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1.
Oral Dis ; 29(4): 1432-1438, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35212093

RESUMO

Halitosis is a term that refers to an unpleasant or foul odour originating from the oral cavity that can be caused by either intra-oral or extra-oral factors. Despite the fact that halitosis has multifactorial aetiology, intra-oral factors play a significant role in the majority of cases. This systematic review assesses halitosis's intra-oral and extra-oral associations. An electronic search through MEDLINE (PubMed), Google Scholar and the Wiley Online Library was conducted to identify relevant manuscripts. A keywords-based search was performed, using the terms 'halitosis', 'bad-breath', and 'oral malodour causes and aetiology'. Articles published from January 2014 to December 2020 were included. We selected studies evaluating the intra-oral and extra-oral factors that induce oral malodour, as well as the factors associated with systemic diseases. Eighty to ninety percent of halitosis is caused by intra-oral factors, with coated tongue, periodontal diseases and poor oral hygiene practices being the principal factors. Ten to twenty percent of halitosis is induced by extra-oral factors associated with systemic diseases. Multiple factors can cause halitosis, but most of the aetiology is intra-oral. Increased medical awareness is needed to determine the actual pathophysiological process of oral malodour in otherwise healthy individuals.


Assuntos
Halitose , Doenças Periodontais , Humanos , Halitose/etiologia , Doenças Periodontais/complicações , Língua
2.
Qatar Med J ; 2022(1): 2, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35251950

RESUMO

Coronavirus disease 2019 (COVID-19) has become one of the worst global pandemics in recent history. Post-COVID-19 interstitial lung disease is a significant concern in COVID-19 survivors. It is a disabling clinical condition for patients and a burden on the healthcare system. With time and subsequent waves of COVID-19 globally, the post-COVID-19 sequelae of lung diseases can be debilitating. We report cases of three patients with persistent hypoxia post-COVID-19, raising concerns for interstitial lung disease in Qatar. In this report, we shared our experience of the patient's clinical course, complications, and outcomes with post-COVID-19 sequelae of lung parenchymal disease. Patients were followed up during and after treatment until recovery or discharge from the hospital.

3.
Qatar Med J ; 2022(1): 18, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35321121

RESUMO

Quality improvement and patient safety are cornerstones to the delivery of effective patient care. The introduction of a quality improvement curriculum for medical students and trainee physicians can have a significant effect on their understanding of the science of improvement and its role in improving the quality of healthcare delivery and patient safety. The article describes the development and implementation of a quality improvement curriculum for trainee physicians in the department of internal medicine at a tertiary care center in Qatar through online training courses, workshops, didactic activities, and trainee-led quality improvement projects.

4.
Qatar Med J ; 2022(3): 22, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35864918

RESUMO

BACKGROUND: Rituximab is used as second-line therapy in patients with immune thrombocytopenic purpura (ITP) who do not respond to first-line management. The response rate for Rituximab is variable in different populations ranging from 30% to 90%. The adverse effects of rituximab in patients with ITP range from infusion site reactions to the reactivation of hepatitis B virus and progressive multifocal leukoencephalopathy and interpopulation variation. METHODS: We conducted a single-center, retrospective study in Qatar's National Center for Cancer Care & Research. The study included patients with chronic refractory ITP who received rituximab as second-line therapy. Descriptive and summary statistics were used to describe the sociodemographic parameters of the study cohort. RESULTS: Of the 41 patients with chronic ITP, 26 were Arabs, 12 were Asians, and 3 were of other ethnicities. Rituximab was associated with an overall response rate of 80.4%. Arabic patients had the highest clinical response (84.6%) among the ethnicities with the lowest adverse effects (11.5%). Asians had a response rate of 66.6%, and adverse effects were seen in 16.7% of the patients. CONCLUSIONS: In chronic refractory ITP, rituximab appears to have a better clinical response in the Arabic population with minimal toxicity than in other ethnicities.

5.
Qatar Med J ; 2022(4): 56, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36466437

RESUMO

INTRODUCTION: Primary spontaneous pneumothorax (PSP) is a common medical emergency. Its treatment includes simple observation, needle thoracentesis, pleural catheter, video-assisted thoracoscopy (VATS), and open surgery. We aimed to establish the demographic, clinical characteristics, and 12-month recurrence rate of patients with PSP in four hospitals of the Hamad Medical Corporation, Qatar. MATERIALS AND METHODS: We conducted a retrospective analysis of patients >14 years old who were admitted with PSP from January 1, 2017 to December 31, 2019. The patients were followed up for 12 months for the recurrence of PSP. RESULTS: Out of 246 patients enrolled in this study, 223 (90.7%) were males and 23 (9.3%) were females. Their mean age was 29.1 ± 9.59 years and their mean body mass index (BMI) was 21.7 ± 4.22 kg/m2. Of these, 123 (51.2%) patients were smokers. Chest pain was the most common presenting complaint (82.5%). A total of 59 (23.98%) patients had a small pneumothorax, whereas 187 (76.01%) patients had a large pneumothorax. Among the patients with small pneumothorax, 16 (28.33%) were managed through observation alone, 2 (3.33%) required needle aspiration, 15 (25%) required pleural catheter insertion, and 26 (44.06%) underwent surgical intervention for management. Out of 187 patients with large pneumothorax, 16 (8.6%) were managed through observation, 7 (3.76%) required needle aspiration, 73 (38.1%) required pleural catheter insertion, and 91 (48.6%) underwent surgery. During the 12-month follow-up, 58 patients were lost to follow-up and 5 patients (5/188; 2.66%) presented with a recurrence of PSP. Out of 108 patients who underwent VATS, 2 (1.85%) had a recurrence of PSP. CONCLUSION: PSP is more common in males than in females, with a tendency for younger age onset. The recurrence rate of PSP in our study was 2.66%. Furthermore, the recurrence rate in our patients who underwent VATS was 1.85%. Prospective studies are warranted to compare the success rates of different treatment interventions.

6.
Qatar Med J ; 2022(4): 53, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36408478

RESUMO

BACKGROUND: Back pain is a rare initial presentation of gastric cancer. Isolated back pain with red flags in middle-aged patients might indicate multiple myeloma. However, it is rarely present in advanced gastric adenocarcinoma; hence, data are limited to case reports only. For a timely diagnosis of the underlying malignancy, endoscopy should be considered if the initial workup for this backache is unrevealing. CASE PRESENTATION: We present a 34-year-old previously healthy gentleman with severe unremitting backache. He was ultimately diagnosed with gastric adenocarcinoma stage IV and received palliative treatment. The manuscript also reviewed relevant literature. CONCLUSION: In rare cases, gastric malignancy can initially present as back pain with lytic bone lesions, mimicking multiple myeloma. Endoscopy early in the course of investigations may help reduce associated morbidities. Further, more extensive studies are required to understand better the clinical characteristics, demographics, and management of such patients.

10.
Surg Obes Relat Dis ; 20(2): 115-126, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37620168

RESUMO

BACKGROUND: Thiamine deficiency (TD) among adolescents following metabolic and bariatric surgery (MBS) has not been assessed. OBJECTIVE: We assessed TD among adolescents following MBS. SETTING: University Hospital. METHODS: A retrospective chart review was conducted for all adolescents and young adults (aged 10-25 years) who had MBS and subsequently presented with TD at our institution (n = 30). Diagnosis used clinical, laboratory, brain imaging, and neurophysiology criteria. Of 1575 patients, 7 subsequently had TD. Another 23 adolescents had MBS at private hospitals or overseas and presented at our institution with TD. RESULTS: Based on MBS undertaken at our institution, TD prevalence was .45 cases per 100 MBS. The mean age of patients was 19.5 ± 3.23 years, 53.3% were male, 96.7% had sleeve gastrectomy, and time from MBS to admission averaged 4.97 ± 11.94 months. Mean weight loss from surgery to admission was 33.68 ± 10.90 kg. Associated factors included poor oral intake (90%), nausea and vomiting (80%), and noncompliance with multivitamins (71%). Signs and symptoms included generalized weakness, nystagmus, numbness, and paraparesis (83.3%-80%). Seven patients had Wernicke encephalopathy full triad; 16 displayed a mixed picture of Wernicke encephalopathy and dry beriberi; and there were no cases of wet beriberi. Half the patients achieved complete resolution of symptoms, whereas 47% and 40% had residual weakness or persistent sensory symptoms, respectively. There was no mortality. Most common concurrent nutritional deficiencies were of vitamins K, D, and A. CONCLUSIONS: This is the first in-depth study of TD among adolescents after MBS. Although TD is uncommon among adolescents after MBS, it is serious, requiring diligent suspicion and prompt treatment. Bariatric teams should emphasize compliance with multivitamin regimens and follow it up.


Assuntos
Cirurgia Bariátrica , Beriberi , Deficiência de Tiamina , Encefalopatia de Wernicke , Humanos , Masculino , Adulto Jovem , Adolescente , Adulto , Feminino , Beriberi/etiologia , Beriberi/diagnóstico , Beriberi/tratamento farmacológico , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/epidemiologia , Encefalopatia de Wernicke/etiologia , Estudos Retrospectivos , Deficiência de Tiamina/epidemiologia , Deficiência de Tiamina/etiologia , Vitaminas/uso terapêutico , Cirurgia Bariátrica/efeitos adversos , Tiamina/uso terapêutico
11.
Ind Psychiatry J ; 33(1): 30-40, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38853796

RESUMO

Background: The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has detrimental effects on physical and mental health. Patients with severe mental illness are at higher risk of contracting the virus due to social determinants of health. Vulnerable populations include the elderly, people with pre-existing conditions, and those exposed to SARS-CoV-2. Unfortunately, only a few countries have updated vaccination strategies to prioritize patients with mental illnesses. Therefore, we aimed to explore whether individuals with mental disorders are prioritized in vaccine allocation strategies in different world regions. They are often neglected in policymaking but are highly vulnerable to the threatening complications of COVID-19. Methods: A questionnaire was developed to record details regarding COVID-19 vaccination and prioritizations for groups of persons with non-communicable diseases (NCDs), mental disorders, and substance use disorders (SUDs). NCDs were defined according to the WHO as chronic diseases that are the result of a combination of genetic, physiological, environmental, and behavioral factors such as cardiovascular diseases, cancer, respiratory diseases, and diabetes. Results: Most countries surveyed (80%) reported healthcare delivery via a nationalized health service. It was found that 82% of the countries had set up advisory groups, but only 26% included a mental health professional. Most frequently, malignancy (68%) was prioritized followed by diabetes type 2 (62%) and type 1 (59%). Only nine countries (26%) prioritized mental health conditions. Conclusion: The spread of the coronavirus has exposed both the strengths and flaws of our healthcare systems. The most vulnerable groups suffered the most and were hit first and faced most challenges. These findings raise awareness that patients with mental illnesses have been overlooked in immunization campaigns. The range of their mortality, morbidity, and quality of life could have widened due to this delay.

12.
Adv Med Educ Pract ; 14: 245-255, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36960386

RESUMO

Purpose: The exponential use of handheld electronic devices (HEDs) among healthcare providers has shown the potential to enhance clinical workflows and improve patient care. However, the challenges and risks of carrying these devices during ward rounds and their impact on postgraduate trainees' (PGTs') training in general and more specifically during the COVID-19 pandemic need to be explored. Methods: A cross-sectional mixed-methods online survey was conducted to evaluate the perceptions of trainees and faculty at Accreditation Council for Graduate Medical Education International accredited residency and fellowships programs in Qatar on the use of HEDs on clinical workflow, trainees' education, and the impact of the COVID-19 pandemic. One hundred and fifty-eight participants were enrolled in the study (87 postgraduate trainees and 71 faculty). Exploratory data analysis and descriptive statistics were performed using STATA version 12 and thematic analysis of 301 qualitative responses to the survey open-ended questions using Atlas. ti qualitative software, version 9.4.0. Results: Almost all PGTs, 83 (95.4%), and faculty 43 (62.3%) use HEDs during ward rounds. Accessibility of patient information by PGTs 73 (94.8%) and faculty 46 (84.4%) and work efficiency were the main perceived benefits. Hindering communication between team members, disruption of interaction with patients, increased risk of infection and breach of patient confidentiality were among the challenges associated with their use. Carrying devices reduced the frequency of hand hygiene practices and physical examinations of patients by trainees. The COVID-19 pandemic led to a decrease in the use of HEDs by both faculty [38(64%)] and PGTs [42(60%)]. Conclusion: HEDs' use is valued by both faculty and PGTs in enhancing workflow, trainees' education, patient experience, and patient care during the COVID-19 pandemic. Graduate medical education leaders should adopt measures to monitor their use during ward rounds as they can negatively impact trainees' education, reduce interaction with patients, increase the risk of infection, and breach patient confidentiality.

13.
J Endocr Soc ; 8(1): bvad133, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38178906

RESUMO

Context: Antithyroid drugs (ATDs) are the cornerstone of hyperthyroidism management. Hepatotoxicity due to ATDs can range from mild transaminase elevation to liver transplantation requirement and mortality. Objective: The primary objective of the systematic review was to assess the clinical characteristics and outcomes of patients with drug induced liver injury (DILI) due to ATDs. Methods: We conducted a systematic review of PUBMED, SCOPUS, and EMBASE on characteristics and outcomes of adults (>18 years) with DILI due to ATDs. We defined DILI as bilirubin ≥2.5 mg/dL or international normalized ratio >1.5 with any rise in alanine aminotransferase (ALT), aminotransferase (AST), or alkaline phosphatase (ALP), or an elevation of ALT or AST >5 times or ALP >2 times the upper limit of normal without jaundice/coagulopathy. Results: The review included 100 articles describing 271 patients; 148 (70.8%) were female (N = 209). Mean age was 42.9 ± 17.2 years. Graves' disease was the most common indication for ATDs. Carbimazole/methimazole (CBM/MMI) was the most common offending agent (55.7%). DILI pattern was hepatocellular in 41.8%, cholestatic in 41.3%, and mixed in 16.9%. Outcomes included death in 11.8%, liver transplantation in 6.4%, partial improvement in 2.2%, and complete resolution in 79.6% with a median time (IQR) to resolution of 45 (20-90) days. Patients in the propylthiouracil (PTU) group had higher initial bilirubin, initial AST, initial ALT, peak ALT, peak AST, severe and fatal DILI, liver transplantation, and mortality than CBM/MMI. Rechallenge of antithyroid medication was infrequently reported (n = 16) but was successful in 75%. Conclusion: DILI due to ATDs can present with different patterns and should prompt immediate drug discontinuation. Referral to a hepatologist should be considered if severe as transplantation is sometimes required. PTU-induced DILI may have worse outcomes than CBM/MMI.

14.
Heliyon ; 9(4): e15379, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37064466

RESUMO

Background and aims: COVID-19 has disrupted the patient workflow in all healthcare settings. Procedures such as bronchoscopy and spirometry require additional pre-procedure screening for SARS-CoV-2. However, there is uncertainty regarding the utility of this universal pre-procedure screening. The State of Qatar has a robust contact tracing system in place in the form of the mobile application 'Ehteraz.' This study assesses the utility of various pre-procedural screening measures in asymptomatic patients and generate recommendations for any potential improvement in the workflow. Methods: This is a cross-sectional study of asymptomatic patients who had SARS-CoV-2 RT-PCR screening performed before bronchoscopy or lung function testing scheduled on an elective basis. Descriptive statistics were used to summarize and determine the sample characteristics. The rate of the positive PCR test result was subsequently calculated. Results: Two patients (0.34%) tested positive for COVID-19 on their pre-procedural screen. Four patients (0.68%) had an inconclusive result. Conclusion: The positivity rate of SARS-CoV-2 RT-PCR is extremely low in asymptomatic individuals screened before bronchoscopy and spirometry. The authors recommend pre-procedural symptom and electronic application-based contact screening instead of universal pre-procedural SARS-CoV-2 RT-PCR for screening asymptomatic individuals.

15.
Am J Trop Med Hyg ; 108(5): 942-947, 2023 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-36940665

RESUMO

This study aimed to evaluate the minimum inhibitory concentration (MIC) of azithromycin (AZM) in clinical isolates of extensively drug-resistant (XDR) Salmonella Typhi (i.e., resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin) using the E-test versus the broth microdilution method (BMD). From January to June 2021, a retrospective cross-sectional study was carried out in Lahore, Pakistan. Antimicrobial susceptibility was performed initially by the Kirby-Bauer disk diffusion method for 150 XDR Salmonella enterica serovar Typhi isolates, and MICs of all the recommended antibiotics were determined by the VITEK 2 (BioMérieux) fully automated system using Clinical Laboratory Standard Institute (CLSI) 2021 guidelines. The E-test method was used to determine AZM MICs. These MICs were compared with the BMD, which is the method recommended by the CLSI but not adopted in routine laboratory reporting. Of 150 isolates, 10 (6.6%) were resistant by disk diffusion. Eight (5.3%) of these had high MICs against AZM by the E-test. Only three isolates (2%) were resistant by E-test, having an MIC of 32 µg/mL. All eight isolates had a high MIC by BMD with different MIC distributions, but only one was resistant, having an MIC of 32 µg/mL by BMD. The sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy of the E-test method versus BMD were 98.65%,100%, 99.3%, 33.3%, and 98.6%, respectively. Similarly, the concordance rate was 98.6%, negative percent agreement was 100%, and positive percent agreement was 33%. The BMD is the most reliable approach for reporting AZM sensitivity in XDR S. Typhi compared with the E-test and disk diffusion methods. Potentially, AZM resistance in XDR S. Typhi is around the corner. Sensitivity patterns should be reported with MIC values, and if possible, higher values should be screened for the presence of any potential resistance genes. Antibiotic stewardship should be strictly implemented.


Assuntos
Salmonella typhi , Febre Tifoide , Humanos , Azitromicina/farmacologia , Febre Tifoide/tratamento farmacológico , Estudos Transversais , Estudos Retrospectivos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Testes de Sensibilidade Microbiana , Farmacorresistência Bacteriana
16.
Eur J Radiol Open ; 11: 100530, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37920681

RESUMO

Rationale and objectives: Burnout among physicians has a prevalence rate exceeding 50%. The radiology department is not immune to the burnout epidemic. Understanding and addressing burnout among radiologists has been a subject of recent interest. Thus, our study aims to systematically review studies reporting the prevalence of burnout in physicians in the radiology department while providing an overview of the factors associated with burnout among radiologists. Materials and methods: The search was conducted from inception until November 13th, 2022, in PubMed, Embase, Education Resources Information Center, PsycINFO, and psycArticles. Studies reporting the prevalence of burnout or any subdimensions among radiology physicians, including residents, fellows, consultants, and attendings, were included. Data on study characteristics and estimates of burnout syndrome or any of its subdimensions were collected and summarized. Results: After screening 6379 studies, 23 studies from seven countries were eligible. The number of participants ranged from 26 to 460 (median, 162; interquartile range, 91-264). In all, 18 studies (78.3%) employed a form of the Maslach Burnout Inventory. In comparison, four studies (17.4%) used the Stanford Professional Fulfillment Index, and one study (4.3%) used a single-item measure derived from the Zero Burnout Program survey. Overall burnout prevalence estimates were reported by 14 studies (60.9%) and varied from 33% to 88%. High burnout prevalence estimates were reported by only five studies (21.7%) and ranged from 5% to 62%. Emotional exhaustion and depersonalization prevalence estimates were reported by 16 studies (69.6%) and ranged from 11%-100% and 4%-97%, respectively. Furthermore, 15 studies (65.2%) reported low personal accomplishment prevalence, ranging from 14.7% to 84%. There were at least seven definitions for overall burnout and high burnout among the included studies, and there was high heterogeneity among the cutoff scores used for the burnout subdimensions. Conclusion: Burnout in radiology is increasing globally, with prevalence estimates reaching 88% and 62% for overall and high burnout, respectively. A myriad of factors has been identified as contributing to the increased prevalence. Our data demonstrated significant variability in burnout prevalence estimates among radiologists and major disparities in burnout criteria, instrument tools, and study quality.

17.
Medicine (Baltimore) ; 102(6): e32919, 2023 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-36820547

RESUMO

The frequency of acute kidney injury (AKI) in COVID-19 patients can be varied and related to worse outcomes in the disease population. AKI is common among hospitalized patients with COVID-19, particularly the ones needing critical care. This study was conducted in order to determine the outcomes of hospitalized patients with prolonged hospital stays who suffered from COVID-19 associated AKI. It was conducted as a multi-centered, retrospective, cohort study, and including all patients who were diagnosed on COVID-19 PCR. End-stage renal disease patients on hemodialysis were excluded. The cohort included 1069 patients, with 68% males, mean age of 56.21 years, and majority within 50 to 75 years age group (60%). Mean disease onset was 14.43 ± 7.44 days and hospital stay was 7.01 ± 5.78 days. About 62% of patients stayed in intensive care and 18% of them were on invasive ventilation. The mortality rate was 27%. Frequency of AKI was 42%, around 14% of them were resolving during hospital stay and other 28% worsened. The mortality rate was significantly higher with AKI (OR: 4.7, P < .001). Alongside AKI, concomitant liver dysfunction was also significantly contributing to mortality (OR: 2.5), apart from ICU stay (OR: 2.9), invasive ventilation (OR: 9.2), and renal replacement therapy (OR: 2.4). Certain laboratory markers were associated with AKI throughout in-hospital stay.


Assuntos
Injúria Renal Aguda , COVID-19 , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , COVID-19/complicações , COVID-19/terapia , Tempo de Internação , Estudos Retrospectivos , Estudos de Coortes , Paquistão/epidemiologia , Unidades de Terapia Intensiva , Mortalidade Hospitalar , Biomarcadores , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/diagnóstico , Fatores de Risco
18.
Medicine (Baltimore) ; 102(45): e35718, 2023 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-37960735

RESUMO

BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker that is used to predict mortality, readmission, early discharge, and LOS, thus, serves as a useful tool for ED physicians. Our study aims to analyze the efficacy of suPAR in predicting these prognostic markers in ED. METHODS: We performed a comprehensive search on 6 databases from the inception to 30th November 2022, to select the following eligibility criteria; a) observation or triage trial studies investigating the role of suPAR levels in predicting: 30 day and 90-day mortality, 30-day readmission, early discharge (within 24hr), and LOS in patients coming to AMU. RESULTS: A total of 13 studies were included, with a population size of 35,178, of which 52.9% were female with a mean age of 62.93 years. Increased risk of 30-day mortality (RR = 10.52; 95% CI = 4.82-22.95; I2 = 38%; P < .00001), and risk of 90-day mortality (RR = 5.76; 95% CI = 3.35-9.91; I2 = 36%; P < .00001) was observed in high suPAR patients. However, a slightly increased risk was observed for 30-day readmission (RR = 1.50; 95% CI = 1.16-1.94; I2 = 54%; P = .002). More people were discharged within 24hr in the low suPAR level group compared to high suPAR group (RR = 0.46; 95% CI = 0.40-0.53; I2 = 41%; P < .00001). LOS was thrice as long in high suPAR level patients than in patients with low suPAR (WMD = 3.20; 95% CI = 1.84-4.56; I2 = 99%; P < .00001). CONCLUSION: suPAR is proven to be a significant marker in predicting 30-day and 90-day mortality in ED patients.


Assuntos
Alta do Paciente , Receptores de Ativador de Plasminogênio Tipo Uroquinase , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Readmissão do Paciente , Tempo de Internação , Biomarcadores , Prognóstico
19.
Curr Probl Cardiol ; 48(8): 101233, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35490770

RESUMO

Cardiovascular diseases (CVDs) are the leading cause of mortality globally. Wald and Law proposed the idea of a "polypill"; a fixed dose combination therapy (FDC) in the form of a single pill to curb the CVD epidemic. Such a drug would include the combination of a broad spectrum of drugs including cholesterol lowering drugs, antihypertensive drugs, antiplatelet drugs, anticoagulation drugs, and antiarrhythmic drugs, which are frequently integrated to combat specific CVDs. This "polypill" holds the potential to pose several advantages like increased compliance, improved quality of life, risk factor control, psychological relief, and cost effectiveness along with minimal side effects. Several trials (like TIPS, UMPIRE, PolyIran, etc.) have tested different treatment strategies to test the hypothesis of Wald and Law. Unlike the past, physicians are now highly aware of this new strategy. The future of polypill in the management of CVD lies in a strategy where polypills are treated supplementary to the already existing preventive care, which includes lifestyle modifications and efforts to reduce tobacco use.


Assuntos
Fármacos Cardiovasculares , Doenças Cardiovasculares , Humanos , Doenças Cardiovasculares/epidemiologia , Aspirina/efeitos adversos , Qualidade de Vida , Combinação de Medicamentos , Inibidores da Agregação Plaquetária/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico
20.
Pharmgenomics Pers Med ; 16: 133-144, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36851992

RESUMO

Sickle cell disease (SCD) is a genetic disease influenced by ethnicity and regional differences in its clinical course. Recent advances in the management of SCD with newer therapies are being introduced to the Western population. However, many of these treatments are yet to be used in the Arabic SCD population. Understanding the genetic variations of SCD regionally is essential to anticipate the utilization of new treatments. This systematic review's main objective is to pool the available data on the genetic composition of SCD in the Arabic population. Data for 44,034 patients was extracted from 184 studies (11 case reports, 8 case series, 56 retrospectives, 107 prospective observational studies, and 2 clinical trials) using PubMed, Scopus, and Google Scholar. Male (49%) and female (51%) patients were equally reported wherever gender was available (N=13105). Various SCD genotypes were reported in a total of 14,257 patients, including Hb SS (77%) Hb Sß0 (9.9%), and Hb Sß+ (7.2%), while the rest of the genotypes, including HbSC, HbSD, HbSE, HbSO Arab, Hb S/α-Thal, Hb Sß0 + α-Thal, and HBS Oman were individually reported in <4% of the cases. Major SCD complications in the Arab population included pain crises (48.25%) followed by neurological complications (33.46%), hepatobiliary complications (25.53%), musculoskeletal complications (24.73%), and hemolytic anemia (23.57%). The treatments reported for SCD included hydroxyurea (20%), blood transfusion (14.32%), and Deferasirox (3.03%). We did not find the use of stem cell transplantation or newer treatments such as L-Glutamine, Voxelotor, Crizanlizumab, or gene therapy reported in any of the studies included in our review. This review highlights the genetic makeup of SCD in Arab countries and its common phenotypic manifestations and will help direct further research on SCD in this region, especially concerning genetic therapy. Systematic Review Registration: The protocol has been registered in the International Prospective Register of Systematic Reviews(PROSPERO):CRD42020218,666. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=218666.

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