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Alhawari H, Alzoubi O, Alshelleh S, Alfaris L, Abdulelah M, AlRyalat SA, Altarawneh S, Alzoubi M. Blood pressure difference between pre and post-menopausal women and age-matched men: A cross-sectional study at a tertiary center. J Clin Hypertens (Greenwich) 2024. [PMID: 38523574 DOI: 10.1111/jch.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
Hypertension is a prominent risk factor for cardiovascular and cerebrovascular diseases. Gender differences and menopausal status contribute to blood pressure changes across the lifespan which have not been completely characterized. Our study aims to explore the impact of multiple factors on blood pressure levels in previously healthy women and men. Factors of interest included gender, menopausal status, age, and body mass index. Healthy women and men were recruited through healthcare facility announcements. Detailed menopausal history was obtained from females. The authors measured each participant's systolic and diastolic blood pressure at our outpatient clinics twice on the same day, and two different days, one week apart, and the authors included the mean of the averaged two readings for each participant. The study sample consisted of 313 participants. Female gender was a significant predictor of lower systolic and diastolic blood pressure (p < .001), while age significantly correlated with higher systolic blood pressure readings (p = .004). Although systolic blood pressure levels were significantly higher in postmenopausal females (124 mmHg) compared to premenopausal females (116 mmHg), our multiple linear regression analysis revealed that postmenopausal status did not significantly predict changes in either systolic or diastolic blood pressure. Our study demonstrates significant associations between blood pressure levels and various factors such as gender and age. This could emphasize the intricate interplay of demographic and clinical factors in blood pressure variations among individuals, highlighting the importance of a holistic approach to diagnosing hypertension, which considers various individual factors, including gender and age.
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Affiliation(s)
- Hussein Alhawari
- Department of Internal Medicine, Faculty of medicine, the University of Jordan, Amman, Jordan
| | - Osama Alzoubi
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sameeha Alshelleh
- Department of Internal Medicine, Faculty of medicine, the University of Jordan, Amman, Jordan
| | - Leen Alfaris
- Departement of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Mohamad Abdulelah
- Departement of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Saif Aldeen AlRyalat
- Department of Special Surgery, Faculty of Medicine, the University of Jordan, Amman, Jordan
| | - Saleh Altarawneh
- Department of Internal Medicine, Faculty of medicine, the University of Jordan, Amman, Jordan
| | - Mohammad Alzoubi
- Department of Internal Medicine, Faculty of medicine, the University of Jordan, Amman, Jordan
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Alrabadi N, Aljarrah Q, Alzoubi O, Al-Jarrah H, Elayyan Y, Alnabulsi Z, Husein A, Alzoubi KH, Bakkar S, Aljanabi M, Zihlif M, Haddad R. Clinical recurrence and antiplatelet drug resistance among patients with lower limb ischemia. Medicine (Baltimore) 2024; 103:e36915. [PMID: 38215136 PMCID: PMC10783292 DOI: 10.1097/md.0000000000036915] [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] [Received: 10/13/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024] Open
Abstract
There is a high prevalence rate of peripheral artery disease worldwide, with estimated cases exceeding 200 million. Most patients are under-diagnosed and under-treated, and there is a lack of knowledge regarding the best therapeutic regimen and therapy duration, which leads to many cases of recurrence, complications, and amputations. This study aims to explore clinical recurrence, which was defined as the worsening of chronic peripheral artery disease requiring hospital admission, and its relationship with antiplatelet drug resistance among patients with lower limb ischemia. This cohort study includes both retrospective and prospective recruitment of patients with chronic lower limb ischemia. Platelet aggregation tests were offered to the patients. Between February 2018 and November 2020, 147 patients were recruited from King Abdullah University Hospital and followed up for at least 1 year. Platelet aggregation tests were done for 93 patients who agreed to participate in this part of the study. The prevalence of chronic lower limb ischemia was higher in young male patients who are current smokers with co-morbid diseases such as hypertension, diabetes mellitus, and/or dyslipidemia. There was a significant association only of clinical recurrence with younger age (P = .011) and with low platelets count in severe stages of the disease (P = .047). No significant association was found in terms of laboratory resistance. The clinical recurrence rates of chronic lower limb ischemia were higher in younger patients and among those with low platelet counts in the severe stages of the disease. Despite the laboratory responsiveness to anti-platelet therapy, we observed significant clinical resistance and increased recurrence rates.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Qusai Aljarrah
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Alzoubi
- Department of Medicine, Division of Rheumatology, the University of Illinois, Chicago, IL, USA
| | - Hussam Al-Jarrah
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yasmin Elayyan
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Zaid Alnabulsi
- Department of Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Anas Husein
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H. Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sohail Bakkar
- Department of General and Specialized Surgery, Faculty of Medicine, the Hashemite University, Zarqa, Jordan
| | - Mukhallad Aljanabi
- Department of Physiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Malik Zihlif
- Department of Pharmacology, School of Medicine, University of Jordan, Amman, Jordan
| | - Razan Haddad
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Jadara University, Irbid, Jordan
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Alrabadi N, Al-Nusair M, El-Zubi FK, Tashtoush M, Alzoubi O, Khamis S, Masadeh MM, Alzoubi KH, Al-Hiari M, Hammoudeh A. Evaluation of Clinical, Echocardiographic, and Therapeutic Characteristics, and Prognostic Outcomes of Coexisting Heart Failure among Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study. Curr Vasc Pharmacol 2024; 22:58-66. [PMID: 38038004 DOI: 10.2174/0115701611260211231115094716] [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] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most commonly encountered cardiac arrhythmia in clinical practice. Heart failure (HF) can occur concurrently with AF. AIM We compared different demographic, clinical, and echocardiographic characteristics between patients with AF+HF and patients with AF only. Furthermore, we explored whether concurrent HF independently predicts several outcomes (all-cause mortality, cardiovascular mortality, ischemic stroke/systemic embolism (IS/SE), major bleeding, and clinically relevant non-major bleeding (CRNMB)). MATERIALS AND METHODS Comparisons between the AF+HF and the AF-only group were carried out. Multivariable Cox proportional hazard models were constructed for each outcome to assess whether HF was predictive of any of them while controlling for possible confounding factors. RESULTS A total of 2020 patients were included in this study: 481 had AF+HF; 1539 had AF only. AF+HF patients were older, more commonly males, and had a higher prevalence of diabetes mellitus, dyslipidemia, coronary artery disease, and chronic kidney disease (p≤0.05). Furthermore, AF+HF patients more commonly had pulmonary hypertension and low ejection fraction (p≤0.001). Finally, HF was independently predictive of all-cause mortality (adjusted HR 2.17, 95% CI (1.66-2.85) and cardiovascular mortality (adjusted HR 2.37, 95% CI (1.68-3.36). CONCLUSION Coexisting AF+HF was associated with a more labile and higher-risk population among Jordanian patients. Furthermore, coexisting HF independently predicted higher all-cause mortality and cardiovascular mortality. Efforts should be made to efficiently identify such cases early and treat them aggressively.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohammed Al-Nusair
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Farah K El-Zubi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mais Tashtoush
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Alzoubi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sa'ed Khamis
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Majd M Masadeh
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Al-Hiari
- Department of Internal Medicine, School of Medicine, Marshall University, Huntington, West Virginia, USA
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Elmhiregh A, Hantouly AT, Alzoubi O, George B, Ahmadi M, Ahmed G. The optimal fluoroscopic views to rule out intra-articular screw penetration during acetabular fracture fixation. Int Orthop 2024; 48:243-252. [PMID: 37855923 PMCID: PMC10766808 DOI: 10.1007/s00264-023-06002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To determine the ideal view(s) and the minimum number of intraoperative fluoroscopic views required to rule out any intra-articular screw violation in acetabular fractures fixation. METHODS This study was conducted using a series of fluoroscopic examinations of pelvic synthetic models with screws positioned in different planes around the acetabulum. Ten screws were placed in the synthetic pelvis models in different planes of the acetabulum. Seven views were taken for each screw. Radiographic images were evaluated by 14 orthopaedic surgeons who were asked to assess joint violation and the view(s) required for assessment. RESULTS The observers' accuracy rate in identifying joint violation was 82.1% for the anterior part of the anterior column and the superior part of the posterior column, 89.3% for the posterior part of the anterior column and the inferior part of the posterior column, and 92.9% for the quadrilateral plate. The sensitivity was 100% for the anterior and posterior parts of the anterior column and the inferior part of the posterior column, 87.5% for the superior part of the posterior column, and 85.7% for the quadrilateral plate. The specificity was 100% for the quadrilateral plate, 80% for the superior part of the posterior column and the posterior part of the anterior column, 78.6% for the inferior part of the posterior column, and 66.7% for the anterior part of the anterior column. There was a strong overall interobserver and intra-observer agreement with intraclass correlation coefficient (ICC) of 0.709 and 0.86, respectively. CONCLUSIONS This study confirms the hypothesis that in a concave surface/joint fixation, such as the acetabulum, the probability of joint violation is unlikely if there is no evidence of it within a single fluoroscopic view. In acetabulum fracture fixation with a screw violating the joint, the screw's presence was evident within the joint space in all fluoroscopic views. However, the absence of joint violation in one fluoroscopic view was adequate to rule out joint penetration.
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Affiliation(s)
- Aissam Elmhiregh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzoubi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Bivin George
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohsen Ahmadi
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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Alrabadi N, Al-faouri I, Hadad R, Al-rabadi D, Alnsour A, Alzoubi O, Obeidat O, Alzoubi KH. The risk of COVID-19 infection among nurses working with COVID-19 patients. Medicine (Baltimore) 2023; 102:e36201. [PMID: 38065848 PMCID: PMC10713127 DOI: 10.1097/md.0000000000036201] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
Working with 2019 coronavirus disease (COVID-19) patients is currently considered one of the main fears and challenges that face healthcare workers (HCWs), especially nurses. This challenge can jeopardize the quality of health care services for those patients and cause a serious mental burden to HCWs. To understand and estimate the risk of COVID-19 infection among HCWs who directly serve COVID-19 patients. Before the community spread of the disease, 270 nurses who worked with COVID-19 wards were followed for 11 weeks to report the COVID-19 cases. On the other hand, during the community spread of the disease, 981 registered nurses (300 worked in COVID-19 wards and 681 worked in non-COVID wards) were followed for up to 16 weeks to report the COVID-19 cases. Before the community spread of COVID-19, none of the nurses who worked with the COVID-19 patients got the infection. On the other hand, during the community spread of the COVID-19 infection, 30% of the 300 nurses who worked in the COVID-19 wards got the COVID-19 infection, while 64% of the 681 HCWs who worked in the non-COVID wards got the infection. The relative risk of getting COVID-19 infection among HCWs who worked in the COVID-19 wards was reduced to about half in comparison to other HCWs who worked in the non-COVID wards (RR = 0.469). HCWs should not fear working with COVID-19 patients. Considering appropriate personal protective measures and infection control standards, the risk of infection transmission from the community is higher than that of COVID-19 patients, if any.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ibrahim Al-faouri
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Razan Hadad
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Jadara University, Irbid, Jordan
| | - Daher Al-rabadi
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ayham Alnsour
- Faculty of Medicine, Al-Balqa’ Applied University, Salt, Jordan
| | - Osama Alzoubi
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Obeidat
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H. Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Alhawari H, Alshelleh S, Alzoubi O, Khanfar AN, Akiely R, Abdallah B, Hajjaj N, Alkhalaileh S, Khader Y. Comparison of Baseline and Test Day Cardiovascular Parameters, Anxiety Scores and Coffee Consumption Among Medical Students Undergoing Objective Structured Clinical Examinations in Jordan. Int J Gen Med 2023; 16:4249-4256. [PMID: 37745136 PMCID: PMC10517688 DOI: 10.2147/ijgm.s432157] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Objective Structured Clinical Examinations (OSCEs) are considered an integral part of the assessment process of many schools of medicine worldwide. Close monitoring by examiners, scrutinized interactions with patients, and fear of the unknown, among other factors have been reported to cause psychological stress among students during the examinations period. In this study, we aimed to assess changes in cardiovascular parameters, anxiety scores, and lifestyle patterns of medical students during their OSCEs as compared to their baseline. Materials and Methods We recruited healthy medical students from our institution's medical school. General demographics, academic, and baseline lifestyle characteristics were collected 1-2 months before the OSCE day. The Generalized Anxiety Disorder 7-item (GAD-7) scale was used to measure anxiety symptoms. Data related to coffee consumption in addition to systolic, diastolic blood pressure and heart rate measurements were collected both at baseline and on OSCE day. Results This study included 325 students (144 (44.3%) males and 181 (55.7%) females). The mean systolic blood pressure, diastolic blood pressure, and heart rate measurements were significantly higher on OSCE day as compared to the baseline. In addition, the daily consumption of coffee increased significantly during OSCE day as compared to the baseline. Although the anxiety score increased during OSCE day compared to the baseline, the difference was not statistically significant. However, the change in anxiety score (OSCE day - baseline) was significantly higher in females compared to males. Conclusion In our study, we observed significant increases in blood pressure, heart rate, and coffee intake on the day of the test compared to baseline measurements. These findings underscore the significance of implementing measures to reduce the harmful effects of stress on students during exam preparations and medical school assessments.
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Affiliation(s)
- Hussein Alhawari
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Sameeha Alshelleh
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Osama Alzoubi
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Asim N Khanfar
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Reem Akiely
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Bayan Abdallah
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Nada Hajjaj
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Saja Alkhalaileh
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
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AlSamhori JF, Alshrouf MA, AlSamhori ARF, Alshadeedi FM, Madi AS, Alzoubi O. Implications of the COVID-19 pandemic on athletes, sports events, and mass gathering events: Review and recommendations. Sports Med Health Sci 2023; 5:165-173. [PMID: 37753427 PMCID: PMC10518794 DOI: 10.1016/j.smhs.2023.07.006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 09/28/2023] Open
Abstract
Since the coronavirus disease 19 (COVID-19), which caused several respiratory diseases, was formally declared a global pandemic by the World Health Organization (WHO) on March 11, 2020, it affected the lifestyle and health of athletes, both directly through cardiorespiratory and other health related effects, and indirectly as the pandemic has forced the suspension, postponement, or cancellation of most professional sporting events around the world. In this review, we explore the journey of athletes throughout the pandemic and during their return to their competitive routine. We also highlight potential pitfalls during the process and summarize the recommendations for the optimal return to sport participation. We further discuss the impact of the pandemic on the psychology of athletes, the variance between the team and individual athletes, and their ability to cope with the changes. Moreover, we specifically reviewed the pandemic impact on younger professional athletes in terms of mental and fitness health. Finally, we shaded light on the various impacts of mass gathering events and recommendations for managing upcoming events.
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Affiliation(s)
| | - Mohammad Ali Alshrouf
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan
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8
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Mózes FE, Lee JA, Vali Y, Alzoubi O, Staufer K, Trauner M, Paternostro R, Stauber RE, Holleboom AG, van Dijk AM, Mak AL, Boursier J, de Saint Loup M, Shima T, Bugianesi E, Gaia S, Armandi A, Lupșor-Platon M, Wong VWS, Li G, Wong GLH, Cobbold J, Karlas T, Wiegand J, Sebastiani G, Tsochatzis E, Liguori A, Yoneda M, Nakajima A, Hagström H, Akbari C, Hirooka M, Chan WK, Mahadeva S, Rajaram R, Zheng MH, George J, Eslam M, Petta S, Pennisi G, Viganò M, Ridolfo S, Aithal GP, Palaniyappan N, Lee DH, Ekstedt M, Nasr P, Cassinotto C, de Lédinghen V, Berzigotti A, Mendoza YP, Noureddin M, Truong E, Fournier-Poizat C, Geier A, Martic M, Tuthill T, Anstee QM, Harrison SA, Bossuyt PM, Pavlides M. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis. Lancet Gastroenterol Hepatol 2023:S2468-1253(23)00141-3. [PMID: 37290471 DOI: 10.1016/s2468-1253(23)00141-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD. METHODS This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: <10 vs 10 to <20 vs ≥20 kPa; FIB-4: <1·3 vs 1·3 to ≤2·67 vs >2·67; NFS: <-1·455 vs -1·455 to ≤0·676 vs >0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226. FINDINGS Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression. INTERPRETATION Simple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases. FUNDING Innovative Medicines Initiative 2.
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Affiliation(s)
- Ferenc E Mózes
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jenny A Lee
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Yasaman Vali
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Osama Alzoubi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Katharina Staufer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rafael Paternostro
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rudolf E Stauber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Adriaan G Holleboom
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Anne-Marieke van Dijk
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Anne Linde Mak
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Jérôme Boursier
- Laboratoire HIFIH, UPRES EA 3859, SFR ICAT 4208, Université d'Angers, Angers, France; Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marc de Saint Loup
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | | | - Silvia Gaia
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Angelo Armandi
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Monica Lupșor-Platon
- Department of Medical Imaging, Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Guanlin Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jeremy Cobbold
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Oxford National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Oxford University Hospitals National Health Service (NHS) Foundation Trust, University of Oxford, Oxford, UK
| | - Thomas Karlas
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Wiegand
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology and Division of Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada
| | - Emmanuel Tsochatzis
- Sheila Sherlock Liver Unit, Royal Free London NHS Foundation Trust, London, UK; Institute for Liver and Digestive Health, University College London, London, UK
| | - Antonio Liguori
- Sheila Sherlock Liver Unit, Royal Free London NHS Foundation Trust, London, UK; Institute for Liver and Digestive Health, University College London, London, UK; Department of Translational Medicine and Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hannes Hagström
- Division of Liver and Pancreatic diseases, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Akbari
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Touon, Japan
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ruveena Rajaram
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Wenzhou Key Laboratory of Hepatology, Wenzhou, China; Institute of Hepatology, Wenzhou Medical University, Wenzhou, China; Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, Palermo, Italy
| | - Grazia Pennisi
- Section of Gastroenterology and Hepatology, PROMISE, Palermo, Italy
| | - Mauro Viganò
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Sofia Ridolfo
- Hepatology Unit, Ospedale San Giuseppe, University of Milan, Milan, Italy
| | - Guruprasad Padur Aithal
- NIHR Nottingham Biomedical Research Centre and Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Naaventhan Palaniyappan
- NIHR Nottingham Biomedical Research Centre and Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dae Ho Lee
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Mattias Ekstedt
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Patrik Nasr
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christophe Cassinotto
- Department of Diagnostic and Interventional Radiology, Saint-Eloi Hospital and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, University Hospital of Montpellier, Montpellier, France
| | - Victor de Lédinghen
- Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France; INSERM1312, Bordeaux University, Bordeaux, France
| | - Annalisa Berzigotti
- Department for Visceral Medicine and Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Yuly P Mendoza
- Department of Biomedical Research, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Mazen Noureddin
- Houston Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Emily Truong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Andreas Geier
- Division of Hepatology, University Hospital Würzburg, Würzburg, Germany
| | - Miljen Martic
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Theresa Tuthill
- Digital Sciences and Translational Imaging, Pfizer, Cambridge, MA, USA
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Stephen A Harrison
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Michael Pavlides
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Oxford National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Oxford University Hospitals National Health Service (NHS) Foundation Trust, University of Oxford, Oxford, UK.
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Alzoubi O, Meyer A, Gonzalez TP, Burgos AC, Sweiss N, Zomorrodi RK, Shahrara S. Significance of IL-34 and SDC-1 in the pathogenesis of RA cells and preclinical models. Clin Immunol 2023; 251:109635. [PMID: 37150238 PMCID: PMC10985830 DOI: 10.1016/j.clim.2023.109635] [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: 01/14/2023] [Revised: 01/22/2023] [Accepted: 03/18/2023] [Indexed: 05/09/2023]
Abstract
IL-34 shares a common receptor with M-CSF, while it can bind to other distinct receptors including protein-tyrosine phosphatase zeta (PTPζ), and syndecan1 (SDC-1). In physiological conditions, IL-34 has a critical role in the maintenance and development of Langerhans and microglial cells in part through PTPζ ligation. Conversely, in autoimmune diseases such as rheumatoid arthritis (RA), SDC-1-induced phosphorylation of M-CSFR was responsible for the pathological effect of IL-34 in patient cells and/or preclinical models. Intriguingly, enrichment of IL-34 is strongly linked to rheumatoid factor (RF), disease activity score (DAS)28, erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and radiographic progression. In parallel, IL-34-induced naïve cell reprogramming into glycolytic RA CD14+CD86+GLUT1+ macrophage was dysregulated via M-CSFR or SDC-1 antibody therapy. Moreover, the inflammatory and erosive imprints of IL-34 arthritic mice were mitigated by glucose uptake inhibition and SDC-1, or RAG deficiency through nullifying macrophage metabolic rewiring and their ability to advance Th1/Th17 cell polarization. Consistently, IL-34-/- and SDC-1-/- mice could effectively impair CIA joint inflammation, osteoclast formation, and neovascularization by restraining monocyte infiltration as well as suppressing the inflammatory macrophage and T effector cell reconfiguration via metabolic deactivation. In conclusion, targeting IL-34/SDC-1 signaling, or its interconnected metabolites can uniquely intercept the crosstalk between glycolytic RA myeloid and lymphoid cells and their ability to trigger arthritis.
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Affiliation(s)
- Osama Alzoubi
- Department of Medicine, Division of Rheumatology, the University of Illinois at Chicago, IL, USA
| | - Anja Meyer
- Jesse Brown VA Medical Center, Chicago, IL, USA; Department of Medicine, Division of Rheumatology, the University of Illinois at Chicago, IL, USA
| | - Tanya Pulido Gonzalez
- Department of Medicine, Division of Rheumatology, the University of Illinois at Chicago, IL, USA
| | - Adel C Burgos
- Jesse Brown VA Medical Center, Chicago, IL, USA; Department of Medicine, Division of Rheumatology, the University of Illinois at Chicago, IL, USA
| | - Nadera Sweiss
- Department of Medicine, Division of Rheumatology, the University of Illinois at Chicago, IL, USA
| | - Ryan K Zomorrodi
- Department of Medicine, Division of Rheumatology, the University of Illinois at Chicago, IL, USA
| | - Shiva Shahrara
- Jesse Brown VA Medical Center, Chicago, IL, USA; Department of Medicine, Division of Rheumatology, the University of Illinois at Chicago, IL, USA.
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Alhawari H, AlShelleh S, Alhawari H, AlRyalat SA, Khanfar AN, Alzoubi O. Prevalence of Undiagnosed Hypertension and Its Predictors in Jordan: A Cross-Sectional Study. Int J Gen Med 2022; 15:7919-7928. [PMID: 36317098 PMCID: PMC9617551 DOI: 10.2147/ijgm.s388121] [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] [Received: 08/30/2022] [Accepted: 10/18/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Hypertension is an important cause of morbidity and mortality worldwide. Undiagnosed hypertension is a serious issue that leads to increased morbidity and mortality. In this study, we aim to identify the prevalence of undiagnosed hypertension in the healthy Jordanian population, as well as identify predictors of high blood pressure readings in presumably healthy Jordanians. Materials and Methods We recruited healthy visitors accompanying patients at our Jordan University Hospital Clinics ranging from 18 to 80 years of age. We measured each participant's systolic and diastolic blood pressure at our outpatient clinics on two different days, one week apart. We also obtained demographic data, weight, height, smoking status, and family history of hypertension and cardiovascular diseases. Results A total of 896 participants were included in this study with a mean age of 48 years. The median of systolic blood pressure readings was 125 mmHg, and the median of diastolic blood pressure readings was 83 mmHg. 38.5% had undiagnosed stage 1 hypertension and 30.5% had undiagnosed stage 2 hypertension according to the American College of Cardiology/American Heart Association guidelines. On the other hand, 25.4% had undiagnosed grade 1 hypertension and 5.1% had undiagnosed grade 2 hypertension according to the European Society of Hypertension guidelines. Conclusion According to the ACC/AHA guidelines, 68.5% of previously healthy Jordanians met the criteria to be diagnosed with hypertension. Predictors of high systolic blood pressure were age, BMI and family history of CAD, while female gender is associated with a lower systolic blood pressure. For diastolic blood pressure, only BMI and family history of CAD were associated with significantly higher diastolic blood pressure, while female gender and exercise were significantly associated with lower diastolic blood pressure.
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Affiliation(s)
- Hussein Alhawari
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan,Correspondence: Hussein Alhawari, Division of Nephrology, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan, Email
| | - Sameeha AlShelleh
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan
| | - Hussam Alhawari
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan
| | - Saif Aldeen AlRyalat
- Department of Special Surgery, School of Medicine, the University of Jordan, Amman, Jordan
| | - Asim N Khanfar
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan
| | - Osama Alzoubi
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan
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11
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Alzoubi O, Maaita W, Madain Z, Alzoubi M, Sweis JJG, Arar AR, Sweis NWG. Association between placenta accreta spectrum and third-trimester serum levels of vascular endothelial growth factor, placental growth factor, and soluble Fms-like tyrosine kinase-1: A meta-analysis. J Obstet Gynaecol Res 2022; 48:2363-2376. [PMID: 35726123 DOI: 10.1111/jog.15330] [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: 12/21/2021] [Revised: 04/10/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
AIM Antenatal suspicion of placenta accreta spectrum (PAS) currently relies on ultrasonographic findings, color doppler, and MRI, which have rendered it operator and expertise-dependent. No serum markers for PAS have been integrated into clinical practice yet. The aim of this meta-analysis was to identify potential serum markers for PAS by investigating third-trimester serum levels of vascular endothelial growth factor (VEFG), placental growth factor (PIGF), and soluble Fms-like tyrosine kinase-1 (sFlt-1) among PAS-cases and controls. METHODS PubMed, Scopus, EBSCO, Web of Science, and CNKI databases were systematically searched for relevant articles. Random-effects model was applied to calculate the overall standardized mean difference (SMD) for each marker. Subgroup analysis and meta-regression were performed to assess for potential covariates. RESULTS Eight studies involving 366 PAS-cases and 518 controls were included. Third trimester sFlt-1 levels were significantly lower in PAS-cases when compared to controls (SMD = -7.76, 95%CI = -10.42 to -5.10). This was, to a certain extent, consistent among studies though they differed in their extent of significance. Levels of VEGF (SMD = 1.59, 95%CI = -0.07 to 3.25) and PlGF (SMD = -0.49, 95%CI = -1.66 to 0.67) were not significantly different between PAS cases and controls, in which studies demonstrated conflicting results. CONCLUSIONS Third trimester sFlt-1 levels may be useful to predict PAS. Nonetheless, further studies are recommended to better understand conflicting results before adopting either VEGF or PlGF.
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Affiliation(s)
- Osama Alzoubi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Ward Maaita
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Zaid Madain
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Ahmad R Arar
- School of Medicine, The University of Jordan, Amman, Jordan
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Samara OA, Alzoubi O, Gharaibeh AM, Alnajjar Q, Alawwa I. Isolated Persistent Left Superior Vena Cava Associated With Autosomal Dominant Polycystic Kidney Disease (ADPKD): Challenges and Clinical Significance. Cureus 2022; 14:e22890. [PMID: 35399489 PMCID: PMC8986345 DOI: 10.7759/cureus.22890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/05/2022] Open
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Alzoubi O, Khanfar A. Association between neutrophil to lymphocyte ratio and mortality among community acquired pneumonia patients: a meta-analysis. Monaldi Arch Chest Dis 2021; 92. [PMID: 34911288 DOI: 10.4081/monaldi.2021.2050] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
The neutrophil to lymphocyte ratio (NLR)is an emerging biomarker used in the prognosis of many conditions. We aimed to conduct a meta-analysis to assess the prognostic accuracy of the NLR in determining mortality in patients with Community acquired pneumonia (CAP). The Pubmed, EBSCO, and Scopus databases were searched to find all relevant articles. 10 articles with 5220 patients were included. The pooled area under the curve (AUC) of NLR admission levels to predict 30-Day mortality of CAP patients was 0.706; 95% CI (0.631 to 0.781), while the pooled AUC of NLR levels taken at 3-5 days was 0.882; 95% CI (0.818 to 0.945). Meta analysis also showed a significant difference in the NLR between the Survivors and 30-Day non-survivors. This difference was greater when NLR levels were taken at 3-5 days; Standardized mean difference (SMD) = 1.646; 95% CI (0.451 to 2.840) compared to NLR levels at admission SMD = 1.139; 95% CI (0.514 to 1.764). These results show that the NLR has potential to be incorporated in the routine assessment and stratification of CAP patients, especially in the early-stage evolution (3-5 days), keeping in mind the availability and cost effectiveness of this test.
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Affiliation(s)
| | - Asim Khanfar
- School of Medicine, University of Jordan, Amman.
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