hôpital de Béthune, Beuvry, France
| | - Emmanuel Besnier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Fadi Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Nadeem Rahman
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Osama Abou-Arab
- Anesthesia and Critical Care department, Amiens Hospital University, Amiens, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France
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Mallat J, Rahman N, Hamed F, Hernandez G, Fischer MO. Pathophysiology, mechanisms, and managements of tissue hypoxia. Anaesth Crit Care Pain Med 2022; 41:101087. [PMID: 35462083 DOI: 10.1016/j.accpm.2022.101087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/01/2022]
Abstract
Oxygen is needed to generate aerobic adenosine triphosphate and energy that is required to support vital cellular functions. Oxygen delivery (DO2) to the tissues is determined by convective and diffusive processes. The ability of the body to adjust oxygen extraction (ERO2) in response to changes in DO2 is crucial to maintain constant tissue oxygen consumption (VO2). The capability to increase ERO2 is the result of the regulation of the circulation and the effects of the simultaneous activation of both central and local factors. The endothelium plays a crucial role in matching tissue oxygen supply to demand in situations of acute drop in tissue oxygenation. Tissue oxygenation is adequate when tissue oxygen demand is met. When DO2 is severely compromised, a critical DO2 value is reached below which VO2 falls and becomes dependent on DO2, resulting in tissue hypoxia. The different mechanisms of tissue hypoxia are circulatory, anaemic, and hypoxic, characterised by a diminished DO2 but preserved capacity of increasing ERO2. Cytopathic hypoxia is another mechanism of tissue hypoxia that is due to impairment in mitochondrial respiration that can be observed in septic conditions with normal overall DO2. Sepsis induces microcirculatory alterations with decreased functional capillary density, increased number of stopped-flow capillaries, and marked heterogeneity between the areas with large intercapillary distance, resulting in impairment of the tissue to extract oxygen and to satisfy the increased tissue oxygen demand, leading to the development of tissue hypoxia. Different therapeutic approaches exist to increase DO2 and improve microcirculation, such as fluid therapy, transfusion, vasopressors, inotropes, and vasodilators. However, the effects of these agents on microcirculation are quite variable.
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Affiliation(s)
- Jihad Mallat
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Normandy University, UNICAEN, ED 497, Caen, France.
| | - Nadeem Rahman
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Fadi Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Glenn Hernandez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontifcia Universidad Católica de Chile, Santiago, Chile
| | - Marc-Olivier Fischer
- Department of Anaesthesiology-Resuscitation and Perioperative Medicine, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
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Souilamas RM, Uzbeck MH, Bayrak Y, Guenif N, Hamed F, Shafiq I, Kakar V, Elkaissi M, Abada H, Younes F, Alzaabi A, Zoumot Z, Wahla A. Thoracic surgery in United Arab Emirates. J Thorac Dis 2022; 14:788-793. [PMID: 35399238 PMCID: PMC8987826 DOI: 10.21037/jtd-21-1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022]
Abstract
The United Arab Emirates (UAE) has undergone a significant change in its population and economy in the last decades and in parallel its healthcare system has evolved rapidly to provide advanced, innovative and world-leading care. At the forefront of this revolution in healthcare is the development of a multidisciplinary multimodality thoracic service provision, offered at quaternary referral hospitals amalgamating academics, training, research and innovation. Previously, thoracic service care was limited to single providers at various public and private hospitals, usually performing lower complexity cases. Most complex thoracic cases were repatriated outside the UAE. This practice was replaced with the opening of Cleveland Clinic Abu Dhabi (CCAD), in 2015, which created a multidisciplinary thoracic program. This included the start of a mini-invasive surgical and lung transplantation program. Since that time other public and private hospitals have emerged providing care in a similar model. The impact of these programs has been a decreased transfer of patients abroad for treatment. Under the umbrella of the Emirates Thoracic Society (ETS) a platform for greater collaboration aimed at improving patient care, potential research and physician education has been created. Direct links have been established with world-leading Thoracic surgery and Respiratory Medicine Centers facilitating this development and offering support and guidance. This article charts these changes in thoracic care in the recent past, present, and delineates plans for the future in the UAE.
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Affiliation(s)
- Redha Mohammed Souilamas
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mateen Haider Uzbeck
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Yusuf Bayrak
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Nacira Guenif
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Fadi Hamed
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Irfan Shafiq
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Vivek Kakar
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mahmoud Elkaissi
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hicham Abada
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Fadi Younes
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ashraf Alzaabi
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Zaid Zoumot
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ali Wahla
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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El Nekidy WS, Almuti K, ElRefaei H, Atallah B, Mohammad LM, AlMahmeed W, Badr M, Abdallah K, Hamed F, Mallat J. QT Prolongation in Critically Ill Patients With SARS-CoV-2 Infection. J Cardiovasc Pharmacol Ther 2022; 27:10742484211069479. [PMID: 35006023 DOI: 10.1177/10742484211069479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several reports linked the use of repurposed drugs such as hydroxychloroquine (HCQ), azithromycin, lopinavir/ritonavir, and favipiravir with QT interval prolongation in patients with SARS-CoV2 infection. Little is known about the risk factors for QT interval prolongation in this population. We sought to describe the prevalence and identify the main risk factors associated with clinically significant corrected QT (QTc) prolongation in this population. METHODS We conducted a retrospective analysis of critically ill patients who were admitted to our intensive care unit (ICU), had at least one electrocardiogram performed during their ICU stay, and tested positive for SARs-CoV-2. Clinically significant QTc interval prolongation was defined as QTc >500 milliseconds (ms). RESULTS Out of the 111 critically ill patients with SARS-CoV-2 infection, QTc was significantly prolonged in 47 cases (42.3%). Patients with a clinically significant QTc prolongation had significantly higher proportions of history of cardiac diseases/surgery (22 [46.8%] vs. 10 [15.6%], P < .001), hypokalemia (10 [21.3] vs. 5 [7.8%], P = .04), and male gender (95% vs. 82.8%, P = .036) than patients with QTc ≤500 ms, respectively. A total of 46 patients (41.4%) received HCQ, 28 (25.2%) received lopinavir/ritonavir, and 5 (4.5%) received azithromycin. Multivariate logistic regression analysis showed that a history of cardiac disease was the only independent factor associated with clinically significant QTc prolongation (P = .004 for the likelihood-ratio test). CONCLUSION The prevalence of clinically significant QTc prolongation in critically ill patients with SARS-CoV-2 infection was high and independent of drugs used. Larger prospective observational studies are warranted to elucidate independent risk factors associated with clinically significant QTc prolongation in this study population.
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Affiliation(s)
- Wasim S El Nekidy
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Khalid Almuti
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Hazem ElRefaei
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Bassam Atallah
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Lana M Mohammad
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Gulf Medical University, Ajman, United Arab Emirates
| | - Wael AlMahmeed
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mohamed Badr
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697West Hertfordshire NHS Trust, Watford, United Kingdom
| | - Khaled Abdallah
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - Fadi Hamed
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Jihad Mallat
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Normandy University, Caen, France
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De Oliveira B, Aljaberi N, Taha A, Abduljawad B, Hamed F, Rahman N, Mallat J. Patient-Ventilator Dyssynchrony in Critically Ill Patients. J Clin Med 2021; 10:jcm10194550. [PMID: 34640566 PMCID: PMC8509510 DOI: 10.3390/jcm10194550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Patient–ventilator dyssynchrony is a mismatch between the patient’s respiratory efforts and mechanical ventilator delivery. Dyssynchrony can occur at any phase throughout the respiratory cycle. There are different types of dyssynchrony with different mechanisms and different potential management: trigger dyssynchrony (ineffective efforts, autotriggering, and double triggering); flow dyssynchrony, which happens during the inspiratory phase; and cycling dyssynchrony (premature cycling and delayed cycling). Dyssynchrony has been associated with patient outcomes. Thus, it is important to recognize and address these dyssynchronies at the bedside. Patient–ventilator dyssynchrony can be detected by carefully scrutinizing the airway pressure–time and flow–time waveforms displayed on the ventilator screens along with assessing the patient’s comfort. Clinicians need to know how to depict these dyssynchronies at the bedside. This review aims to define the different types of dyssynchrony and then discuss the evidence for their relationship with patient outcomes and address their potential management.
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Affiliation(s)
- Bruno De Oliveira
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi P.O. Box 112412, United Arab Emirates; (B.D.O.); (N.A.); (A.T.); (B.A.); (F.H.); (N.R.)
| | - Nahla Aljaberi
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi P.O. Box 112412, United Arab Emirates; (B.D.O.); (N.A.); (A.T.); (B.A.); (F.H.); (N.R.)
| | - Ahmed Taha
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi P.O. Box 112412, United Arab Emirates; (B.D.O.); (N.A.); (A.T.); (B.A.); (F.H.); (N.R.)
| | - Baraa Abduljawad
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi P.O. Box 112412, United Arab Emirates; (B.D.O.); (N.A.); (A.T.); (B.A.); (F.H.); (N.R.)
| | - Fadi Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi P.O. Box 112412, United Arab Emirates; (B.D.O.); (N.A.); (A.T.); (B.A.); (F.H.); (N.R.)
| | - Nadeem Rahman
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi P.O. Box 112412, United Arab Emirates; (B.D.O.); (N.A.); (A.T.); (B.A.); (F.H.); (N.R.)
| | - Jihad Mallat
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi P.O. Box 112412, United Arab Emirates; (B.D.O.); (N.A.); (A.T.); (B.A.); (F.H.); (N.R.)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Faculty of Medicine, Normandy University, UNICAEN, ED 497, 1400 Caen, France
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier de Lens, 62300 Lens, France
- Correspondence:
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El Nekidy WS, Shatnawei A, Abdelsalam MM, Hassan M, Dajani RZ, Salem N, St John TJL, Rahman N, Hamed F, Mallat J. Hypertriglyceridemia in Critically Ill Patients With SARS-CoV-2 Infection. Ann Pharmacother 2021; 56:637-644. [PMID: 34470517 DOI: 10.1177/10600280211038302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with SARS-CoV-2 infection could develop severe disease requiring critical care admission. Case reports indicated high incidence of hypertriglyceridemia (HTG) in critically ill patients infected with SARS-CoV-2, which might be related to the drugs. OBJECTIVE We sought to determine the risk factors associated with HTG in this population and to investigate the relationship between HTG and lipase. METHODS A retrospective observational study was conducted at our hospital between March 1 and June 30, 2020. Patients were included if they were ≥18 years old, admitted to the intensive care unit (ICU), tested positive for SARS-CoV-2, and had triglycerides (TG) checked during their hospital stay. RESULTS Of the 111 critically ill patients, 103 patients were included. Males comprised 88.3% of the sample. The median TG at baseline was 197.4 (IQR: 139.8-283) mg/dL. The lipase median level at baseline was 23.00 (IQR: 0.00-69.50) IU/L. The results of the mixed-effects logistic regression analysis indicated that patient-level variables, favipiravir use, blood glucose level, and propofol use were significantly associated with HTG. There was no relationship between lipase and TG levels over time. Furthermore, TG concentrations over time showed a similar trend to inflammatory markers. CONCLUSION AND RELEVANCE The incidence of clinically significant HTG was high and was associated with propofol and favipiravir use. HTG might reflect the high inflammatory state in these patients. Clinicians should look at the full picture before changing therapies based only on HTG. Our findings need to be replicated in a larger prospective study.
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Affiliation(s)
- Wasim S El Nekidy
- Cleveland Clinic Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
| | | | | | | | | | | | | | - Nadeem Rahman
- Cleveland Clinic Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
| | | | - Jihad Mallat
- Cleveland Clinic Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA.,Normandy University, Caen, France
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Abuzakouk M, Saleh K, Algora M, Nusair A, Alameri J, Alshehhi F, Alkhaja S, Badr M, Abdallah K, De Oliveira B, Nadeem A, Varghese Y, Munde D, Salam S, Abduljawad B, Elkambergy H, Wahla A, Taha A, Dibu J, Bayrlee A, Hamed F, AbdelWareth L, Rahman N, Guzman J, Mallat J. Convalescent Plasma Efficacy in Life-Threatening COVID-19 Patients Admitted to the ICU: A Retrospective Cohort Study. J Clin Med 2021; 10:2113. [PMID: 34068847 PMCID: PMC8153619 DOI: 10.3390/jcm10102113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: There are limited data regarding the efficacy of convalescent plasma (CP) in critically ill patients admitted to the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). We aimed to determine whether CP is associated with better clinical outcome among these patients. (2) Methods: A retrospective single-center study including adult patients with laboratory-confirmed SARS-CoV-2 infection admitted to the ICU for acute respiratory failure. The primary outcome was time to clinical improvement, within 28 days, defined as patient discharged alive or reduction of 2 points on a 6-point disease severity scale. (3) Results: Overall, 110 COVID-19 patients were admitted. Thirty-two patients (29%) received CP; among them, 62.5% received at least one CP with high neutralizing antibody titers (≥1:160). Clinical improvement occurred within 28 days in 14 patients (43.7%) of the CP group vs. 48 patients (61.5%) in the non-CP group (hazard ratio (HR): 0.75 (95% CI: 0.41-1.37), p = 0.35). After adjusting for potential confounding factors, CP was not independently associated with time to clinical improvement (HR: 0.53 (95% CI: 0.23-1.22), p = 0.14). Additionally, the average treatment effects of CP, calculated using the inverse probability weights (IPW), was not associated with the primary outcome (-0.14 days (95% CI: -3.19-2.91 days), p = 0.93). Hospital mortality did not differ between CP and non-CP groups (31.2% vs. 19.2%, p = 0.17, respectively). Comparing CP with high neutralizing antibody titers to the other group yielded the same findings. (4) Conclusions: In this study of life-threatening COVID-19 patients, CP was not associated with time to clinical improvement within 28 days, or hospital mortality.
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Affiliation(s)
- Mohamed Abuzakouk
- Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA; (M.A.); (A.W.)
| | - Khaled Saleh
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Manuel Algora
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA; (M.A.); (A.W.)
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates;
| | - Ahmad Nusair
- Medical Subspecialties Institute-Infectious Diseases, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates;
| | - Jawahir Alameri
- Education Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.A.); (F.A.); (S.A.)
| | - Fatema Alshehhi
- Education Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.A.); (F.A.); (S.A.)
| | - Sara Alkhaja
- Education Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (J.A.); (F.A.); (S.A.)
| | - Mohamed Badr
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Khaled Abdallah
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Bruno De Oliveira
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Ashraf Nadeem
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Yeldho Varghese
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Dnyaseshwar Munde
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Shameen Salam
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Baraa Abduljawad
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Hussam Elkambergy
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Ali Wahla
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA; (M.A.); (A.W.)
| | - Ahmed Taha
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Jamil Dibu
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Ahmed Bayrlee
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Fadi Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Laila AbdelWareth
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates;
| | - Nadeem Rahman
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Jorge Guzman
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
| | - Jihad Mallat
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA; (M.A.); (A.W.)
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates; (K.S.); (M.B.); (K.A.); (B.D.O.); (A.N.); (Y.V.); (D.M.); (S.S.); (B.A.); (H.E.); (A.T.); (J.D.); (A.B.); (F.H.); (N.R.); (J.G.)
- Faculty of Medicine, Normandy University, UNICAEN, ED 497, 1400 Caen, France
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8
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Zoumot Z, Bonilla MF, Wahla AS, Shafiq I, Uzbeck M, El-Lababidi RM, Hamed F, Abuzakouk M, ElKaissi M. Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease. BMC Pulm Med 2021; 21:24. [PMID: 33435949 PMCID: PMC7803002 DOI: 10.1186/s12890-020-01379-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pulmonary radiological findings of the novel coronavirus disease 2019 (COVID-19) have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, lung cavitation has not been commonly described in these patients. The objective of this study was to assess the incidence of pulmonary cavitation in patients with COVID-19 and describe its characteristics and evolution. METHODS We conducted a retrospective review of all patients admitted to our institution with COVID-19 and reviewed electronic medical records and imaging to identify patients who developed pulmonary cavitation. RESULTS Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n = 12/359) of patients who developed COVID-19 pneumonia, and 11% (n = 12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died, and six discharged home. CONCLUSION Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.
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Affiliation(s)
- Zaid Zoumot
- Department of Pulmonology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Maria-Fernanda Bonilla
- Department of Infectious Diseases, Medical Specialties Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ali S Wahla
- Department of Pulmonology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Irfan Shafiq
- Department of Pulmonology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mateen Uzbeck
- Department of Pulmonology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Rania M El-Lababidi
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Fadi Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mohamed Abuzakouk
- Department of Allergy and Immunology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mahmoud ElKaissi
- Imaging Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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9
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Mallat J, Hamed F, Balkis M, Mohamed MA, Mooty M, Malik A, Nusair A, Bonilla MF. Hydroxychloroquine is associated with slower viral clearance in clinical COVID-19 patients with mild to moderate disease. Medicine (Baltimore) 2020; 99:e23720. [PMID: 33350752 PMCID: PMC7769326 DOI: 10.1097/md.0000000000023720] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT There are conflicting data regarding the use of hydroxychloroquine (HCQ) in COVID-19 hospitalized patients. The objective of this study was to assess the efficacy of HCQ in increasing SARS-CoV-2 viral clearance.Hospitalized adult patients with confirmed SARS-CoV-2 infection were retrospectively included in the study. The primary outcome was the time from a confirmed positive nasopharyngeal swab to turn negative. A negative nasopharyngeal swab conversion was defined as a confirmed SARS-CoV-2 case followed by 2 negative results using RT-PCR assay with samples obtained 24 hours apart. Multiple linear regression analysis was used to adjust for potential confounders.Thirty-four confirmed COVID-19 patients completed the study. Nineteen (55.9%) patients presented with symptoms, and 14 (41.2%) had pneumonia. Only 21 (61.8%) patients received HCQ. The time to SARS-CoV-2 negativity nasopharyngeal test was significantly longer in patients who received HCQ than those who did not receive HCQ [17 (13-21) vs 10 (4-13) days, P = .023]. HCQ was independently associated with time to negativity test after adjustment for potential confounders (symptoms, comorbidities, antiviral drugs, pneumonia, or oxygen therapy) in multivariable Cox proportional hazards regression analysis (hazard ratio = 0.33, 95% confidence interval: 0.13-0.9, P = .024). On day 14, 47.8% (14/23) patients tested negative in the HCQ group compared with 90.9% (10/11) patients who did not receive HCQ (P = .016).HCQ was associated with a slower viral clearance in COVID-19 patients with mild to moderate disease. Data from ongoing randomized clinical trials with HCQ should provide a definitive answer regarding the efficacy and safety of this treatment.
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Affiliation(s)
- Jihad Mallat
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
- Normandy University, UNICAEN, ED 497, Caen, France
| | - Fadi Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | - Mohamed A. Mohamed
- Hospital Medicine, Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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10
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Atallah B, Sadik ZG, Salem N, El Nekidy WS, Almahmeed W, Park WM, Cherfan A, Hamed F, Mallat J. The impact of protocol-based high-intensity pharmacological thromboprophylaxis on thrombotic events in critically ill COVID-19 patients. Anaesthesia 2020; 76:327-335. [PMID: 33047335 PMCID: PMC7675553 DOI: 10.1111/anae.15300] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 01/02/2023]
Abstract
The reported incidence rate of venous and arterial thrombotic events in critically ill patients with COVID‐19 infections is high, ranging from 20% to 60%. We adopted a patient‐tailored thromboprophylaxis protocol based on clinical and laboratory presentations for these patients in our institution. We hypothesised that patients who received high‐intensity thromboprophylaxis treatment would experience fewer thrombotic events. The aims of our study were to explore the incidence of thrombotic events in this population; to assess independent factors associated with thrombotic events and to evaluate the incidence of haemorrhagic events. A retrospective review of all adult patients with confirmed SARS‐CoV‐2 infection admitted to the intensive care unit (ICU) between 1 March and 29 May 2020 was performed. The primary outcome was a composite of venous and arterial thrombotic events diagnosed during the ICU stay. Multivariable logistic regression was used to identify the independent factors associated with thrombotic events. A total of 188 patients met the inclusion criteria. All received some type of thromboprophylaxis treatment except for six patients who did not receive any prophylaxis. Of the 182 patients who received thromboprophylaxis, 75 (40%) received high‐intensity thromboprophylaxis and 24 (12.8%) were treated with therapeutic anticoagulation. Twenty‐one patients (11.2%) experienced 23 thrombotic events (incidence rate of 12.2% (95%CI 7.9–17.8)), including 12 deep venous thromboses, 9 pulmonary emboli and 2 peripheral arterial thromboses. The multivariable logistic regression analysis showed that only D‐dimer (OR 2.80, p = 0.002) and high‐intensity thromboprophylaxis regimen (OR 0.20, p = 0.01) were independently associated with thrombotic events. Thirty‐one patients (16.5%) experienced haemorrhagic events; among them, 13 were classified as major bleeding according to the International Society on Thrombosis and Haemostasis criteria. Therapeutic anticoagulation, but not the high‐intensity thromboprophylaxis regimen, was associated with major bleeding. A proactive approach to the management of thromboembolism in critically ill COVID‐19 patients utilising a high‐intensity thromboprophylaxis regimen in appropriately selected patients may result in lower thrombotic events without increasing the risk of bleeding.
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Affiliation(s)
- B Atallah
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Z G Sadik
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - N Salem
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - W S El Nekidy
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - W Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - W M Park
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - A Cherfan
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - F Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - J Mallat
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Normandy University, Caen, France.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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11
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Atallah B, El Nekidy W, Mallah SI, Cherfan A, AbdelWareth L, Mallat J, Hamed F. Thrombotic events following tocilizumab therapy in critically ill COVID-19 patients: a Façade for prognostic markers. Thromb J 2020; 18:22. [PMID: 32922212 PMCID: PMC7479301 DOI: 10.1186/s12959-020-00236-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hospitals in the Middle East Gulf region have experienced an influx of COVID-19 patients to their medical wards and intensive care units. The hypercoagulability of these patients has been widely reported on a global scale. However, many of the experimental treatments used to manage the various complications of COVID-19 have not been widely studied in this context. The effect of the current treatment protocols on patients' diagnostic and prognostic biomarkers may thus impact the validity of the algorithms adopted. CASE PRESENTATION In this case series, we report four cases of venous thromboembolism and 1 case of arterial thrombotic event, in patients treated with standard or intensified prophylactic doses of unfractionated heparin or low molecular weight heparin at our institution. Tocilizumab has been utilized as an add-on therapy to the standard of care to treat patients with SARS-CoV-2 associated acute respiratory distress syndrome, in order to dampen the hyperinflammatory response. It is imperative to be aware that this drug may be masking the inflammatory markers (e.g. IL6, CRP, fibrinogen, and ferritin), without reducing the risk of thrombotic events in this population, creating instead a façade of an improved prognostic outcome. However, the D-dimer levels remained prognostically reliable in these cases, as they were not affected by the drug and continued to be at the highest level until event occurrence. CONCLUSIONS In the setting of tocilizumab therapy, traditional prognostic markers of worsening infection and inflammation, and thus potential risk of acute thrombosis, should be weighed carefully as they may not be reliable for prognosis and may create a façade of an improved prognostic outcome insteasd. Additionally, the fact that thrombotic events continued to be observed despite decrease in inflammatory markers and the proactive anticoagulative approach adopted, raises more questions about the coagulative mechanisms at play in COVID-19, and the appropriate management strategy.
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Affiliation(s)
- Bassam Atallah
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Wasim El Nekidy
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Saad I. Mallah
- School of Medicine, Royal College of Surgeons in Ireland–Bahrain, Al Sayh, Bahrain
| | - Antoine Cherfan
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | - Laila AbdelWareth
- Department of Clinical Pathology, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | - Jihad Mallat
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
- Normandy University, UNICAEN ED 497, Caen, France
| | - Fadi Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
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12
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Nadeem A, Hamed F, Saleh K, Abduljawad B, Mallat J. ICU outcomes of COVID-19 critically ill patients: An international comparative study. Anaesth Crit Care Pain Med 2020; 39:487-489. [PMID: 32654909 PMCID: PMC7333618 DOI: 10.1016/j.accpm.2020.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/16/2023]
Key Words
- icu, intensive care unit
- uae, united arab emirates
- rt-pcr, real time reverse transcriptase–polymerase chain reaction
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- covid-19, coronavirus disease
- sofa, sequential organ failure
- apache, acute physiology and chronic health evaluation
- mv, mechanical ventilation
- los, length of stay
- ecmo, extracorporeal membrane oxygenation
- mr, mortality rate
- ards, acute respiratory distress syndrome
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Affiliation(s)
- Ashraf Nadeem
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Fadi Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Khaled Saleh
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Baraa Abduljawad
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Jihad Mallat
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Normandy University, UNICAEN, ED 497, Caen, France.
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13
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Abdallah K, Hamed F, Rahman N, Salam S, Mallat J. Characteristics of critically ill patients infected with COVID-19 in Abu Dhabi, United Arab Emirates. Anaesth Crit Care Pain Med 2020; 39:483-485. [PMID: 32660852 PMCID: PMC7328597 DOI: 10.1016/j.accpm.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Khaled Abdallah
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Fadi Hamed
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Nadeem Rahman
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Shameen Salam
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Jihad Mallat
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Normandy University, UNICAEN, ED 497, Caen, France.
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14
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Gholinejad M, Hamed F, Biji P. Correction: A novel polymer containing phosphorus–nitrogen ligands for stabilization of palladium nanoparticles: an efficient and recyclable catalyst for Suzuki and Sonogashira reactions in neat water. Dalton Trans 2019; 48:4067-4069. [DOI: 10.1039/c9dt90055a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Correction for ‘A novel polymer containing phosphorus–nitrogen ligands for stabilization of palladium nanoparticles: an efficient and recyclable catalyst for Suzuki and Sonogashira reactions in neat water’ by M. Gholinejad, et al., Dalton Trans., 2015, 44, 14293–14303.
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Affiliation(s)
- M. Gholinejad
- Department of Chemistry
- Institute for Advanced Studies in Basic Sciences (IASBS)
- Gavazang
- Iran
| | - F. Hamed
- Department of Chemistry
- Institute for Advanced Studies in Basic Sciences (IASBS)
- Gavazang
- Iran
| | - P. Biji
- Nanotech Research
- Innovation and Incubation Center
- PSG Institute of Advanced Studies
- Coimbatore-641 004
- India
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15
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16
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Mansour HE, Abdullrhman MA, Mobasher SA, El Mallah R, Abaza N, Hamed F, Khalil AAF. Serum Calprotectin in Rheumatoid Arthritis: A Promising Diagnostic Marker, How Far Is It Related to Activity and Sonographic Findings? J Med Ultrasound 2017; 25:40-46. [PMID: 30065453 PMCID: PMC6029292 DOI: 10.1016/j.jmu.2016.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Received: 07/22/2016] [Accepted: 11/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background: In the past 2 decades, there has been increasing interest in calprotectin. It is released and detected in serum and body fluids as a potentially useful clinical inflammatory marker. The protein has been described in synovial tissue in rheumatoid arthritis (RA) patients, specifically in the lining layer adjacent to the cartilage–pannus junction, which is the primary site of cartilage destruction and bone erosion. Assessment of inflammatory activity in RA is of pivotal importance for the optimal treatment. Our aim in this study is to measure the serum calprotectin levels in RA patients and to assess its association—if there is any—with disease activity score and radiological findings using the musculoskeletal ultrasound. Patients and methods: In our case control study, we included 44 RA patients (Group I) and 20 age- and sex-matched healthy volunteers who served as the control group (Group II). Both groups were subjected to full history taking and thorough clinical examination. Assessment of RA disease activity state was done for all RA patients using the Disease Activity Score 28. Laboratory investigations included the measurement of complete blood cell count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, anticitrullinated peptide antibodies, kidney, liver functions; serum calprotectin levels were determined using enzyme-linked immunosorbent assay and radiological joint assessment was done using musculoskeletal ultrasound score. Results: There was a statistically significant elevation of serum calprotectin levels among RA patients when compared with healthy controls. Statistically significant correlations were also found between serum calprotectin and the ultrasound grading score, Disease Activity Score 28, and erythrocyte sedimentation rate, which reflect the degree of inflammatory activity in the affected joints in RA patients. Moreover, the study yielded a significant correlation between serum calprotectin levels and rheumatoid autoantibodies (rheumatoid factor and anticitrulli-nated peptide antibodies), which are strong predictors of the aggressiveness of the disease. Serum calprotectin at a cutoff level of 93.9 μg/dL had 88.6% sensitivity and 100% specificity for diagnosis of RA. Conclusion: Calprotectin was found to have high association with laboratory and ultrasonography markers of inflammation in RA patients, so it is recommended for use as a marker of inflammatory activity in RA patients especially for the follow-up of patients on biological therapy to assess its efficacy.
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Affiliation(s)
- H E Mansour
- Internal Medicine - Rheumatology Division, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M A Abdullrhman
- Internal Medicine - Rheumatology Division, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - S A Mobasher
- Internal Medicine - Rheumatology Division, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Reem El Mallah
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nouran Abaza
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - F Hamed
- MBCHB of Medicine Ain Shams University, Cairo, Egypt
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17
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Tonelli AR, Ahmed M, Hamed F, Prieto LR. Peripheral pulmonary artery stenosis as a cause of pulmonary hypertension in adults. Pulm Circ 2015; 5:204-10. [PMID: 25992283 DOI: 10.1086/679727] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/28/2014] [Indexed: 11/03/2022] Open
Abstract
Peripheral pulmonary artery stenosis (PPAS) is an underrecognized condition in the adult population. PPAS can lead to pulmonary hypertension but is likely misdiagnosed as either idiopathic pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. We retrospectively identified adult patients with PPAS either in its isolated form or related to other congenital defects from January 1998 to September 2012. We reviewed the patients' clinical data by using our hospital electronic medical records and/or their paper charts. We identified 6 adult patients with PPAS with an age range of 16-56 years (1 woman and the rest men). Presenting signs and symptoms were thoracic murmurs, progressive dyspnea, and syncope. Three patients had Williams-Beuren syndrome. Pulmonary angiography showed that PPAS was predominantly located in main branches or lobar pulmonary arteries in 5 patients, while in 1 patient the arterial narrowing was at the level of the segmental pulmonary arteries. Right heart catheterization showed a mean pulmonary artery pressure (PAP) ranging from 35 to 60 mmHg. Balloon dilation was performed in all patients, predominantly in the lobar arteries, and it caused a decrease in mean PAP that ranged from 16% to 46% in 5 patients. In 1 patient the mean PAP did not decrease. All but 1 patient had follow-up echocardiograms at 1 year that showed stable echocardiographic findings. Pulmonary hypertension due to PPAS continues to presents a diagnostic challenge. Therefore, a high index of suspicion during the initial evaluation of pulmonary hypertension is essential for its prompt diagnosis and adequate treatment.
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Affiliation(s)
- Adriano R Tonelli
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mostafa Ahmed
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Chest Diseases, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Fadi Hamed
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lourdes R Prieto
- Center for Pediatric and Congenital Heart Disease, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Gholinejad M, Hamed F, Biji P. A novel polymer containing phosphorus–nitrogen ligands for stabilization of palladium nanoparticles: an efficient and recyclable catalyst for Suzuki and Sonogashira reactions in neat water. Dalton Trans 2015. [DOI: 10.1039/c5dt01642h] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Highly monodispersed palladium nanoparticles supported on polymer containing phosphorus and nitrogen ligands was successfully synthesized, characterized and used in Suzuki and Sonogashira coupling reactions in water.
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Affiliation(s)
- M. Gholinejad
- Department of Chemistry
- Institute for Advanced Studies in Basic Sciences (IASBS)
- Zanjan 45137-6731
- Iran
| | - F. Hamed
- Department of Chemistry
- Institute for Advanced Studies in Basic Sciences (IASBS)
- Zanjan 45137-6731
- Iran
| | - P. Biji
- Nanotech Research
- Innovation and Incubation Center
- PSG Institute of Advanced Studies
- Coimbatore-641 004
- India
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Obaidat IM, Hamed F. Magnetic field dependence of the relative critical current density in γ-irradiated polycrystalline YBa2Cu3O7. Cryst Res Technol 2008. [DOI: 10.1002/crat.200710996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hamed F, Fuller MP, Telli G. The pattern of freezing of grapevine shoots during early bud growth. Cryo Letters 2000; 21:255-260. [PMID: 12148043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The pattern of freezing of two varieties of grapevine during spring bud burst was characterised using infrared thermography. All plants studied showed endogenous freezing of the stems and subsequent rapid ice spread (0.47 cm/s) analogous to ice spread in bulk water suggesting ice travel in the xylem. Barriers to ice spread were observed between stembranches and more importantly between the stem and buds. Buds froze after the stem and freezing appeared to be initiated from the stem. The lack of a fully functional xylem system is proposed as the barrier to ice spread. All buds which froze suffered complete frost kill whilst frozen stem recovered unharmed. Only 58% of the buds froze and those that did not freeze survived completely.
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Affiliation(s)
- F Hamed
- Department of Horticulture, Faculty of Agriculture, University of Damascus, Syria
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Hamed F, Razavi FS, Bose SK, Startseva T. Spin fluctuations in metallic glasses Zr75(NixFe1-x)25 at ambient and higher pressures. Phys Rev B Condens Matter 1995; 52:9674-9678. [PMID: 9980017 DOI: 10.1103/physrevb.52.9674] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Rioseco AJ, Ivankovic MB, Manzur A, Hamed F, Kato SR, Parer JT, Germain AM. Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. Am J Obstet Gynecol 1994; 170:890-5. [PMID: 8141222 DOI: 10.1016/s0002-9378(94)70304-3] [Citation(s) in RCA: 261] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Intrahepatic cholestasis of pregnancy has been related to a high frequency of abnormal intrapartum fetal heart rate, amniotic fluid meconium, prematurity, and perinatal mortality. To determine whether these adverse perinatal outcomes could be improved with active intervention, we evaluated our results. STUDY DESIGN We report a retrospective case-control study of 320 consecutive patients with intrahepatic cholestasis of pregnancy management with antepartum testing and active intervention over a 2-year period. RESULTS Our results indicate a higher incidence of meconium staining in amniotic fluid at delivery (25% vs 16%, p < 0.05) and spontaneous preterm delivery (12.1% vs 3.9%, p < 0.05), without an increase in the frequency of abnormal intrapartum fetal heart rate (12% vs 11%, not significant), 5-minute Apgar score < 7 (2.0% vs 1.0%, not significant), or perinatal mortality (18/1000 vs 13/1000, not significant). CONCLUSION Antenatal testing and timed intervention of patients with intrahepatic cholestasis of pregnancy is associated with a reduction of the previously reported adverse perinatal outcomes.
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Affiliation(s)
- A J Rioseco
- Department of Obstetrics and Gynecology, Pontificia Universidad Católica de Chile School of Medicine, Santiago
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Badia J, Chuaqui R, Hamed F, Wild R, Barrena N, Mayerson D, Oyarzún E. [An intraoperative anatomicopathological study of myometrial penetration in endometrial cancer: its usefulness in making decisions on extending the primary surgical treatment]. Rev Chil Obstet Ginecol 1992; 57:420-3. [PMID: 1364567] [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: 03/25/2023]
Abstract
The accuracy of frozen section biopsy was evaluated determining the deep of myometrial invasion in 30 samples of hysterectomies performed because of endometrial cancer. Results were compared with the definitive biopsy. Two sections were performed guided by the site of largest lesion seen when the uterus was sectioned in a frontal plane. The diagnosis of myometrial invasion was well determined in 29 cases with a 96.6% of accuracy. We conclude that frozen section is an exact and low cost method to determine intraoperatively, deep of myometrial invasion. This method helps the surgeon to decide the extent of surgery, specially if lymphadenectomy is necessary, during staging laparotomy.
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Affiliation(s)
- J Badia
- Departamento de Obstetricia y Ginecología, Unidad de Ginecología Oncológica, Pontificia Universidad Católica de Chile
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Hamed F, Razavi FS, Zaleski H, Bose SK. Pressure dependence of spin fluctuations in metallic glasses Ni25Zr75 and Fe100-xZrx (x=75,80). Phys Rev B Condens Matter 1991; 43:3649-3651. [PMID: 9997683 DOI: 10.1103/physrevb.43.3649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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