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Chowdhury D, Bansal N, Ansong A, Baker Smith C, Bauser-Heaton H, Choueiter N, Co-Vu J, Elliott P, Fuller S, Jain SS, Jone PN, Johnson JN, Karamlou T, Kipps AK, Laraja K, Lopez KN, Rasheed M, Ronai C, Sachdeva R, Saidi A, Snyder C, Sutton N, Stiver C, Taggart NW, Shaffer K, Williams R. Mind the Gap! Working Toward Gender Equity in Pediatric and Congenital Heart Disease: Present and Future. J Am Heart Assoc 2024; 13:e032837. [PMID: 38639355 DOI: 10.1161/jaha.123.032837] [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: 04/20/2024]
Abstract
Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.
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Affiliation(s)
| | - Neha Bansal
- Division of Pediatric Cardiology Mount Sinai Kravis Children's Hospital New York NY USA
| | - Annette Ansong
- Division of Pediatric Cardiology Children's National Hospital Washington DC USA
| | | | - Holly Bauser-Heaton
- Division of Pediatric Cardiology Children's Healthcare of Atlanta Atlanta GA USA
| | - Nadine Choueiter
- Division of Pediatric Cardiology Mount Sinai Kravis Children's Hospital New York NY USA
| | - Jennifer Co-Vu
- University of Florida Congenital Heart Center Gainesville FL USA
| | | | - Stephanie Fuller
- Division of Cardiothoracic Surgery Children's Hospital of Philadelphia Philadelphia PA USA
| | - Supriya S Jain
- New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center Valhalla NY USA
| | - Pei-Ni Jone
- Department of Pediatrics (Cardiology) Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology Mayo Clinic Rochester MN USA
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery Cleveland Clinic Children's Cleveland OH USA
| | - Alaina K Kipps
- Division of Pediatric Cardiology Stanford School of Medicine Stanford CA USA
| | - Kristin Laraja
- Division of Pediatric Cardiology, Department of Pediatrics University of Massachusetts Medical School Worcester MA USA
| | - Keila N Lopez
- Department of Pediatric Cardiology Baylor College of Medicine, Texas Children's Hospital Houston TX USA
| | - Muneera Rasheed
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - Christina Ronai
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School Boston MA USA
| | - Ritu Sachdeva
- Division of Pediatric Cardiology Children's Healthcare of Atlanta Atlanta GA USA
| | - Arwa Saidi
- University of Florida Gainesville FL USA
| | - Chris Snyder
- Division of Pediatric Cardiology UH Cleveland Medical Center Cleveland OH USA
| | - Nicole Sutton
- Children's Hospital at Montefiore, Albert Einstein College of Medicine Bronx NY USA
| | - Corey Stiver
- The Heart Center, Nationwide Children's Hospital Columbus OH USA
| | - Nathaniel W Taggart
- Department of Pediatrics, Division of Pediatric Cardiology Mayo Clinic Rochester MN USA
| | - Kenneth Shaffer
- Dell Children's Medical Center University of Texas at Austin Dell Medical School Austin TX USA
| | - Roberta Williams
- Division of Pediatric Cardiology, Keck School of Medicine of USC Children's Hospital Los Angeles Los Angeles CA USA
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2
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Harahsheh AS, Shah S, Dallaire F, Manlhiot C, Khoury M, Lee S, Fabi M, Mauriello D, Tierney ESS, Sabati AA, Dionne A, Dahdah N, Choueiter N, Thacker D, Giglia TM, Truong DT, Jain S, Portman M, Orr WB, Harris TH, Szmuszkovicz JR, Farid P, McCrindle BW. Kawasaki Disease in the Time of COVID-19 and MIS-C: The International Kawasaki Disease Registry. Can J Cardiol 2024; 40:58-72. [PMID: 37290536 PMCID: PMC10245460 DOI: 10.1016/j.cjca.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Patients with multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) have overlapping clinical features. We compared demographics, clinical presentation, management, and outcomes of patients according to evidence of previous SARS-CoV-2 infection. METHODS The International Kawasaki Disease Registry (IKDR) enrolled KD and MIS-C patients from sites in North, Central, and South America, Europe, Asia, and the Middle East. Evidence of previous infection was defined as: Positive (household contact or positive polymerase chain reaction [PCR]/serology), Possible (suggestive clinical features of MIS-C and/or KD with negative PCR or serology but not both), Negative (negative PCR and serology and no known exposure), and Unknown (incomplete testing and no known exposure). RESULTS Of 2345 enrolled patients SARS-CoV-2 status was Positive for 1541 (66%) patients, Possible for 89 (4%), Negative for 404 (17%) and Unknown for 311 (13%). Clinical outcomes varied significantly among the groups, with more patients in the Positive/Possible groups presenting with shock, having admission to intensive care, receiving inotropic support, and having longer hospital stays. Regarding cardiac abnormalities, patients in the Positive/Possible groups had a higher prevalence of left ventricular dysfunction, and patients in the Negative and Unknown groups had more severe coronary artery abnormalities. CONCLUSIONS There appears to be a spectrum of clinical features from MIS-C to KD with a great deal of heterogeneity, and one primary differentiating factor is evidence for previous acute SARS-CoV-2 infection/exposure. SARS-CoV-2 Positive/Possible patients had more severe presentations and required more intensive management, with a greater likelihood of ventricular dysfunction but less severe coronary artery adverse outcomes, in keeping with MIS-C.
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Affiliation(s)
- Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, Children's National Hospital; George Washington University School of Medicine and Health Sciences; Washington, DC, USA.
| | - Samay Shah
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Frederic Dallaire
- Department of Paediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Khoury
- Division of Paediatric Cardiology, Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Lee
- The Heart Center at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marianna Fabi
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Daniel Mauriello
- Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Elif Seda Selamet Tierney
- Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California, USA
| | | | - Audrey Dionne
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nagib Dahdah
- Division of Paediatric Cardiology, CHU Ste-Justine, University of Montréal, Montréal, Québec, Canada
| | - Nadine Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Therese M Giglia
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dongngan T Truong
- University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Supriya Jain
- New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA
| | | | - William B Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Tyler H Harris
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Pedrom Farid
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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3
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Walton M, Raghuveer G, Harahsheh A, Portman MA, Lee S, Khoury M, Dahdah N, Fabi M, Dionne A, Harris TH, Choueiter N, Garrido-Garcia LM, Jain S, Dallaire F, Misra N, Hicar MD, Giglia TM, Truong DT, Tierney ESS, Thacker D, Nowlen TT, Szmuszkovicz JR, Norozi K, Orr WB, Farid P, Manlhiot C, McCrindle BW. Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19. Pediatr Cardiol 2023:10.1007/s00246-023-03338-z. [PMID: 38157048 DOI: 10.1007/s00246-023-03338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show clinical overlap and both lack definitive diagnostic testing, making differentiation challenging. We sought to determine how cardiac biomarkers might differentiate KD from MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C pediatric patients from 42 sites from January 2020 through June 2022. The study population included 118 KD patients who met American Heart Association KD criteria and compared them to 946 MIS-C patients who met 2020 Centers for Disease Control and Prevention case definition. All included patients had at least one measurement of amino-terminal prohormone brain natriuretic peptide (NTproBNP) or cardiac troponin I (TnI), and echocardiography. Regression analyses were used to determine associations between cardiac biomarker levels, diagnosis, and cardiac involvement. Higher NTproBNP (≥ 1500 ng/L) and TnI (≥ 20 ng/L) at presentation were associated with MIS-C versus KD with specificity of 77 and 89%, respectively. Higher biomarker levels were associated with shock and intensive care unit admission; higher NTproBNP was associated with longer hospital length of stay. Lower left ventricular ejection fraction, more pronounced for MIS-C, was also associated with higher biomarker levels. Coronary artery involvement was not associated with either biomarker. Higher NTproBNP and TnI levels are suggestive of MIS-C versus KD and may be clinically useful in their differentiation. Consideration might be given to their inclusion in the routine evaluation of both conditions.
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Affiliation(s)
- Mollie Walton
- Children's Mercy Hospital, Kansas City, MO, USA.
- Division of Pediatric Cardiology, Ward Family Heart Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 61408, USA.
| | | | - Ashraf Harahsheh
- Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Simon Lee
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Audrey Dionne
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tyler H Harris
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Nadine Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Supriya Jain
- New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Frédéric Dallaire
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Nilanjana Misra
- Cohen Children's Medical Center, Northwell Health, Queens, NY, USA
| | - Mark D Hicar
- Jacobs School of Medicine and BioMedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Dongngan T Truong
- University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Elif Seda Selamet Tierney
- Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA
| | | | | | | | - Kambiz Norozi
- Department of Pediatrics, Pediatric Cardiology, Western University, London, ON, Canada
| | - William B Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Pedrom Farid
- Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center, Johns Hopkins University, Baltimore, MD, USA
| | - Brian W McCrindle
- Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada
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4
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Alzyoud R, El-Kholy N, Arab Y, Choueiter N, Harahsheh AS, Aselan AS, Kotby A, Bouaziz A, Salih AF, Abushhaiwia A, Alahmadi F, Agha HM, Elmarsafawy HM, Alrabte H, Al-Saloos H, Boudiaf H, Hijazi I, Bouayed K, Al Senaidi KS, Boughammoura L, Jalal M, Ladj MS, Abu-Shukair ME, ElGanzoury MM, Hammadouche N, Elsamman N, Mouawad P, Boukari R, Benalikhoudja N, Jdour S, Abu Al-Saoud SY, Touri SN, Kammoun T, Fitouri Z, Dahdah N. Access to Care and Therapy for Kawasaki Disease in the Arab Countries: A Kawasaki Disease Arab Initiative (Kawarabi) Multicenter Survey. Pediatr Cardiol 2023:10.1007/s00246-023-03166-1. [PMID: 37126143 DOI: 10.1007/s00246-023-03166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/25/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
Kawasaki Disease (KD) is still the most common acquired heart disease in children below the age of five years; it has been well described in the developed world; however, data from the Arab world are limited to case reports or single-center case series. In an effort of optimizing KD research in the Arab world, a group of physicians and researchers established the KD Arab Initiative (Kawarabi) in 2021, and published the first survey, which showed disparities in the availability of intravenous immunoglobulin (IVIG); this had prompted Kawarabi to assess the access to care and therapy of KD patients in Arab countries. A 32 structured questions survey was conducted in thirteen Arab countries and addressed KD patients' access to healthcare in urban and rural settings. The survey results showed that access to care was uniform across large, mid-size cities and rural areas in 7/13 (54%) countries, while in 6/13 (46%) countries, it was in favor of large and mid-size cities over rural areas. The quality of medical services received by children with KD in large cities was rated as excellent in 6/13 or good in 7/13 countries compared to fair in 4/13 or poor in 4/13 countries in rural areas. Availability of IVIG was limited (23%) in mid-size cities and almost impossible (23%) in rural areas. The KD patients in mid-size cities and rural areas have limited access to standard healthcare in the Arab world. This survey laid the foundation for future Kawarabi endeavors to improve the care of children with KD.
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Affiliation(s)
- Raed Alzyoud
- Chief of Pediatric Allergy, Immunology and Rheumatology Divsion, Queen Rania Children's Hospital, Amman, Jordan
| | | | - Yousra Arab
- Université de Sherbrooke, Sherbrooke, Canada
| | | | - Ashraf S Harahsheh
- Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine & HealthSciences Cardiology, Washington, DC, USA
| | - Adnan Salem Aselan
- Pediatric Cardiologist, Madinah Maternity and Children Hospital, King Salman Medical City, Al Madinah Al Munawwarah, Saudi Arabia
| | - Alyaa Kotby
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Asma Bouaziz
- Headmaster of Children and Neonatal Department, Hôpital Régional, Tunis, Tunisia
| | - Aso F Salih
- HD Cardiology, Pediatric Cardiology Department, Children's Heart Hospital, Sulaimani College of Medicine, Sulaimani University, Sulaimani, Iraq
| | - Awatif Abushhaiwia
- Pediatric Rheumatology Department, Tripoli Children's Hospital, Tripoli, Libya
| | - Fahad Alahmadi
- King Faisal Specialist Hospital and Research Center, Pediatric Cardiology, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Hala M Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Hala M Elmarsafawy
- Pediatric Cardiology Division, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Hanifa Alrabte
- Pediatric Cardiology Department, Tripoli Children's Hospital, Tripoli, Libya
| | - Hesham Al-Saloos
- Division of Cardiology, Clinical Pediatrics, Sidra Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Houda Boudiaf
- Onco-Pediatric Department, University Hospital Mustapha Bacha, Algiers University, Algiers, Algeria
| | - Issa Hijazi
- Cardiology Center, King Hussein Medical Center, Amman, Jordan
| | - Kenza Bouayed
- Harouchi, Mother and Child Hospital, CHU Ibn Rochd, Casablanca, Morocco
| | | | - Lamia Boughammoura
- Pediatric Department of Farhat Hached Hospital, Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Maryam Jalal
- Harouchi, Mother and Child Hospital, CHU Ibn Rochd, Casablanca, Morocco
| | - Mohamed S Ladj
- Pediatric Department, Faculty of Medicine, Djillali Belkhenchir University Hospital, Algiers University, Algiers, Algeria
| | | | - Mona M ElGanzoury
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nacera Hammadouche
- Pediatric Department, Faculty of Medicine, Djillali Belkhenchir University Hospital, Algiers University, Algiers, Algeria
| | - Nora Elsamman
- Pediatric Cardiology, Pediatrics Department, Ain Shams University, Cairo, Egypt
| | - Pierre Mouawad
- Pediatric Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rachida Boukari
- Pediatric Department University Hospital, Mustapha Bacha, Algiers, Algeria
| | | | - Salima Jdour
- Pediatric Cardiology Department, Tripoli Children's Hospital, Tripoli, Libya
| | - Sima Y Abu Al-Saoud
- Department of Pediatrics, Faculty of Medicine, Makassed Hospital, Al- Quds University, Jerusalem, Palestine
| | | | - Thouraya Kammoun
- Pediatric Department of Hedi Chakar Hospital, Faculté de Médecine de Sfax, Sfax, Tunisia
| | - Zohra Fitouri
- Unit of Rheumatology, Emergency and Outpatient Department, Pediatric Hospital of Béchir Hamza of Tunis. University Tunis El Manar, Tunis, Tunisia
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Université de Montréal, Montréal, Canada.
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5
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Arab Y, Choueiter N, Dahdah N, El-Kholy N, Abu Al-Saoud SY, Abu-Shukair ME, Agha HM, Al-Saloos H, Al Senaidi KS, Alzyoud R, Bouaziz A, Boukari R, El Ganzoury MM, Elmarsafawy HM, ELrugige N, Fitouri Z, Ladj MS, Mouawad P, Salih AF, Rojas RG, Harahsheh AS. Kawasaki Disease Arab Initiative [Kawarabi]: Establishment and Results of a Multicenter Survey. Pediatr Cardiol 2022; 43:1239-1246. [PMID: 35624313 PMCID: PMC9140321 DOI: 10.1007/s00246-022-02844-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
Studies on Kawasaki disease (KD) in Arab countries are scarce, often providing incomplete data. This along with the benefits of multicenter research collaboratives led to the creation of the KD Arab Initiative [Kawarabi] consortium. An anonymous survey was completed among potential collaborative Arab medical institutions to assess burden of KD in those countries and resources available to physicians. An online 32-item survey was distributed to participating institutions after conducting face validity. One survey per institution was collected. Nineteen physicians from 12 countries completed the survey representing 19 out of 20 institutions (response rate of 95%). Fifteen (79%) institutions referred to the 2017 American Heart Association guidelines when managing a patient with KD. Intravenous immunoglobulin (IVIG) is not readily available at 2 institutions (11%) yet available in the country. In one center (5%), IVIG is imported on-demand. The knowledge and awareness among countries' general population was graded (0 to 10) at median/interquartiles (IQR) 3 (2-5) and at median/IQR 7 (6-8) in the medical community outside their institution. Practice variations in KD management and treatment across Arab countries require solid proactive collaboration. The low awareness and knowledge estimates about KD among the general population contrasted with a high level among the medical community. The Kawarabi collaborative will offer a platform to assess disease burden of KD, among Arab population, decrease practice variation and foster population-based knowledge.
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Affiliation(s)
- Yousra Arab
- University of Sherbrooke, Sherbrooke, QC Canada
| | - Nadine Choueiter
- Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montreal, QC H3T 1C5 Canada
| | - Nermeen El-Kholy
- Pediatric Cardiology Department, AlJalila Children’s Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Sima Y. Abu Al-Saoud
- Department of Pediatrics, Makassed Hospital, Faculty of Medicine, Al- Quds University, East-Jerusalem, Palestine
| | | | - Hala M. Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Hesham Al-Saloos
- Division of Cardiology, Sidra Medicine, Doha, Qatar
- Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar
| | | | - Raed Alzyoud
- Pediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, Amman, Jordan
| | - Asma Bouaziz
- Headmaster of Children and Neonatal Department, Hôpital Régional, Ben Arous, Tunisia
| | - Rachida Boukari
- Pediatric Department, University Hospital Mustapha Bacha, Algiers University, Algiers, Algeria
| | - Mona M. El Ganzoury
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala M. Elmarsafawy
- Pediatric Cardiology Division, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Najat ELrugige
- Pediatric Cardiology Department, Benghazi Children Hospital, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Zohra Fitouri
- Unit of Rheumatology, Emergency and Outpatient Department, Pediatric Hospital of Béchir Hamza of Tunis, University Tunis El Manar, 1007 Djebel Lakhedher Bab Saadoun, Tunis, Tunisia
| | - Mohamed S. Ladj
- Pediatric Department, Djillali Belkhenchir University Hospital, Algiers, Algeria
- Faculty of Medicine, Algiers University, Algiers, Algeria
| | - Pierre Mouawad
- Pediatric Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Aso F. Salih
- Pediatric Cardiology Department/Children’s Heart Hospital- Sulaimani College of Medicine- Sulaimani University, Al-Sulaimaniyah, Iraq
| | - Rocio G. Rojas
- Clinical Research Program, Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, QC H3T 1C5 Canada
| | - Ashraf S. Harahsheh
- Division of Cardiology, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine & Health Sciences, 111 Michigan Ave, NW, Washington, DC 20010 USA
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6
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Sharma M, Choueiter N. 50 Years Ago in TheJournalofPediatrics: Congenital Heart Disease and Genetic Counseling: Shifting Paradigm. J Pediatr 2022; 244:e6. [PMID: 35534172 DOI: 10.1016/j.jpeds.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Madhu Sharma
- Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Bronx, New York
| | - Nadine Choueiter
- Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Bronx, New York
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7
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Jhaveri S, Choueiter N, Manwani D, Ranabothu S, Morrone K, Hafeman M, Reidy K, Kaskel F, Mahgerefteh J. Association of Anemia and Blood Pressure With Novel Markers of Diastolic Function in Pediatric Sickle Cell Disease. J Pediatr Hematol Oncol 2021; 43:e486-e493. [PMID: 33625076 PMCID: PMC8513807 DOI: 10.1097/mph.0000000000002104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
Abstract
Diastolic dysfunction is a known cause of mortality in adults with sickle cell disease (SCD). Left atrial function (LAf) and strain (LAS) are novel echocardiographic parameters to assess early diastolic dysfunction, which have not been assessed in pediatric SCD. Through a retrospective single-center study, we describe echocardiographic parameters of diastology in children with SCD and evaluate their relationship with clinical variables including anemia and blood pressure. Baseline clinical data, 24-hour ambulatory blood pressure monitoring data and echocardiography results were collected. LAf and LAS were measured using volumetric data and speckle-tracking echocardiography, respectively. Sixty-seven children with SCD (13.5±7 y, 47% male, 7% hypertensive) with a mean hemoglobin of 8.8±1.3 g/dL, LAf of 61±8% (n=53) and LAS of 46.3±7.4% (n=28) were included. LAS was significantly associated with hemoglobin (ρ=0.43, P=0.022) but not with maximal left atrial (LA) volume (ρ=-0.05, P=0.79) or any blood pressure parameters. On multivariate analysis, LAS decreased by 3.2% (1.3, 5.1) and LA volume increased by 1.6 mL/m2 (3.1, 0.08) for every 1 g/dL decrease in hemoglobin. Thus, severity of baseline anemia in pediatric SCD correlates with diastolic function as measured by LAS, independent of LA dilation.
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Affiliation(s)
- Simone Jhaveri
- Department of Pediatric Cardiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
- Cohen Children’s Medical Center of New York – Hofstra Northwell School of Medicine, New Hyde Park, NY USA
| | - Nadine Choueiter
- Department of Pediatric Cardiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Deepa Manwani
- Department of Hematology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Saritha Ranabothu
- Department of Nephrology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kerry Morrone
- Department of Hematology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Michael Hafeman
- Department of Nephrology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kimberly Reidy
- Department of Nephrology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Frederick Kaskel
- Department of Nephrology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Joseph Mahgerefteh
- Department of Pediatric Cardiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
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8
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Clark BC, Sanchez-de-Toledo J, Bautista-Rodriguez C, Choueiter N, Lara D, Kang H, Mohsin S, Fraisse A, Cesar S, Sattar Shaikh A, Escobar-Diaz MC, Hsu DT, Randanne PC, Aslam N, Kleinmahon J, Lamour JM, Johnson JN, Sarquella-Brugada G, Chowdhury D. Cardiac Abnormalities Seen in Pediatric Patients During the SARS-CoV2 Pandemic: An International Experience. J Am Heart Assoc 2020; 9:e018007. [PMID: 32957826 PMCID: PMC7763413 DOI: 10.1161/jaha.120.018007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background During the SARS-CoV2 pandemic, there has been increase in hyperinflammatory presentation in previously healthy children with a variety of cardiac manifestations. Our objective is to describe the cardiac manifestations found in an international cohort of 55 pediatric cases with multi-system inflammatory syndrome (MIS-C) during the SARS-CoV2 pandemic. Methods and Results We reviewed data on previously healthy pediatric patients (≤18 years) with structurally normal hearts who presented at hospitals in the United States, United Kingdom, Spain and Pakistan with MIS-C and had consultation with a pediatric cardiologist. Data collected included demographics, clinical presentation, laboratory values, electrocardiographic abnormalities, echocardiographic findings and initial therapies. A total of 55 patients presented with MIS-C. Thirty-five patients (64%) had evidence of decreased left ventricular function, 17 (31%) had valvulitis, 12 (22%) with pericardial effusion and 11 (20%) with coronary abnormalities. Twenty-seven (49%) required ICU admission and 24 (44%) had evidence of shock. Eleven patients (20%) fulfilled complete Kawasaki disease criteria and had lower NT pro-BNP, D-dimer and ferritin levels compared with those who did not fulfill criteria. Electrophysiologic abnormalities occurred in 6 patients and included complete atrioventricular (AV) block, transient AV block and ventricular tachycardia. Conclusions We describe the first international cohort of pediatric patients with MIS-C during the SARS-CoV2 pandemic with a range of cardiac manifestations. This paper brings awareness and alertness to the global medical community to recognize these children during the pandemic and understand the need for early cardiology evaluation and follow-up.
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Affiliation(s)
- Bradley C Clark
- Division of Cardiology Children's Hospital at Montefiore Department of Pediatrics Albert Einstein College of Medicine Bronx NY
| | - Joan Sanchez-de-Toledo
- Department of Cardiology Hospital Sant Joan de Deu Barcelona Spain.,Department of Critical Care Medicine Children's Hospital of Pittsburgh Pittsburgh PA
| | - Carles Bautista-Rodriguez
- Paediatric Cardiology Services Royal Brompton and Harefield Hospitals Trust National Heart and Lung Institute Imperial College London UK
| | - Nadine Choueiter
- Division of Cardiology Children's Hospital at Montefiore Department of Pediatrics Albert Einstein College of Medicine Bronx NY
| | - Diego Lara
- Division of Cardiology Ochsner Health New Orleans LA
| | - Hechaan Kang
- Paediatric Cardiology Services Royal Brompton and Harefield Hospitals Trust National Heart and Lung Institute Imperial College London UK
| | - Shazia Mohsin
- Section of Pediatric Cardiology Department of Pediatric and Child Health Aga Khan University Hospital Karachi Pakistan
| | - Alain Fraisse
- Paediatric Cardiology Services Royal Brompton and Harefield Hospitals Trust National Heart and Lung Institute Imperial College London UK
| | - Sergi Cesar
- Department of Cardiology Hospital Sant Joan de Deu Barcelona Spain
| | - Abdul Sattar Shaikh
- Paediatric Cardiology National Institute of Cardiovascular Diseases Karachi Pakistan
| | | | - Daphne T Hsu
- Division of Cardiology Children's Hospital at Montefiore Department of Pediatrics Albert Einstein College of Medicine Bronx NY
| | - Paula C Randanne
- Department of Cardiology Hospital Sant Joan de Deu Barcelona Spain
| | - Nadeem Aslam
- Section of Pediatric Cardiology Department of Pediatric and Child Health Aga Khan University Hospital Karachi Pakistan
| | | | - Jacqueline M Lamour
- Division of Cardiology Children's Hospital at Montefiore Department of Pediatrics Albert Einstein College of Medicine Bronx NY
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Satzer M, Hodzic E, Argilla M, Choueiter N. Fetal Diagnosis of Tetralogy of Fallot, Major Aortopulmonary Collateral Arteries, and an "Inverted" Pulmonary Valve Causing a Circular Shunt. ACTA ACUST UNITED AC 2020; 4:356-361. [PMID: 33117928 PMCID: PMC7581609 DOI: 10.1016/j.case.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pulmonary blood supply is the main determinant of physiology in tetralogy of Fallot. This case exhibits a highly abnormal pulmonary valve and blood flow pattern. Circular shunting may spare fetal health yet lead to neonatal hypoxemia and shock. Surgical intervention stabilizes pulmonary blood supply in this unusual physiology. Comparison is made with known subtypes of tetralogy of Fallot.
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Affiliation(s)
- Michael Satzer
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Emina Hodzic
- Division of Pediatric Cardiology, Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Michael Argilla
- Division of Pediatric Cardiology, Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Nadine Choueiter
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
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10
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Lorenzoni RP, Elkins N, Quezada M, Silver EJ, Mahgerefteh J, Choueiter N. CORONARY ARTERY INVOLVEMENT IN CHILDREN WITH KAWASAKI DISEASE USING THE PEDIATRIC HEART NETWORK Z SCORE SYSTEM. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Farooqi KM, Uppu SC, Nguyen K, Srivastava S, Ko HH, Choueiter N, Wollstein A, Parness IA, Narula J, Sanz J, Nielsen JC. Application of Virtual Three-Dimensional Models for Simultaneous Visualization of Intracardiac Anatomic Relationships in Double Outlet Right Ventricle. Pediatr Cardiol 2016; 37:90-8. [PMID: 26254102 DOI: 10.1007/s00246-015-1244-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 06/02/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
Our goal was to construct three-dimensional (3D) virtual models to allow simultaneous visualization of the ventricles, ventricular septal defect (VSD) and great arteries in patients with complex intracardiac anatomy to aid in surgical planning. We also sought to correlate measurements from the source cardiac magnetic resonance (CMR) image dataset and the 3D model. Complicated ventriculo-arterial relationships in patients with complex conotruncal malformations make preoperative assessment of possible repair pathways difficult. Patients were chosen with double outlet right ventricle for the complexity of intracardiac anatomy and potential for better delineation of anatomic spatial relationships. Virtual 3D models were generated from CMR 3D datasets. Measurements were made on the source CMR as well as the 3D model for the following structures: aortic diameter in orthogonal planes, VSD diameter in orthogonal planes and long axis of right ventricle. A total of six patients were identified for inclusion. The path from the ventricles to each respective outflow tract and the location of the VSD with respect to each great vessel was visualized clearly in all patients. Measurements on the virtual model showed excellent correlation with the source CMR when all measurements were included by Pearson coefficient, r = 0.99 as well as for each individual structure. Construction of virtual 3D models in patients with complex conotruncal defects from 3D CMR datasets allows for simultaneous visualization of anatomic relationships relevant for surgical repair. The availability of these models may allow for a more informed preoperative evaluation in these patients.
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Affiliation(s)
- Kanwal M Farooqi
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA. .,Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA.
| | - Santosh C Uppu
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Khanh Nguyen
- Department of Pediatric Cardiac Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Shubhika Srivastava
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - H Helen Ko
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Nadine Choueiter
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Adi Wollstein
- Department of Pediatric Cardiac Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Ira A Parness
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Jagat Narula
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA
| | - Javier Sanz
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA
| | - James C Nielsen
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA.,Division of Pediatric Cardiology, Stony Brook University Medical Center, Stonybrook, NY, USA
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