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3. The Spasmolytic, Bronchodilator, and Vasodilator Activities of Parmotrema perlatum Are Explained by Anti-Muscarinic and Calcium Antagonistic Mechanisms

Author

Musaddique Hussain, Hazoor Bakhsh, Shahzada Khurram Syed, Malik Saad Ullah, Ali M. Alqahtani, Taha Alqahtani, Afaf A. Aldahish, Talha Bin Emran, Kashif Ur Rehman, and Khalid Hussain Janbaz

Subjects
acute toxicity, spasmolytic, bronchodilator, vasodilator, Ca+2 antagonist, Parmotremaperlatum, Organic chemistry, QD241-441
Abstract

Parmotremaperlatum is traditionally used in different areas of Pakistan to treat gastrointestinal, respiratory, and vascular diseases. This study evaluates the underlying mechanisms for traditional uses of P. perlatum in diarrhea, asthma, and hypertension. In vitro pharmacological studies were conducted using isolated jejunum, trachea, and aortic preparations, while the cytotoxic study was conducted in mice. Crude extract of P. perlatum(Pp.Cr), comprising appreciable quantities of alkaloids and flavonoids, relaxed spontaneously contracting jejunum preparation, K+ (80 mM)-induced, and carbachol (1 µM)-induced jejunum contractions in a concentration-dependent manner similar to dicyclomine and dantrolene. Pp.Cr showed a rightward parallel shift of concentration-response curves (CRCs) of Cch after a non-parallel shift similarto dicyclomine and shifted CRCs of Ca+2 to rightward much likeverapamil and dantrolene, demonstrating the coexistence of antimuscarinic and Ca+2 antagonistic mechanism. Furthermore, Pp.Cr, dicyclomine, and dantrolene relaxed K+ (80 mM)-induced and Cch (1 µM)-induced tracheal contractions and shifted rightward CRCs of Cch similar to dicyclomine, signifying the dual blockade. Additionally, Pp.Cr also relaxed the K+ (80 mM)-induced and phenylephrine (1 µM)-induced aortic contraction, similarly to verapamil and dantrolene, suggesting Ca+2 channel antagonism. Here, we explored for the first time thespasmolytic and bronchodilator effects of Pp.Crand whether they maybe due to the dual blockade of Ca+2 channels and muscarinic receptors, while the vasodilator effect might be owing to Ca+2 antagonism. Our results provide the pharmacological evidence that P. perlatum could be a new potential therapeutic option to treat gastrointestinal, respiratory, and vascular diseases. Hence, there is a need for further research to explore bioactive constituent of P. perlatum as well as further investigation by suitable experimental models are required to further confirm the importance and usefulness of P. perlatum in diarrhea, asthma, and hypertension treatment.

Published
2021
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5. Abstract 13628: Cardiovascular Toxicity Associated With Vascular Endothelial Growth Factor Receptor Inhibitors Use in Oncology: A Network Meta-Analysis of Phase 3 Clinical Trials

Author

malik, saad ullah, primary, Malik, Asad Ullah, additional, Ezeh, Ebubechukwu, additional, Kachynski, Yury, additional, Nwanwene, Kemnasom, additional, Akhigbe, Esiemoghie, additional, Hamilton, Mackenzie, additional, Quadri, Ameer, additional, Nogot, Russell, additional, Tirona, Maria Tria, additional, and Thompson, Ellen, additional

Published
2021
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6. Cardiac Arrhythmias and Mortality after Hematopoietic Stem Cell Transplant (HSCT): A Systematic Review and Meta-Analysis

Author

Malik, Saad Ullah, primary, Braunstein, Zachary, additional, Vasu, Sumithira, additional, Penza, Sam, additional, Saad, Ayman, additional, Denlinger, Nathan, additional, de Lima, Marcos J.G., additional, Vallakati, Ajay, additional, Baliga, Ragavendra, additional, Jaglowski, Samantha, additional, Brammer, Jonathan E., additional, and Addison, Daniel, additional

Published
2021
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7. The Spasmolytic, Bronchodilator, and Vasodilator Activities of Parmotrema perlatum Are Explained by Anti-Muscarinic and Calcium Antagonistic Mechanisms

Author

Khalid Hussain Janbaz, Shahzada Khurram Syed, Talha Bin Emran, Afaf A Aldahish, Taha Alqahtani, Ali Alqahtani, Hazoor Bakhsh, Musaddique Hussain, Malik Saad Ullah, and Kashif Ur Rehman

Subjects
Carbachol, Parmotrema perlatum, medicine.drug_class, bronchodilator, Vasodilator Agents, Pharmaceutical Science, Organic chemistry, Muscarinic Antagonists, Pharmacology, acute toxicity, Dicyclomine, Dantrolene, Article, Analytical Chemistry, Mice, QD241-441, Ca+2 antagonist, Bronchodilator, Drug Discovery, Muscarinic acetylcholine receptor, medicine, Toxicity Tests, Acute, Animals, Parmotremaperlatum, Physical and Theoretical Chemistry, Phenylephrine, vasodilator, Chromatography, High Pressure Liquid, Biological Products, spasmolytic, biology, Dose-Response Relationship, Drug, Molecular Structure, Chemistry, Parmeliaceae, Spectrum Analysis, Parasympatholytics, biology.organism_classification, Calcium Channel Blockers, Bronchodilator Agents, Chemistry (miscellaneous), Molecular Medicine, Verapamil, medicine.drug
Abstract

Parmotremaperlatum is traditionally used in different areas of Pakistan to treat gastrointestinal, respiratory, and vascular diseases. This study evaluates the underlying mechanisms for traditional uses of P. perlatum in diarrhea, asthma, and hypertension. In vitro pharmacological studies were conducted using isolated jejunum, trachea, and aortic preparations, while the cytotoxic study was conducted in mice. Crude extract of P. perlatum(Pp.Cr), comprising appreciable quantities of alkaloids and flavonoids, relaxed spontaneously contracting jejunum preparation, K+ (80 mM)-induced, and carbachol (1 µM)-induced jejunum contractions in a concentration-dependent manner similar to dicyclomine and dantrolene. Pp.Cr showed a rightward parallel shift of concentration-response curves (CRCs) of Cch after a non-parallel shift similarto dicyclomine and shifted CRCs of Ca+2 to rightward much likeverapamil and dantrolene, demonstrating the coexistence of antimuscarinic and Ca+2 antagonistic mechanism. Furthermore, Pp.Cr, dicyclomine, and dantrolene relaxed K+ (80 mM)-induced and Cch (1 µM)-induced tracheal contractions and shifted rightward CRCs of Cch similar to dicyclomine, signifying the dual blockade. Additionally, Pp.Cr also relaxed the K+ (80 mM)-induced and phenylephrine (1 µM)-induced aortic contraction, similarly to verapamil and dantrolene, suggesting Ca+2 channel antagonism. Here, we explored for the first time thespasmolytic and bronchodilator effects of Pp.Crand whether they maybe due to the dual blockade of Ca+2 channels and muscarinic receptors, while the vasodilator effect might be owing to Ca+2 antagonism. Our results provide the pharmacological evidence that P. perlatum could be a new potential therapeutic option to treat gastrointestinal, respiratory, and vascular diseases. Hence, there is a need for further research to explore bioactive constituent of P. perlatum as well as further investigation by suitable experimental models are required to further confirm the importance and usefulness of P. perlatum in diarrhea, asthma, and hypertension treatment.

Published
2021

9. Clove oil based co-surfactant free microemulsion of flurbiprofen: Improved solubility with ameliorated drug-induced gastritis

Author

Muhammad Umair, Tanzeem, Sajid, Asghar, Syed Haroon, Khalid, Muhammad, Asif, Malik Saad, Ullah, Ikram Ullah, Khan, Ikrima, Khalid, Syed Ali, Faran, Abdul, Rehman, Umar Farooq, Gohar, and Tanveer, Hussain

Subjects
Chemistry, Pharmaceutical, Anti-Inflammatory Agents, Non-Steroidal, Polysorbates, Water, Polyethylene Glycols, Rats, Drug Liberation, Surface-Active Agents, Flurbiprofen, Clove Oil, Gastritis, Animals, Emulsions, Particle Size
Abstract

Flurbiprofen, an NSAID, is a water insoluble drug that is also notorious for gastric irritation and inflammation. This study was aimed at using a natural gastrprotective oil as the internal phase to develop flurbiprofen micro emulsion (ME) to improve it solubility and ameliorate its gastric side effects. Upon screening of ME components for drug solubility, clove oil, tween 80 and transcutol were identified as the oil, surfactant and co surfactant, respectively, with higher flurbiprofen solubility. Pseudo-ternary phase diagrams revealed that the ME made with surfactant only and without co-surfactant displayed the similar ME region as made with the mixture of surfactant and co-surfactant. Furthermore, drug loaded oil was also used to draw pseudo-ternary phase diagram and a very little decrease in the ME region was observed. Therefore, co-surfactant free flurbiprofen loaded ME was developed to avoid side effects associated with the use of excessive surfactant quantities. ME were found to possess size in the range of 11-41 nm with PDI0.5 and a slightly negative charge. Conductivity, pH and refractive indices of the selected MEs were well in the range. Drug release studies indicated maximum drug release from MEs within 5 min. Analysis of the gastric mucosa of rats after oral administration of drug solution and drug loaded ME confirmed that clove oil based ME provided significant protection against the NSAIDs induced gastric damage.

Published
2020

11. Efficacy and Safety of Amlodipine in Preventing Myocardial Iron Overload in Patients with Transfusion-Dependent Thalassemia Major : A Systematic Review and Meta-Analysis

Author

Kashyap, Richi, primary, Ali, Muhammad Ashar, additional, Malik, Saad Ullah, additional, Khalid, Farhan, additional, Jaan, Ali, additional, Khalid, Awais, additional, Dar, Abdul Jabbar, additional, Khurshid, Qasim, additional, Neupane, Karun, additional, Haider, Mobeen Zaka, additional, Abdullah, Syed Maaz, additional, and Anwer, Faiz, additional

Published
2020
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12. A SYSTEMATIC REVIEW AND META-ANALYSIS ON THE PROGNOSTIC VALUE OF RED CELL DISTRIBUTION WIDTH ON DEVELOPMENT OF CONTRAST INDUCED NEPHROPATHY IN CORONARY ARTERY DISEASE PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

Author

Ahsan, Muhammad J., primary, Malik, Saad Ullah, additional, Kousa, Omar, additional, Fazeel, Hafiz Muhammad, additional, Javed, Nisma, additional, Tahseen, Sidra, additional, Latif, Azka, additional, Hashmi, Mydah, additional, Shaikh, Kashif, additional, Andukuri, Venkata, additional, and Holmberg, Mark, additional

Published
2020
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13. A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROGNOSTIC SIGNIFICANCE OF ACQUIRED THROMBOCYTOPENIA AFTER PERCUTANEOUS CORONARY INTERVENTION ON IN-HOSPITAL AND 30-DAY CARDIOVASCULAR OUTCOMES IN CORONARY ARTERY DISEASE PATIENTS

Author

Ahsan, Muhammad J., primary, Fazeel, Hafiz Muhammad, additional, Lateef, Noman, additional, Malik, Saad Ullah, additional, Anwar, Anosha, additional, Hassan, Syeda, additional, Hassan, Muryum, additional, Latif, Azka, additional, Ullah, Muhammad Qudrat, additional, Ashraf, Aqsa, additional, Townley, Theresa, additional, and Koster, Nancy, additional

Published
2020
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20. Efficacy of Ibrutinib-Based Regimen in Chronic Lymphocytic Leukemia: A Systematic Review

Author

Sardar, Muhammad, primary, Malik, Saad ullah, additional, Khan, Ali, additional, Idrees, Muhammad, additional, Ahmad, Qistas, additional, Sohail, Chaudhry, additional, Naseer, Raza, additional, Amin, Saher, additional, McBride, Ali, additional, Abuzar, Muhammad, additional, Safdar, Ahmed, additional, Chakraborty, Rajshekhar, additional, Lee, Patrick, additional, Sharon, David, additional, and Anwer, Faiz, additional

Published
2019
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21. Significant Risk of Graft-versus-Host Disease with Exposure to Checkpoint Inhibitors before and after Allogeneic Transplantation

Author

Ijaz, Awais, primary, Khan, Ali Younas, additional, Malik, Saad Ullah, additional, Faridi, Warda, additional, Fraz, Muhammad Asad, additional, Usman, Muhammad, additional, Tariq, Muhammad Junaid, additional, Durer, Seren, additional, Durer, Ceren, additional, Russ, Atlantis, additional, Parr, Nadia Nunes Cavalcante, additional, Baig, Zeeshan, additional, Sagar, FNU, additional, Ali, Zeeshan, additional, McBride, Ali, additional, and Anwer, Faiz, additional

Published
2019
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23. Gene Therapy for Thalassemia and Sickle Cell Anemia Poses Acceptable Toxicity and Efficacy: Clinical Outcomes in Forty-Seven Cases

Author

Fazeel, Hafiz Muhammad, primary, Abu Zar, Muhammad, additional, Malik, Saad Ullah, additional, Kamal, Ahmad, additional, Malik, Mustafa Nadeem, additional, Hassan, Syed Shabee, additional, Batool, Syeda Sabeeka, additional, Durer, Ceren, additional, Durer, Seren, additional, Aslam, Shehroz, additional, Shafqat, Madeeha, additional, Ijaz, Faiqa, additional, Anwer, Faiz, additional, and Hashmi, Shahrukh K., additional

Published
2018
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24. Presentation Patterns and Management Strategies for Central Nervous System Involvement in Multiple Myeloma: A Systematic Review of Literature

Author

Jose, Jemin Aby, primary, Selene, Insija Ilyas, additional, Malik, Mustafa Nadeem, additional, Qureshi, Anum, additional, Rafae, Abdul, additional, Fazeel, Hafiz Muhammad, additional, Abu Zar, Muhammad, additional, Kamal, Ahmad, additional, Malik, Saad Ullah, additional, Durer, Ceren, additional, Durer, Seren, additional, Jamil, Faiza, additional, Shafqat, Madeeha, additional, Usman, Muhammad, additional, Mahdi, Giyth Mithim, additional, and Anwer, Faiz, additional

Published
2018
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26. Efficacy of Lenalidomide Based Three Drug Versus Two Drug Regimen for Relapsed Multiple Myeloma: A Systematic Review and Meta-Analysis of Randomized Trials

Author

Usman, Muhammad, primary, Faridi, Warda, additional, Fraz, Muhammad Asad, additional, Tariq, Muhammad Junaid, additional, Malik, Saad Ullah, additional, Sagar, Fnu, additional, Ijaz, Awais, additional, Hussain, Abid, additional, Ahmad, Malik Qistas, additional, Khalil, Muhammad Jahanzeb, additional, Khalid, Amna, additional, Lakhani, Midhat, additional, Durer, Ceren, additional, Durer, Seren, additional, and Anwer, Faiz, additional

Published
2018
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27. Pomalidomide Based Regimens for Treatment of Relapsed Multiple Myeloma: A Systematic Review and Meta-Analysis of Clinical Trials

Author

Mushtaq, Adeela, primary, Iftikhar, Ahmad, additional, Lakhani, Midhat, additional, Sagar, Fnu, additional, Kamal, Ahmad, additional, Zahid, Umar, additional, Hassan, Hamza, additional, Ali, Zeeshan, additional, Razzaq, Faryal, additional, Malik, Saad Ullah, additional, Hassan, Syeda Fatima, additional, Abu Zar, Muhammad, additional, Bilal Chaudhary, Mohammad, additional, Safdar, Ahmad, additional, Bakr, Mohamed Mokhtar, additional, and Anwer, Faiz, additional

Published
2018
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30. Role of Ibrutinib Based Regimen in Chronic Lymphocytic Leukemia

Author

Sardar, Muhammad, primary, Malik, Saad Ullah, additional, Khan, Ali Younas, additional, Sohail, Chaudhry Saad, additional, Ahmad, Malik Qistas, additional, Amin, Saher Nasir, additional, Chakraborty, Rajshekar, additional, McBride, Ali, additional, Azharuddin, Muhammad, additional, Sharon, David, additional, Lee, Patrick, additional, Faridi, Warda, additional, and Anwer, Faiz, additional

Published
2018
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31. Efficacy and Safety Profile of Novel Alkylators in Combination Regimens for Patients with Multiple Myeloma: A Review of Literature

Author

Aslam, Shehroz, primary, Riaz, Rida, additional, Rafae, Abdul, additional, Malik, Mustafa Nadeem, additional, Jose, Jemin Aby, additional, Shah, Zunairah, additional, Abu Zar, Muhammad, additional, Qureshi, Anum, additional, Kamal, Ahmad, additional, Ijaz, Awais, additional, Khan, Ali Younas, additional, Malik, Saad Ullah, additional, and Anwer, Faiz, additional

Published
2018
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32. Efficacy and Safety of Newer Targeted Immunotherapy for Multiple Myeloma

Author

Aslam, Shehroz, primary, Riaz, Rida, additional, Malik, Mustafa Nadeem, additional, Rafae, Abdul, additional, Faridi, Warda, additional, Malik, Saad Ullah, additional, Selene, Insija Ilyas, additional, Shah, Zunairah, additional, Sohail, Chaudhry Saad, additional, Mahfooz, Faisal, additional, Samuel, Sharoon, additional, Yasir, Muhammad, additional, and Anwer, Faiz, additional

Published
2018
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33. Efficacy and Safety of Daratumumab Based Regimens for Multiple Myeloma: A Systematic Review and Meta-Analysis

Author

Abu Zar, Muhammad, primary, Kamal, Ahmad, additional, Khan, Ali Younas, additional, Malik, Saad Ullah, additional, Malik, Mustafa Nadeem, additional, Rafae, Abdul, additional, Durer, Ceren, additional, Durer, Seren, additional, Selene, Insija Ilyas, additional, Qureshi, Anum, additional, Jose, Jemin Aby, additional, Fazeel, Hafiz Muhammad, additional, Shah, Zunairah, additional, Rehman, Muhammad Adil, additional, and Anwer, Faiz, additional

Published
2018
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34. Impact of Newer Agents on Progression Free Survival of Multiple Myeloma in the 2nd 3rd and 4th Line Setting- a Systematic Review

Author

Sardar, Muhammad, primary, Jose, Jemin Aby, additional, Shah, Zunairah, additional, Sohail, Chaudhry Saad, additional, Selene, Insija Ilyas, additional, Shafqat, Madeeha, additional, Qureshi, Anum, additional, Naseer, Raza, additional, Khan, Ali Younas, additional, Malik, Saad Ullah, additional, and Anwer, Faiz, additional

Published
2018
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39. How to Prevent Hepatitis B Reactivation after Allogeneic Stem Cell Transplantation in the Era of Novel Antiviral Drugs: A Systematic Review and Meta-Analysis

Author

Siyahian, Aida, primary, Malik, Saad Ullah, additional, Mushtaq, Adeela, additional, Howe, Carol L., additional, Majeed, Aneela, additional, Zangeneh, Tirdad, additional, Iftikhar, Samar, additional, Zahid, Umar, additional, Riaz, Irbaz Bin, additional, Warraich, Zabih, additional, Faridi, Warda, additional, and Anwer, Faiz, additional

Published
2018
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42. 465. Comparative Efficacy of Double vs. Single Antibiotic Regimens for the Empiric Treatment of MRSA-Induced Acute Bacterial Skin and Skin Structure Infection.

Author

Alhifany, Abdullah A, Bifari, Nisrin, Alatawi, Yasser, Malik, Saad Ullah, and Almangour, Thamer

Subjects
SKIN infections, RANDOM effects model, GRAM-positive bacterial infections, GRAM-negative bacteria, CLINICAL trials
Abstract

Background The initial management of Acute bacterial skin and skin structure infection (ABSSSI) is burdensome. It requires empirical antibiotic therapy that covers both gram-positive and gram-negative bacteria. Vancomycin plus aztreonam are the most commonly used antibiotic combination, nonetheless, they have many limitations which limits their use. Hence, many new single agents with MRSA and gram-negative coverage, oral options, and/or good safety profile have been developed to be a potential alternative such as: ceftaroline, ceftobiprole, tigecycline and the recent FDA approved antibiotic (delafloxacin). In the absence of head-to-head trials comparing these agents, we decided to conduct a network meta-analysis for these therapeutic regimens. Methods A Bayesian network meta-analysis of randomized clinical trials identified in PubMed/Medline and Embase databases was conducted. We performed both fixed and random effect models for clinical cure as the primary outcome of interest. Additionally, rankograms were generated using the surface under the cumulative ranking curve (SUCRA) to obtain the treatment ranking probabilities in relation to their relative effect. Results We identified 10 eligible studies involving 4,914 patients. The indirect comparison demonstrated that delafloxacin showed no difference in terms of clinical cure compared with ceftaroline (OR, 0.82, 95% Cr.I 0.39–1.8), ceftobiprole (OR, 0.79, 95% Cr.I 0.32–1.9), SOC (OR, 1.2, 95% Cr.I 0.62–2.4) and tigecycline (OR, 1.0, 95% Cr.I 0.45–2.2) in the fixed effect analysis, nor in the random-effect analysis (OR, 0.8, 95% Cr.I 0.26–2.2; OR, 0.78, 95% Cr.I 0.2–3.0; OR, 1.2, 95% Cr.I 0.51–3.1; and OR, 0.96, 95% Cr.I 0.30–3.0), respectively. Furthermore, the ranking probabilities in the fixed-effect and random-effect analysis showed that ceftaroline was ranked the first in terms of clinical cure (SUCRA, 40.02%) followed by ceftobiprole (SUCRA, 22.80%), delafloxacin (SUCRA, 16.60%), SOC (SUCRA, 13.80%), and then tigecycline (SUCRA, 6.70%). Conclusion Ceftaroline, ceftbiprole, delafoxacin, SOC and tigecycline are similarly effective. However, delafloxacin provides better convenience. Further comparative studies regarding their safety are needed. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Published
2019
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43. Abstract 15272: Transcatheter versus Surgical Aortic Valve Replacement in Patients With Prior Cardiac Surgery: A Systematic Review and Meta-Analysis

Author

Lateef, Noman, Ahsan, Muhammad Junaid, Malik, Saad Ullah, Minhas, Abdul Mannan, Haseeb, Abdul, Mirza, Mohsin M, Doukky, Rami, and Koster, Nancy

Abstract

Background:An increasing number of patients with severe aortic stenosis (AS) have history of prior cardiac surgery which is associated with increased risk of aortic valve replacement. In such cases, the proposed benefit of surgical (SAVR) versus transcatheter aortic valve replacement (TAVR) remains unknown.Objective:To evaluate the impact of prior cardiac surgery on clinical end points in patients undergoing TAVR versus SAVR for severe AS.Methods:Literature search was performed using MEDLINE (via PUBMED), EMBASE, Google Scholar and Scopus databases. The included outcomes were procedural time, acute kidney injury (AKI), bleeding complications, stroke, permanent pacemaker implantation (PPI), duration of hospital stay, 30-day all-cause mortality and 1-2 year all-cause mortality, The main summary estimate was random effects Odds ratio (OR) with 95% confidence intervals (CIs).Results:7 studies (3 randomized trials, 4 cohort) including 8,922 patients with mean age 80 ? 6.6/78 ? 6.3 and 75.5%/75.5% males in the TAVR and SAVR groups, respectively, were included. Our study found that, compared with SAVR, TAVR was associated with lower incidence of stroke (OR = 0.65 (95% CI: 0.44 - 0.97), p = 0.03) and bleeding complications (OR = 0.36 (95% CI: 0.21 - 0.59), p = <0.01). There was no difference in terms of AKI (OR = 0.71 (95% CI: 0.49 - 1.02), p = 0.06), PPI (OR = 1.56 (95% CI: 0.97-12.54), p = 0.06), 30-day all-cause mortality (OR = 0.87 (95% CI: 0.56 - 1.37), p = 0.54) and 1-2 year all-cause mortality (OR = 1.15 (95% CI: 0.71 - 1.86), p = 0.57) between the two groups (Figure 1). The average procedure time and duration of hospital stay were 170 minutes less (95% CI: -249.37, -92.53), p = <0.01) and 3.6 days shorter (95% CI: -5.43, -1.95), p <0.01) in patients with TAVR, respectively.Conclusions:In patients with prior cardiac surgery and severe AS, both TAVR and SAVR are reasonable options. However, TAVR may be associated with lower incidence of outcomes like stroke and perioperative bleeding.

Published
2019
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44. Abstract 16460: Dual Antiplatelet Therapy for Three Months Followed by Monotherapy is Non-inferior to One Year Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention- A Systematic Review and Meta-Analysis

Author

Anwar, Muhammad Fazeel, Khan, Behram A, Hassan, Syeda Fatima, Nasreen, Sarwat, Malik, Saad Ullah, Fazeel, Hafiz Muhammad, Tameez Ud Din, Asim, Chung, Jacqueliene, and Mirza, Mohsin

Abstract

Introduction:Dual antiplatelet therapy (DAPT) is recommended as a standard treatment for patients with the acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI) using drug-eluting stents (DES).The optimal duration for DAPT has been an ongoing debate. Purpose of our study is to compare the safety and efficacy of shorter therapy i.e. DAPT for 3 months, from longer therapy i.e. DAPT for 12 months.Methods:We searched PubMed, Ovid Embase, Web of science, Cochrane library and Clinicaltrials.gov for studies reporting the comparative use of DAPT for 3 months versus 12 months after PCI in patients with ACS. The primary endpoint was all-cause mortality. Secondary outcomes were cardiovascular mortality (CVM), post-PCI myocardial infarction (MI), stent thrombosis, major adverse cardiovascular events (MACE) and target vessel revascularization (TVR).Results:Four studies- three randomized control trials and one retrospective study, with N= 22016 were included. Out of these, 11263 patients received shorter DAPT while 10753 patients received longer DAPT. Our results indicated that shorter DAPT showed similar efficacy to longer DAPT in regards to of all-cause mortality [RR = 0.86 (0.66-1.12), p= 0.225] and CVM [RR = 0.82 (0.52-1.29), p= 0.381]. In terms of safety, there was no difference between the two groups in rates of post-PCI MI [RR = 1.01 (0.86-1.18), p= 0.927], MACE [RR = 0.933 (0.82-1.06), p= 0.274], stroke [RR= 0.98 (0.73-1.31), p= 0.885], stent thrombosis [RR: 0.99 (0.73-1.34), p= 0.937], bleeding events [RR = o.91 (0.75-1.10), p= 0.314] and TVR [.RR= 0.91 (0.81-1.03), p= 0.133].Conclusion:Our study supports that DAPT given for only 3 months followed by monotherapy(either with plavix or ticagrelor) shows comparable efficacy and safety to treatment with DAPT over 12 months in patients post-PCI with DES placement especially after non-ST segment elevation ACS.

Published
2019
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45. Abstract 17211: Safety and Effectiveness of Trans-Catheter versus Surgical Aortic Valve Replacement in Nonagenarians With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis

Author

Ahsan, Muhammad Junaid, Fazeel, Hafiz Muhammad, Malik, Saad Ullah, tameez ud din, asim, Hassan, Syeda, Khan, Behram Ahmed, Hashmi, Mydah S, and Mirza, Mohsin M

Abstract

Introduction:Nonagenarians i.e. age > 90 are usually not considered for surgical aortic valve replacement (SAVR) owing to their increased surgical risk. This patient population is also under represented in clinical trials that have evaluated the role of trans-catheter aortic valve replacement (TAVR) for severe aortic stenosis.So the effectiveness of TAVR as compared to SAVR remains unknown.Objective:To compare safety and effectiveness of TAVR versus SAVR in nonagenarians.Methods:Literature search was performed using PubMed, Embase, Web of science, Cochrane library and clinicaltrials.gov. Databases were systematically searched up to 5-21-2019. Primary end point was 30-day mortality. Secondary end points were post-operative incidences of stroke or transient ischemic attacks, vascular access related complications, acute renal failure, transfusion requirement, length of hospital stay, respectively.The main summary estimate was random effects Risk ratio(RR) with 95% confidence intervals (CIs).Results:Four retrospective studies were included (N= 8389). TAVR was performed in 3112 patients while 5277 patients underwent SAVR. Our study found no difference in 30-days mortality between TAVR and SAVR [RR = 0.91 (0.76 - 1.10), p= 0.318]. TAVR was associated with a significantly reduced risk of post-operative ARF [RR = 0.72 (0.62 - 0.83), p<0.001] and a lower transfusion requirement [RR = 0.71 (0.62 - 0.81), p < 0.001], respectively. There was no difference in risk of stroke/TIA between two groups [RR = 1.01 (0.70 - 1.45), p= 0.957] and risk of vascular access complications was significantly higher with TAVR [RR = 3.39 (2.65 - 4.333), p<0.001].On an average, Length of hospital stay was 3 days less in patients undergoing TAVR (p= 0.037).Conclusion:TAVR was not shown to have an increased risk of short term mortality or stroke along with a better post-operative outcomes when weighed against SAVR in nonagenarians.

Published
2019
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46. Abstract 15936: Fluoroquinolones and the Risk of Aortopathy: A Systematic Review and Meta-Analysis

Author

Latif, Azka, Ahsan, Muhammad Junaid, Malik, Saad Ullah, Lateef, Noman, Kapoor, Vikas, Anwar, Muhammad Fazeel, Mirza, Mohsin M, and Holmberg, Mark J

Abstract

Introduction:Recent studies have raised concern that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection. We performed a meta-analysis with a comprehensive literature review to further investigate this association.Hypothesis:Increased risk aortopathy with use of fluoroquinolone.Methods:This analysis was conducted per PRISMA guidelines. PubMed, Cochrane library, ClinicalTrials.gov, Embase, web of science and Google Scholar were searched for studies including adult (age > 18 years), patients exposed to fluoroquinolones or control antibiotics (amoxicillin/Any other antibiotic) for urinary tract infection or pneumonia with a primary outcome of aortic aneurysm or dissection. Data was extracted in predefined tables and meta-analysis was performed using random effects model. Heterogeneity was calculated using Q statistic and I2. The main summary estimate was Relative Risk with 95% confidence intervals (CI) as shown in figure.Results:Seven studies (2 retrospective, 1 longitudinal cohort, 1 nested case control, 1 nationwide cohort, 1 case time control, and 1 case cross-over study) with 59% males were included. Our analysis showed increased combined risk of development of AA and AD with quinolone exposure when compared with controls (relative risk [RR] (95% confidence interval [CI]) = 2.11 (1.62 - 2.75),I2=83.700). Individual RR for aortic aneurysm (RR of 2.83 (95% confidence interval [CI]) = 2.02 - 3.95,I2=89.150)) and AD (RR of 1.99 (95% confidence interval [CI]) = 1.23-3.06), I2=71.33) were also significantly increased.Conclusion:Compared to other antibiotics, use of fluoroquinolones was associated with significantly higher risk of aortic aneurysm and dissection combined.

Published
2019
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47. Abstract 15926: Impact of Extent of Coronary Revascularization on Mortality After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Author

Ahsan, Muhammad Junaid, Lateef, Noman, Malik, Saad Ullah, Anwar, Muhammad Fazeel, Zubair, Hafiz Muhammad Z, Latif, Azka, Mirza, Mohsin M, and Holmberg, Mark J

Abstract

Background:The concurrent incidence of aortic stenosis (AS) and coronary artery disease is estimated to be 50 - 60%. Coronary intervention in patients with severe CAD leads to improved outcomes, however impact of completeness of revascularization remains unknown.Objective:The primary objective was to evaluate the prognostic impact of completeness of coronary revascularization on all-cause mortality in patients undergoing TAVR.Methods:Literature search was performed using MEDLINE, EMBASE, Google Scholar and Scopus databases. Three sets of comparisons were performed: 1) Patients with no CAD versus CAD patients with high residual syntax score(rSS) >10, 2) Patients with no CAD versus CAD patients with low rSS ?10, 3) CAD Patients with low rSS versus CAD patients with high rSS. Data on all-cause mortality was extracted digitally form the Kaplan-Meier curves. Hazard ratios were calculated using Palmer method and meta-analysis was performed using random effects model. Heterogeneity was calculated using Q statistic and I2. The main summary estimate was random effects hazard Ratio (HR) with 95% confidence intervals (CIs).Results:Eight studies including 4,237 patients were included to look for prognostic effect of revascularization completeness before TAVR using rSS. Follow up period ranged from 0.7 to 4.8 years. Our results showed that CAD Patients with high rSS (>10) had increased risk of all-cause mortality as compared to patients with no CAD at longest follow up (HR=1.40, 95% CI: 1.10 - 1.78, I2=38.826). Whereas, there was no difference in patients with CAD and low rSS (?10) versus no CAD (HR=1.12, 95% CI: 0.85 - 1.60, I2=57.632). Interestingly, comparison of CAD patients with low rSS and high rSS also revealed no difference in all-cause mortality (HR = 1.05, 95% CI: 0.76 - 1.44,I2=58.88).Conclusions:Completeness of coronary revascularization with PCI or CABG in patients undergoing TAVR for AS did not significantly impact long-term all-cause mortality.

Published
2019
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48. Fluoroquinolones and the Risk of Aortopathy: A Systematic Review and Meta-Analysis.

Author

Latif A, Ahsan MJ, Kapoor V, Lateef N, Malik SU, Patel AD, Khan BA, Bittner M, and Holmberg M

Subjects
Adolescent, Adult, Anti-Bacterial Agents adverse effects, Female, Fluoroquinolones adverse effects, Humans, Male, Aortic Dissection chemically induced, Aortic Dissection drug therapy, Aortic Dissection epidemiology, Aortic Aneurysm chemically induced, Aortic Aneurysm drug therapy, Aortic Aneurysm epidemiology
Abstract

Introduction: Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection., Objective: We performed a meta-analysis with a comprehensive literature review to further investigate this association., Methods: This analysis was conducted per PRISMA guidelines. PubMed, Cochrane Library, ClinicalTrials.gov, Embase, Web of Science, and Google Scholar were searched for studies that included adult patients (age >18 years) exposed to fluoroquinolones or control antibiotics (amoxicillin/any other antibiotic) for urinary tract infection or pneumonia with a primary outcome of aortic aneurysm or dissection. Heterogeneity was calculated using Q statistic I 2  ., Results: A total of 6 studies-comprised of 59% males-were included in our analysis, which showed an increased combined risk of development of aortic aneurysm and aortic dissection with quinolone exposure when compared with controls (relative risk [RR] = 2.11; 95% CI, 1.62 - 2.75; I 2  = 83.700). Individual relative risk for aortic aneurysm (RR = 2.83; 95% CI, 2.02 - 3.95, I 2   = 89.150) and aortic dissection (RR = 1.99; 95% CI, 1.23 - 3.06; I2 2  = 71.33) also were significantly increased., Conclusion: Compared to other antibiotics, the use of fluoroquinolones was associated with a significantly higher risk of aortic aneurysm and dissection combined., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Published
2020

49. Disease Milestones through Bibliometric Analysis of the Top 100 Cited Articles in Multiple Myeloma.

Author

Latif A, Kapoor V, Sipra QUAR, Malik SU, Bilal J, Bin Riaz I, and Anwer F

Abstract

Multiple myeloma (MM) accounts for 1.6% of all cancers and 5%-10% of all hematologic malignancies in the United States (US). Despite marked progress in disease management, it remains incurable with high rates of relapse. We conducted a bibliographic analysis on the Web of Science (WOS) from July 25, 2017 and July 29, 2017. Among the top 100 most-cited articles (1901-2012), the most cited article received 2404 citations and least cited article received 336 citations. Forty-four of 100 articles were published in journals with impact factors greater than 20. We observed that over the years, the focus of research has shifted from diagnosis, staging, and pathogenesis to better treatment outcomes. A subgroup analysis of the top 100 cited articles published in the last five years (2012-2017) demonstrated that several landmark studies, which will likely change the landscape of treating multiple myeloma, were not included in the top 100 list. Interestingly, most of these articles were focused on novel therapeutic agents. This bibliographic analysis provides a list of the 100 top-cited articles in multiple myeloma along with the captivating comprehension of the history and development in various aspects of disease processes. The landscape of this disease is rapidly evolving, and bibliometric studies such as the one presented provide a valuable tool that can highlight the important transitions in the field., Competing Interests: The authors have declared that no competing interests exist.

Published
2018
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