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1. Analgesic effect of ginger and peppermint on adolescent girls with primary dysmenorrhea

Author

Zaheer Ahmed, Farhat Rashid, Sana Sultan, Asma Afreen, Nauman Khalid, and Fatima Majeed

Subjects
peppermint, Analgesic effect, pain score, Traditional medicine, Nutrition. Foods and food supply, ginger, business.industry, adolescent girls, T1-995, Medicine, TX341-641, relief, business, Technology (General), primary dysmenorrhea, Food Science, Biotechnology
Abstract

Present study was aimed to explore the impact of ginger and peppermint in adolescents suffering with primary dysmenorrhea. For that purpose, 150 adolescents, aged 13-22 years, with regular menstruation suffering with moderate to severe dysmenorrhea (scoring 3-5 on pain scale) and preferably not taking any medication were enrolled and randomly divided into three groups i.e. control, ginger and peppermint. Baseline data was collected with help of self-administered questionnaire. To determine comparative analgesic effect of ginger and peppermint, capsules were formulated, and each group received total number of 15 capsules in a month (3 capsules/day for consecutive 5 days). Compared with baseline data, ginger was found more effectual than peppermint in releasing dysmenorrhea i.e. observed scoring in case of ginger was reduced from mean value of 4.13 ± 0.63 to 2.10 ± 1.52 (p = 0.001). Similarly, ginger intervention exhibited gradual betterment of 10% in symptoms of dysmenorrhea but also affected blood pressure positively (p < 0.05). However, blood hemoglobin and serum calcium levels acted as independent variables in ginger and peppermint groups (p > 0.05), not affected by any mode of intervention. It was concluded that ginger exhibited superior impact in lowering pain as compared to peppermint and control groups.

Published
2021

2. High-Risk Percutaneous Coronary Intervention of Native Coronary Arteries Without Mechanical Circulatory Support in Acute Coronary Syndrome Without Cardiogenic Shock

Author

Nauman Khalid, Brian C. Case, Cheng Zhang, Evan Shlofmitz, Charan Yerasi, Corey Shea, Toby Rogers, Anees Musallam, Itsik Ben-Dor, Ron Waksman, Hayder Hashim, Nelson L. Bernardo, Yuefeng Chen, and Lowell F. Satler

Subjects
Male, Acute coronary syndrome, medicine.medical_specialty, medicine.medical_treatment, Coronary artery disease, Percutaneous Coronary Intervention, Postoperative Complications, Risk Factors, Internal medicine, medicine, Humans, Angina, Unstable, Assisted Circulation, Hospital Mortality, cardiovascular diseases, Myocardial infarction, Non-ST Elevated Myocardial Infarction, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Unstable angina, Cardiogenic shock, Percutaneous coronary intervention, Middle Aged, medicine.disease, Survival Rate, Coronary arteries, medicine.anatomical_structure, Conventional PCI, Cardiology, Feasibility Studies, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Widespread utilization of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (PCI) remains controversial, with a lack of randomized supporting evidence and associated risk of device-related complications. We investigated whether high-risk PCI of native coronary arteries without elective MCS in patients with acute coronary syndrome (ACS) is safe and feasible. We performed a single-center, retrospective analysis for ACS patients meeting American College of Cardiology high-risk criteria: unprotected left main disease, last remaining conduit, ejection fraction

Published
2021

3. Electrocardiographic changes in Emphysema

Author

Misbah Gill, Puneet Gupta, Waseem Chaudhry, Nauman Khalid, Lovely Chhabra, Hitangee Jain, and Gurpreet Bharaj

Subjects
medicine.medical_specialty, MEDLINE, Clinical settings, Precordial examination, QRS complex, Sensitivity, Internal medicine, medicine, cardiovascular diseases, skin and connective tissue diseases, Emphysema, P-wave axis, COPD, business.industry, Chronic obstructive pulmonary disease, Minireviews, medicine.disease, Obstructive lung disease, respiratory tract diseases, Electrocardiogram, Surface electrocardiogram, Cardiology, Specificity, sense organs, Cardiology and Cardiovascular Medicine, business
Abstract

Chronic obstructive lung disease (COPD), predominantly emphysema, causes several thoracic anatomical and hemodynamic changes which may cause changes in various electrocardiographic parameters. A 12-lead electrocardiogram (ECG), which is often a part of routine evaluation in most clinical settings, may serve as a useful screening modality for diagnosis of COPD or emphysema. Our current article aims to provide a comprehensive review of the electrocardiographic changes encountered in COPD/emphysema utilizing published PubMed and Medline literature database. Several important ECG changes are present in COPD/emphysema and may serve as a good diagnostic tool. Verticalization of P-vector, changes in QRS duration, pattern recognition of precordial R-wave progression and axial shifts can be considered some of the most valuable markers among other changes. In conclusion, 12-lead surface electrocardiogram can serve as a valuable tool for the diagnosis of COPD and/or emphysema. An appropriate knowledge of these ECG changes can not only help in the diagnosis but can also immensely help in an appropriate clinical management of these patients.

Published
2021

4. Impact of intravascular ultrasound on Outcomes following PErcutaneous coronary interventioN for In-stent Restenosis (iOPEN-ISR study)

Author

Aaphtaab Dheendsa, Hector M. Garcia-Garcia, Nauman Khalid, Toby Rogers, Itsik Ben-Dor, Cheng Zhang, Yuefeng Chen, Rebecca Torguson, Anees Musallam, Hayder Hashim, Evan Shlofmitz, Ron Waksman, and Gary S. Mintz

Subjects
medicine.medical_specialty, medicine.medical_treatment, Coronary Artery Disease, Coronary Angiography, Coronary Restenosis, Percutaneous Coronary Intervention, Restenosis, Internal medicine, Intravascular ultrasound, Clinical endpoint, medicine, Humans, cardiovascular diseases, Myocardial infarction, Ultrasonography, Interventional, medicine.diagnostic_test, business.industry, Percutaneous coronary intervention, Drug-Eluting Stents, equipment and supplies, medicine.disease, Treatment Outcome, surgical procedures, operative, Drug-eluting stent, Conventional PCI, cardiovascular system, Cardiology, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

Percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) remains common. Intravascular imaging allows for the determination of the mechanism of ISR, potentially guiding appropriate therapy. Intravascular ultrasound (IVUS)-guided stent implantation is associated with a reduction in adverse events after PCI, but its impact on treatment of ISR is not clear.All patients with 1-year follow-up after ISR treatment from 2003 through 2016 were included and stratified by IVUS use. The primary endpoint was the rate of major adverse cardiac events (MACE) at 1 year, defined as the composite of all-cause mortality, Q-wave myocardial infarction, and target vessel revascularization (TVR).The final analysis included 1522 ISR patients, 65.9% of whom were treated with IVUS guidance. The primary endpoint occurred in 18.0% of patients treated with IVUS guidance vs. 24.5% of patients treated with angiography guidance (p = 0.0014). Post-dilatation was used more often with IVUS (18.6% vs. 14.1%, p 0.001), with a larger diameter of new stents (3.04 ± 0.35 mm vs. 2.94 ± 0.47 mm, p = 0.001). At 1 year, TVR occurred in 14.5% with IVUS guidance and 19.2% with angiography guidance (p = 0.021).The use of IVUS is associated with decreased MACE at 1 year following PCI for ISR. These results support routine IVUS for the treatment of ISR lesions.

Published
2021

5. Modes of failure with fractional flow reserve guidewires: Insights from the manufacturer and user facility device experience database

Author

Mahboob Alam, Yagya Pandey, Jason P Wermers, Umair Khalid, Nauman Khalid, Waleed T. Kayani, Lovely Chhabra, Hassan Kamran, and Hani Jneid

Subjects
Fractional flow reserve, Database, business.industry, Coronary guidewire, medicine.medical_treatment, Food and Drug Administration, Stent, computer.software_genre, Food and drug administration, Retrospective Study, Adverse events, Modes of failure, Functional significance, Medicine, User Facility, In patient, Cardiology and Cardiovascular Medicine, business, Artery dissection, Manufacturer and user facility device experience, computer, Cardiac catheterization
Abstract

Background Fractional flow reserve (FFR) measurement is commonly used in the cardiac catheterization laboratory to assess the functional significance of coronary arterial plaques. Robust real-world data on complications and modes of failure of FFR guidewires are limited. Aim To characterize these outcomes by analyzing the post-marketing surveillance data from the United States Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database for commonly used FFR guidewires. Methods The MAUDE database was queried from January 2010 through April 2020 for 3 FFR guidewires [PressureWireTM X (Abbott), CometTM (Boston Scientific), and VerrataTM (Philips)] by searching for the following events: "Injury", "malfunction", "death", and "other". This yielded 544 reports. After excluding incomplete reports, 486 reports were analyzed. Results Guidewire tip fracture was the most commonly reported mode of failure, in 174 (35.8%) cases followed by guidewire kinking (n = 152, 31.3%), communication failure (n = 141, 29.0%), and shaft fracture (n = 67, 13.8%). In total, 133 (27.4%) device failures resulted in patient adverse events. The most common adverse event was retained guidewire tip, in 71 (53.4%) cases, followed by freshly deployed stent dislodgment (n = 26, 19.6%) and coronary artery dissection (n = 23, 17.3%). Seven deaths were reported. Conclusion FFR guidewire failures can occur because of various mechanisms and cause patient adverse events. The MAUDE database serves as an important platform for improved collaboration among clinicians, device manufacturers, and regulators to improve device performance and optimize patient outcomes. Our analysis provides mechanistic insights of FFR guidewire failure and associated adverse events but cannot verify causality or provide a comparison among different guidewires.

Published
2021

6. Real-World Experience of the MANTA Closure Device: Insights From the FDA Manufacturer and User Facility Device Experience (MAUDE) Database

Author

Chava Chezar-Azerrad, Nauman Khalid, Charan Yerasi, Brian C. Case, Ron Waksman, Sant Kumar, Evan Shlofmitz, Anees Musallam, Lowell F. Satler, Toby Rogers, Brian J. Forrestal, Itsik Ben-Dor, and Jaffar M. Khan

Subjects
Surveillance data, Databases, Factual, Adverse outcomes, Vessel occlusion, Hemorrhage, 030204 cardiovascular system & hematology, computer.software_genre, Food and drug administration, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Vascular closure device, User Facility, 030212 general & internal medicine, Major complication, Closure (psychology), Database, United States Food and Drug Administration, business.industry, General Medicine, United States, Femoral Artery, Treatment Outcome, Cardiology and Cardiovascular Medicine, business, computer, Vascular Closure Devices
Abstract

Background/purpose The MANTA vascular closure device (VCD) is the first commercially available dedicated closure device for large-bore femoral arterial access-site closure and was approved by the United States Food and Drug Administration (FDA) in February 2019. Real-world data on the most commonly reported complications and modes of failure associated with the MANTA closure device are limited. We analyzed post-marketing surveillance data from FDA's Manufacturer and User Facility Device Experience (MAUDE) database for the MANTA VCD (Teleflex, Wayne, Pennsylvania). Methods/materials Post-marketing surveillance data from the FDA MAUDE database from February 2019 through March 2020 were analyzed, yielding 170 reports. Results Of the 170 reports of major complications involving MANTA devices, 141 reports involved either injury (136) or death (5) related to the device. Of the 141 reports, bleeding was the most common adverse outcome described (45), followed by vessel occlusion (30) and vessel dissection (21). Device malfunction incidents (29 reports) were reported in 4 main categories: failed deployment (16 reports), malposition of the collagen (9), insufficient information (3), and device dislocation (1). Conclusions Our analysis of the MAUDE database demonstrates that in real-world practice, the MANTA VCD was found to be associated with complications, including death, vascular injury , and difficulties with the device itself. Ongoing user education, proctoring, and pre-procedural patient selection are important to minimize risks associated with the MANTA VCD.

Published
2021

7. Food security challenges for Pakistan during COVID‐19 pandemic: An overview of the response plan

Author

Waqas Asghar, Nauman Khalid, and Hafiz Ubaid-ur-Rehman

Subjects
agri‐food system, Economic growth, education.field_of_study, Food security, business.industry, Supply chain, Population, Public policy, response plan, food security, malnutrition, medicine.disease, Livelihood, Malnutrition, COVID‐19, Pandemic, Food processing, medicine, education, business, Research Articles, Research Article
Abstract

The COVID-19 pandemic has imparted a significant impact on the global economic conditions. The food security status in the developing and under-developed countries is getting worse with the progression of the pandemic. According to the World Food Program (WFP), 271.8 million people were acutely food insecure due to the destructive impact of COVID-19 pandemic across the world. Similarly, around 20%?30% population of Pakistan, that is, 40?62 million people, has been suffering from acute food insecurity due to the pandemic, and other socio-economic and environmental/climatic issues. The highly vulnerable groups include daily wage class, refugees, and people living in drought-affected areas, locust-affected areas and areas with winterized emergency. The COVID-19 response plan of Pakistan aimed at improving the food security situation and protecting the livelihood of the demographic groups highly vulnerable to the COVID-19 pandemic through defining the implementing the policy for ensuring the uninterrupted food production and supply chain, integrating the food production system into the COVID-19 relief packages, adopting innovative practices to enhance the functionality of food supply chain market, and treatment of acutely malnourished and groups affected by food insecurity. Accordingly, this opinion-based article reports the food security challenges faced in Pakistan in the COVID-19 era and explicates the government policies for stabilizing the functionality of agri-food systems in Pakistan.

Published
2021

8. Electrocardiographic changes in Takotsubo cardiomyopathy

Author

Vraj Patel, Nausharwan Butt, Waleed T. Kayani, Gurpreet Bharaj, Sarah Aftab Ahmad, Nauman Khalid, Lovely Chhabra, and Anita Sangong

Subjects
medicine.medical_specialty, Cardiac biomarkers, Cardiomyopathy, Coronary Artery Disease, Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Diagnostic tools, Diagnosis, Differential, Coronary artery disease, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Takotsubo Cardiomyopathy, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Cardiac imaging, business.industry, medicine.disease, Electrocardiographic Finding, Risk stratification, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract

Takotsubo Cardiomyopathy (TC) is a syndrome characterized by reversible left ventricular dysfunction in the presence of possible emotional or physical triggers but without evidence of obstructive coronary artery disease. It has become increasingly reported worldwide and is associated with significant morbidity and mortality. TC may present with an array of electrocardiographic (ECG) findings. These ECG findings, if accurately interpreted, can play an important role in the diagnosis and risk stratification of this syndrome. In the last three decades since the disease was first described, multiple diagnostic criteria have been established. The key diagnostic tools for TC include clinical symptomatology, cardiac biomarkers, non-invasive cardiac imaging, and coronary angiography. The ECG findings in TC can be variable, however, some ECG scores have been proposed in association with TC with reasonably good diagnostic sensitivity and specificity. This article aims to provide a succinct review of important electrocardiographic findings associated with TC and its impact on clinical outcomes.

Published
2021

9. EFFICACY OF SELECTIVE ALPHA-1 RECEPTOR BLOCKERS (TAMSULOSIN) IN FACILITATING THE PASSAGE OF RENAL STONES AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

Author

Aijaz Hussain Memon, Wasim Sarwar Bhatti, Muhammad Waqas Iqbal, Nauman Khalid, Hanan Noor, and Muhammad Sohail

Subjects
Tamsulosin, medicine.medical_specialty, business.industry, medicine.medical_treatment, Urinary system, lcsh:R, Urology, lcsh:Medicine, Alpha blocker, Diclofenac Sodium, medicine.disease, Extracorporeal shock wave lithotripsy, law.invention, renal stone fragments, Randomized controlled trial, law, medicine, Outpatient clinic, Urinary tract obstruction, business, ESWL, medicine.drug
Abstract

BACKGROUND & OBJECTIVE: Urinary system stone disease is a common entity. Small renal stones are preferably treated using Extracarporeal Shock Wave Lithotripsy (ESWL) technique. Passage of stone fragments result in pain, hematuria and urinary tract obstruction. This can be avoided by the use selective α-1 receptor antagonists like Tamsulosin. However, their efficacy remains a matter of debate. In this study the role of selective α-1 blocker was evaluated in facilitating spontaneous expulsion of renal stone fragments after ESWL. The objective of our study was to find out the Efficacy of Tamsulosin (Selective α-1 blocker) in facilitating the transit of stone fragments (4-7mm) after ESWL. Follow up X-ray KUB was used to confirm the stone clearance. Efficacy was measured in terms of stone expulsion rate. METHODOLOGY: It was randomized controlled trial including 150 patients coming to outpatient department of Urology Lahore General Hospital, Lahore from January 25, 2010­ to July 25, 2010. Total 150 patients with renal stones broken down into fragments (4-7mm) after ESWL were enrolled using non-probability purposive sampling technique. Patients were categorized into group A and B. Patients of group A received cap. Tamsulosin 0.4mg along with Tab. Diclofenac sodium 50mg. Whereas, patients belonging to group B received only diclofenac sodium 50 mg twice daily. Patients underwent ESWL every three weeks, in case of non-fragmentation, to the maximum of 4 sessions. All the patients were followed with X Ray KUB for stone clearance. The data of all patients was incorporated into pre designed Performa. Statistical evaluation of clinical variables done in terms of efficacy i.e. stone clearance. RESULTS: Stone clearance rate of patients in group A was 86.6% as compared to only 76% in group B. Usage of selective α-1 blockers in group A enhanced the stone clearance rate as compared to group B. However this difference was statistically insignificant (p-value-0.094). CONCLUSION: There was increased stone clearance in alpha one blocker group but not statistically significant. Further studies with larger sample size are required to evaluate the role of Selective α-1 blockers (Tamsulosin) after ESWL.

Published
2021

10. Ischemic Versus Bleeding Outcomes After Percutaneous Coronary Interventions in Patients With High Bleeding Risk

Author

Itsik Ben-Dor, Cheng Zhang, Jaffar M. Khan, Toby Rogers, Ron Waksman, Yuefeng Chen, Lowell F. Satler, Deepakraj Gajanana, Nauman Khalid, Evan Shlofmitz, Anees Musallam, William S. Weintraub, Paul Kolm, Rebecca Torguson, and Micaela Iantorno

Subjects
Male, Risk, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Myocardial Infarction, Psychological intervention, Target vessel revascularization, Hemorrhage, Comorbidity, Coronary Artery Disease, Postoperative Hemorrhage, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Cause of Death, Internal medicine, Myocardial Revascularization, Prevalence, medicine, Humans, In patient, Renal Insufficiency, 030212 general & internal medicine, Mortality, Aged, Heart Failure, Aspirin, business.industry, Dual Anti-Platelet Therapy, Percutaneous coronary intervention, Thrombosis, Middle Aged, medicine.disease, Clopidogrel, Heart failure, Cohort, Conventional PCI, Cardiology, Female, Stents, Gastrointestinal Hemorrhage, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors
Abstract

Patients undergoing percutaneous coronary intervention (PCI) often have high-bleeding-risk (HBR) factors. Dual antiplatelet therapy (DAPT) further increases this risk of bleeding. We sought to compare clinical outcomes according to presence or absence of HBR factors in patients with elevated ischemic risk (DAPT score ≥ 2) undergoing PCI. We evaluated all patients undergoing PCI at MedStar Washington Hospital Center (January 2009 to July 2018) with DAPT score ≥2, which is associated with elevated risk of ischemic events. Patients were categorized as HBR group (HBR score ≥1) or low-bleeding-risk (LBR) group (HBR score = 0). Outcomes included major adverse cardiac events such as target vessel revascularization, stent thrombosis, death, and bleeding events at 30 days, 6 months, 1 year, and 2 years. The final cohort consisted of 7,499 patients: 3,949 patients had LBR features, and 3,550 patients had HBR features. The 2 groups were different at baseline, with HBR patients being older and having a higher prevalence of congestive heart failure and renal dysfunction than the LBR group. The mean DAPT score was 2.96±1.1 for the LBR group and 3.7±1.4 for the HBR group (p0.001). During follow-up at 30 days, 6 months, and 1 and 2 years, the rates of target vessel revascularization and stent thrombosis were not significantly different between the 2 groups. Bleeding events and all-cause mortality were significantly more frequent in the HBR group than in the LBR group. In conclusion, patients undergoing PCI often have pre-existing risk factors that predispose them to ischemic and bleeding complications. Prolonged duration of DAPT to mitigate ischemic events could lead to a disproportionate increase in bleeding events, especially in HBR patients.

Published
2020

11. Paclitaxel-related balloons and stents for the treatment of peripheral artery disease: Insights from the Food and Drug Administration 2019 Circulatory System Devices Panel Meeting on late mortality

Author

Nauman Khalid, Evan Shlofmitz, Jason P. Wermers, Ron Waksman, Rebecca Torguson, Hector M. Garcia-Garcia, Kazuhiro Dan, Alexandre Hideo-Kajita, and Paul Kolm

Subjects
medicine.medical_specialty, Paclitaxel, Arterial disease, medicine.medical_treatment, Advisory committee, Disease, 030204 cardiovascular system & hematology, Prosthesis Design, Food and drug administration, Peripheral Arterial Disease, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Coated Materials, Biocompatible, Angioplasty, Humans, Medicine, In patient, 030212 general & internal medicine, United States Food and Drug Administration, business.industry, Congresses as Topic, Antineoplastic Agents, Phytogenic, United States, chemistry, Circulatory system, Emergency medicine, Stents, Cardiology and Cardiovascular Medicine, business, Angioplasty, Balloon
Abstract

Following the December 2018 publication of a meta-analysis by Katsanos et al reporting higher rates of long-term mortality with the utilization of paclitaxel-related devices (balloons and stents) when compared to control in femoropopliteal arteries, the US Food and Drug Administration (FDA) issued a safety alert in January 2019 and further detailed the implications for future clinical use of these devices in March 2019. The FDA convened a public meeting of the Circulatory System Devices Panel of the Medical Devices Advisory Committee in June 2019. This report summarizes the proceedings of this meeting and the panel's response to the 12 questions posed by the FDA related to the potentially increased late mortality of drug-coated balloons and drug-eluting stents with paclitaxel in patients with peripheral arterial disease.

Published
2020

12. Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience Database for Patient- and Circuit-Related Adverse Events Involving Extracorporeal Membrane Oxygenation

Author

Toby Rogers, Anees Musallam, Nauman Khalid, James Edelman, Nelson L. Bernardo, Yuefeng Chen, Hayder Hashim, Evan Shlofmitz, Sarah Aftab Ahmad, Hasan Javed, and Ron Waksman

Subjects
Databases, Factual, Heart Diseases, Membrane oxygenator, medicine.medical_treatment, 030204 cardiovascular system & hematology, computer.software_genre, Risk Assessment, Food and drug administration, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Risk Factors, Device Approval, Product Surveillance, Postmarketing, Extracorporeal membrane oxygenation, Humans, Medicine, User Facility, Decompensation, Treatment Failure, 030212 general & internal medicine, Adverse effect, Oxygenators, Membrane, Database, United States Food and Drug Administration, business.industry, Hemodynamics, General Medicine, United States, Atrial Perforation, surgical procedures, operative, Equipment Failure, Patient Safety, Respiratory Insufficiency, Cardiology and Cardiovascular Medicine, Complication, business, computer
Abstract

Background/Purpose We assessed commonly reported patient- and circuit-related adverse events involving extracorporeal membrane oxygenation (ECMO) devices by analyzing post-marketing surveillance data from the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database. ECMO is a rescue therapy for critically ill patients requiring oxygenation and cardiopulmonary support. Key configurations include veno-venous (VV) ECMO for respiratory support and veno-arterial (VA) ECMO for cardio-respiratory support. Robust data on the most commonly reported complications associated with ECMO therapy are limited. Methods/Materials The MAUDE database was queried from January 1, 2009, through March 31, 2019, yielding 93 reports. After excluding duplicate reports, 82 reports were included in the final analysis. Results Percentages represent the proportion of total submitted MAUDE reports on ECMO. Of the reported cases, 24 were VV-ECMO, 8 were VA-ECMO, and the remainder were unspecified. The most commonly reported patient-related adverse events included hemodynamic decompensation of patients (12.2%), death (12.2%), atrial perforation (7.3%), and bleeding (7.3%). The most commonly reported failure modes were in the following circuit components: mechanical pump (19.5%, mostly due to technical failure or clots), membrane oxygenator (19.5%, mostly due to tear in the membrane or temperature probe), and access cannulae (18.3%, mostly due to structural damage). Conclusions Analysis of the MAUDE database demonstrates that in real-world practice, ECMO devices are associated with important complications. With broadened global utilization of ECMO devices, standard complication and failure reporting policies may improve patient selection, operator proficiency, and existing device technology. Summary An analysis of the Food and Drug Administration's Manufacturer and User Facility Device Experience database demonstrates that in real-world practice, extracorporeal membrane oxygenation devices are associated with serious complications. The most commonly reported patient-related adverse events were hemodynamic decompensation of patients and death, and the most commonly reported failure modes were in the device's mechanical pump and membrane oxygenator.

Published
2020

13. Should Non-ST-Elevation Myocardial Infarction be Treated like ST-Elevation Myocardial Infarction With Shorter Door-to-Balloon Time?

Author

Yuefeng Chen, Ron Waksman, Evan Shlofmitz, Nauman Khalid, Paul Kolm, Rebecca Torguson, William S. Weintraub, Toby Rogers, Micaela Iantorno, and Deepakraj Gajanana

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Time Factors, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Coronary Angiography, Time-to-Treatment, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, Humans, Medicine, Hospital Mortality, Registries, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Non-ST Elevated Myocardial Infarction, education, Aged, Retrospective Studies, education.field_of_study, business.industry, Percutaneous coronary intervention, Retrospective cohort study, Middle Aged, medicine.disease, Survival Rate, Treatment Outcome, District of Columbia, Conventional PCI, Door-to-balloon, Cardiology, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business, Mace, Follow-Up Studies
Abstract

It is estimated that each year in the United States780,000 persons will experience an acute coronary syndrome. Approximately 70% of these will have non-ST-elevation myocardial infarction (NSTEMI). Optimal timing of angiography in NSTEMI is a matter of debate. The aim of this retrospective analysis was to evaluate whether and how the timing of percutaneous coronary intervention (PCI) affects the 1-year rate of major adverse cardiac events (MACE) in patients presenting with NSTEMI. Within our PCI database, we identified 1550 patients who underwent PCI for NSTEMI. We then divided the population into 3 groups based on door-to-balloon time (D2BT) (group 1 = D2BT90 minutes; group 2 = D2BT90 minutes24 hours; group 3 = D2BT24 hours). Primary outcome was MACE, a composite of MI, death and target vessel revascularization (TVR), or TVR at 1 year. Baseline characteristics were heterogeneous among the 3 groups, with patients who underwent angiograms24 hours from presentation being older with more cardiovascular co-morbidities. Patients with D2BT90 minutes were more likely to present with cardiogenic shock and had higher troponin levels. In-hospital mortality was similar among the 3 groups, but 1-year MACE/TVR was significantly higher in groups 1 and 3, driven by worse mortality. In this large cohort of patients presenting with NSTEMI, patients who underwent PCI between 90 minutes to 24 hours from presentation had better 1-year outcomes but also had fewer co-morbidities and with significantly lower prevalence of cardiogenic shock and high troponin on presentation. Therefore, treatment selection bias makes causal inference concerning rapid revascularization and outcome unreliable. Randomized clinical trials are warranted to assess outcome of rapid revascularization in patients presenting with NSTEMI.

Published
2020

14. Right Heart Catheterization-Related Complications

Author

Itsik Ben-Dor, Nelson L. Bernardo, Yuefeng Chen, William S. Weintraub, Evan Shlofmitz, Nauman Khalid, and Ron Waksman

Subjects
Male, Risk, Cardiac Catheterization, medicine.medical_specialty, medicine.medical_treatment, Arteriovenous fistula, 030204 cardiovascular system & hematology, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, medicine.artery, medicine, Humans, 030212 general & internal medicine, Adverse effect, Tricuspid valve, business.industry, General surgery, Gold standard, Pulmonary artery catheter, General Medicine, medicine.disease, Catheter, medicine.anatomical_structure, Practice Guidelines as Topic, Pulmonary artery, Female, Cardiology and Cardiovascular Medicine, Complication, business
Abstract

Right heart catheterization (RHC) is considered to be the gold standard for the measurement of pulmonary artery pressure and has a class 1 indication to confirm the diagnosis of pulmonary arterial hypertension and to guide treatment decisions. Associated complications with RHC in contemporary practice are uncommon. In this review, we aim to summarize the complications that have been published in case reports or case series with updated management and techniques to prevent and mitigate complications. We searched the PubMed database for the following reports: "right heart catheterization," "Swan-Ganz catheter," "pulmonary artery catheter," "balloon-tip catheter," and "complication" or "adverse event." Complications reported in 46 manuscripts were included in the final analysis. After evaluation of all reports, complications were grouped categorically. We found that the most commonly reported access site-related issues were either carotid artery injury or arteriovenous fistula formation, and injury to the tricuspid valve was the most commonly reported catheter-related complication. Our findings suggest that infrequent complications can occur with RHC and can be fatal. The optimal technique should be used to minimize complications. Operators should always be cautious during the procedure and monitor the patient closely.

Published
2020

15. Transcatheter aortic valve implantation in patients with chronic obstructive pulmonary disease

Author

Nauman Khalid, Sarah Aftab Ahmad, Waleed T. Kayani, and Nausharwan Butt

Subjects
Male, China, medicine.medical_specialty, Time Factors, Databases, Factual, Transcatheter aortic, Clinical Investigations, Pulmonary disease, aortic valve stenosis, Risk Assessment, chronic obstructive pulmonary disease, Transcatheter Aortic Valve Replacement, Pulmonary Disease, Chronic Obstructive, Internal medicine, Medicine, Humans, In patient, postoperative complication, Hospital Mortality, Letters to the Editor, Propensity Score, Letter to the Editor, Aged, Retrospective Studies, Inpatients, Transcatheter aortic valve implantation, National Inpatient Sample, business.industry, General Medicine, Hospitals, respiratory tract diseases, Survival Rate, Treatment Outcome, Aortic Valve, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Background Comorbid chronic obstructive pulmonary disease (COPD) increases morbidity and mortality among aortic valve replacement patients undergoing conventional surgery. The impact of COPD in patients undergoing less invasive transcatheter aortic valve insertion (TAVI) is unclear. Hypothesis This study evaluates the in‐hospital outcomes of TAVI in patients with and without COPD. Methods This population‐based, retrospective study of 8466 TAVI patients (29.87% with COPD) evaluates the effects of COPD on short‐term clinical outcomes (in‐hospital mortality, length of hospital stay, and postoperative complications) using data from the National Inpatient Sample database from 2011 to 2014. Logistic regression analysis was used to determine factors associated with in‐hospital mortality and postoperative complications. Linear regression analysis was used to identify factors associated with length of hospital stay. Results COPD is significantly associated with increased risk of respiratory complications and pneumonia after TAVI (aOR = 1.43, 95% CI: 1.24‐1.64; P

Published
2022

16. Review on physicochemical, medicinal and nutraceutical properties of poppy seeds: a potential functional food ingredient

Author

Rao Sanaullah Khan, Aleem Muhammad, Sadia Aslam, Zaheer Ahmed, Nauman Khalid, and Aqsa Akhtar

Subjects
Nutrition and Dietetics, food.ingredient, biology, Food industry, business.industry, food and beverages, Medicine (miscellaneous), Poppyseed oil, Poppy seed, biology.organism_classification, Biochemistry, Ingredient, food, Nutraceutical, Functional food, Poppy, Papaver, Food science, business, Food Science
Abstract

The poppy seed plant (Papaver somniferum L.) is well known for its health benefits. It contains plenty of nutrients including proteins, oil content, dietary fiber, antioxidants, tocopherols and other micronutrients. It is also under exploration considering its in vitro bioactive potential against various health issues such as hypertension, pain and cancer. Poppy is mainly grown for its opium and oil contents; however, poppy seeds are also widely used for cooking purposes. Poppy seeds contain various essential bioactive compounds including alkaloids, flavonoids, phenolic compounds and polyunsaturated fatty acids that can be effectively used as food ingredients in various applications. Poppyseed oil is considered a good quality oil owing to its rich polyunsaturated fatty acid content. Thus, tremendous potential exists in poppy seeds to be used as functional food ingredients and nutraceutical agents in various formulations. Medicinal and functional uses of poppy seed have been discussed, including some aspects of the utilization of the poppy seeds in the food industry. Further research is required to bring out its ingredient potential in food and health supplements. Keywords: Poppy, seed oil, health attributes, industrial uses, medicinal uses

Published
2021

17. COVID-19 Pandemic and Food Safety Issues in Pakistan

Author

Sadia Aslam and Nauman Khalid

Subjects
2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, Environmental health, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pandemic, Medicine, TP368-456, business, Food safety, Food processing and manufacture, Food Science
Abstract

This article has no abstract. DOI: 10.18502/jfqhc.8.3.7193

Published
2021

18. Response by Khalid et al to Letter Regarding Article, 'Feasibility and Safety of High-Risk Percutaneous Coronary Intervention Without Mechanical Circulatory Support'

Author

Toby Rogers, Ron Waksman, and Nauman Khalid

Subjects
medicine.medical_specialty, Percutaneous Coronary Intervention, business.industry, medicine.medical_treatment, Circulatory system, medicine, Feasibility Studies, Humans, Percutaneous coronary intervention, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published
2021

19. Feasibility and Safety of High-Risk Percutaneous Coronary Intervention Without Mechanical Circulatory Support

Author

Nauman Khalid, Itsik Ben-Dor, Ron Waksman, Rebecca Torguson, Cheng Zhang, Hayder Hashim, Jason P. Wermers, Toby Rogers, Corey Shea, Anees Musallam, Nelson L. Bernardo, Yuefeng Chen, Lowell F. Satler, Brian C. Case, and Evan Shlofmitz

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, 030204 cardiovascular system & hematology, medicine.disease, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Cigarette smoking, Internal medicine, Circulatory system, medicine, Cardiology, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Recommendations to broaden the use of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (PCI) remain controversial with the absence of robust evidence from randomized clinical trials and the risk of device-related complications. This investigation examined whether performing high-risk PCI without elective MCS is feasible and safe. Methods: We performed a single-center, retrospective analysis for patients meeting contemporary high-risk PCI criteria as defined by the Interventional Council of the American College of Cardiology. These criteria include unprotected left main disease, last remaining conduit, left ventricular ejection fraction Results: The analysis included a cohort of 1680 patients (2887 lesions) with stable coronary artery disease who met high-risk PCI criteria and were treated from 2003 to 2018. The study population comprised 75% men and 68% whites. Mean age was 69.16±11.19 years. Conventional cardiovascular risk factors among our cohort were as follows: hypertension, 91%; hypercholesterolemia, 91%; diabetes, 44%; and cigarette smoking, 14%. Intravascular ultrasound was performed on 53% of the lesions. Rescue MCS was required in 0.8% of the patients. Procedural success was observed in 98.2% of the patients, while the 30-day mortality rate was 1.6%. The incidence of major complications was as follows: all-cause mortality, 1.6%; cardiac death, 0.8%; acute renal failure, 4.6%; stroke, 0.2%; and major bleeding, 1.1%. Conclusions: High-risk PCI as defined by the professional societies without elective MCS is feasible and safe in the majority of patients, challenging the current recommendations and practice. A randomized trial comparing unprotected versus protected high-risk PCI for these broad recommendations is warranted to best ascertain which patients would benefit from MCS.

Published
2021

20. Adverse events with orbital atherectomy: an analytic review of the MAUDE database

Author

Evan Shlofmitz, Rebecca Torguson, Anees Musallam, Hasan Javed, Jaffar M. Khan, Nelson L. Bernardo, Yuefeng Chen, Toby Rogers, Jason P. Wermers, Hayder Hashim, Nauman Khalid, and Ron Waksman

Subjects
Atherectomy, Coronary, medicine.medical_specialty, Atherectomy, business.industry, medicine.medical_treatment, Treatment outcome, MEDLINE, Coronary Artery Disease, Orbital atherectomy, United States, Treatment Outcome, medicine, Humans, Radiology, Vascular Calcification, Cardiology and Cardiovascular Medicine, Adverse effect, business
Published
2020

21. Trends in Death Rate 2009 to 2018 Following Percutaneous Coronary Intervention Stratified by Acuteness of Presentation

Author

Itsik Ben-Dor, Evan Shlofmitz, Alexandre H. Kajita, Nauman Khalid, Rebecca Torguson, Deepakraj Gajanana, Jaffar M. Khan, Toby Rogers, Yuefeng Chen, Lowell F. Satler, Hayder Hashim, Micaela Iantorno, Anees Musallam, William S. Weintraub, Ron Waksman, and Paul Kolm

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Population, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Cause of Death, Internal medicine, medicine, Humans, Hospital Mortality, Postoperative Period, Prospective Studies, Registries, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Prospective cohort study, education, Aged, education.field_of_study, business.industry, Mortality rate, Percutaneous coronary intervention, Middle Aged, medicine.disease, United States, Survival Rate, Conventional PCI, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Forecasting
Abstract

Percutaneous coronary intervention (PCI) has evolved dramatically, along with patient complexity. We studied trends in in-hospital mortality with changes in patient complexity over the last decade stratified by clinical presentation. The study population included all patients presenting to the cardiac catheterization lab between January 2009 and July 2018. Expected in-hospital mortality was calculated using the National Cardiovascular Data Registry CathPCI risk scoring system. Yearly mean in-hospital mortality rates (%) were plotted and smoothed by weighted least squares regression for each presentation: ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndrome (NSTE-ACS), and stable ischemic coronary artery disease (SI CAD). The overall cohort included 13,732 patients who underwent PCI during the study period, of whom 2,142 were for STEMI, 2,836 for NSTE-ACS, and 8,754 for SI CAD. Indications for PCI have changed over time, with more PCIs being performed for NSTE-ACS and STEMI than for SI CAD. NSTE-ACS and STEMI patients had a steady decrease in in-hospital mortality over time compared with SI CAD patients. Overall observed mortality continues to decrease in NSTE-ACS patients, with reduction in the observed mortality rate within the STEMI population to below expected since 2013. Patient complexity has not changed significantly. These results may be attributed to improved patient selection coupled with optimal pharmacotherapy with more robust therapies during procedure and hospitalization.

Published
2019

23. Takotsubo syndrome: The past, the present and the future

Author

Nauman Khalid, Lovely Chhabra, Sarah Aftab Ahmad, and Pooja Sareen

Subjects
Takotsubo syndrome, Acute coronary syndrome, medicine.medical_specialty, business.industry, Triggers, Disease, Research opportunities, 030204 cardiovascular system & hematology, Coronary disease, medicine.disease, Prognosis, Pathophysiology, 03 medical and health sciences, 0302 clinical medicine, Editorial, medicine, Anatomic variants, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Intensive care medicine
Abstract

Takotsubo syndrome is a wide spectrum disease with a dramatic clinical presentation mimicking acute coronary syndrome albeit without obstructive coronary disease and typically manifests in the backdrop of intense emotional or physical trigger. Pathophysiology is incompletely understood with multifactorial mechanistic pathways circling around a heart-brain-endocrine axis. Several anatomic and phenotypic variants exist with varied clinical manifestations. The aftermath of Takotsubo syndrome is not always benign and both short- and long-term complications can occur which may impact its prognosis. Several gaps in knowledge exist providing an impetus for tremendous future research opportunities.

Published
2019

24. Vitamin D deficiency in Pakistani population: critical overview from 2008 to 2018

Author

Saif Ullah, Faiza Syed, Nauman Khalid, Iftikhar Ahmed, Sadia Bibi, and Malik Shah Zaman Latif

Subjects
Vitamin, 0303 health sciences, education.field_of_study, Nutrition and Dietetics, 030309 nutrition & dietetics, business.industry, Khyber pakhtunkhwa, Population, Pakistani population, 030209 endocrinology & metabolism, medicine.disease, vitamin D deficiency, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, chemistry, Vitamin D and neurology, Medicine, business, education, Food Science, Demography
Abstract

PurposeThe purpose of this paper is to access the present situation of the Pakistani population that suffers from vitamin D deficiency.Design/methodology/approachA review-based study was conducted based on publications from Pakistan between the years 2008 and 2018. The publications were archived from Pub Med and Google Scholar databases. A total of 18 publications were shortlisted, based on the cutoff values of vitamin D sufficiency, insufficiency and deficiency.FindingsAs per the data, 38.5 per cent of the participants were males, 48.7 per cent were females and 12.8 per cent of the studies have not mentioned the genders of the participants. The cumulative results show that 58.17 per cent (95 per cent CI: 52.17, 64.16) of the population is vitamin D-deficient and 26.65 per cent (95 per cent CI: 21.63, 31.66) is insufficient in vitamin D. The highest level of vitamin D deficiency was reported from Sindh (62.15 per cent), followed by Khyber Pakhtunkhwa (60.57 per cent), Punjab (51.75 per cent) and the Federal Capital (49.25 per cent). Moreover, Cochran’s Q test indicated considerable heterogeneity (p= >0.001) with regard to Vitamin D deficiency (VDD) prevalence found among samples from the selected studies.Originality/valueThe present analysis suggests that more than half of the Pakistani population suffers from VDD, which, thus, should be considered as an epidemic and treated likewise.

Published
2019

25. Opportunities and challenges for functional and medicinal beverages: Current and future trends

Author

Rao Sanaullah Khan, Wahab Nazir, Sajid Maqsood, Nauman Khalid, Misbah Nazir, and Sania Arif

Subjects
2. Zero hunger, 0303 health sciences, Food industry, 030309 nutrition & dietetics, business.industry, 04 agricultural and veterinary sciences, Health consciousness, 040401 food science, 03 medical and health sciences, 0404 agricultural biotechnology, Functional food, Sugar intake, Food products, New product development, In patient, Clinical efficacy, Marketing, business, Food Science, Biotechnology
Abstract

Health and wellness are among the core segments of the fast-moving consumer goods (FMCG), with the ever-increasing health consciousness among consumers around the globe. Functional foods and beverages, formulated from natural ingredients with targeted physiological functions, are at the heart of research and development in food industry. However, the novel functional food product development requires extensive research and development activities i.e., clinical efficacy trials, which the food manufacturing companies cannot afford to perform owing to their limited R&D budget and limited technical know-how in this particular aspect. Further the consumer acceptance of these food products is another area of concern for functional beverages development. For example, among the beverages, one challenging task is to replace sucrose with naturally occurring sweeteners, which could effectively address concerns of sugar intake in patients with diabetes and provide a healthy choice for consumers. However, consumer acceptance of these beverages from the sensory point of view remains challenging. Therefore, to better map the opportunities and challenges associated with functional beverages development, this review focusses on recent trends in the global market and new opportunities that may arise as a result. A detailed analytical discussion on new potential functional beverages and related products has also been presented.

Published
2019

26. Techniques to Optimize the Use of Optical Coherence Tomography: Insights from the Manufacturer and User Facility Device Experience (MAUDE) Database

Author

Hayder Hashim, Robert Gallino, Nauman Khalid, Toby Rogers, Nelson L. Bernardo, Yuefeng Chen, Hector M. Garcia-Garcia, Ron Waksman, Evan Shlofmitz, Alexandre H. Kajita, Rebecca Torguson, Micaela Iantorno, and Jaffar M. Khan

Subjects
Percutaneous, Databases, Factual, medicine.medical_treatment, Coronary Artery Disease, 030204 cardiovascular system & hematology, computer.software_genre, Cardiac Catheters, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Optical coherence tomography, Predictive Value of Tests, Risk Factors, medicine, Humans, 030212 general & internal medicine, Adverse effect, Retrospective Studies, Modality (human–computer interaction), Database, medicine.diagnostic_test, Event (computing), business.industry, Percutaneous coronary intervention, Equipment Design, General Medicine, Coronary Vessels, Coronary arteries, Catheter, medicine.anatomical_structure, Equipment Failure, Stents, Cardiology and Cardiovascular Medicine, business, computer, Tomography, Optical Coherence
Abstract

Background/purpose Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality used to assess coronary arteries and as an adjunctive tool for optimization of percutaneous coronary interventions. Overall, the rate of complications and adverse events related to intravascular imaging is low. Limited data exist on the most commonly reported complications and modes of failure related to the use of OCT. Therefore, we analyzed the post-marketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to assess the reported complications and failure modes for OCT and reviewed techniques to optimize device use. Methods/materials The MAUDE database was queried for all event reports involving coronary OCT devices. Two independent reviewers identified 49 device reports included in the final analysis. Modes of failure and device-related patient complications were assessed. Results Of the 49 cases with reported device-related issues, 6.1% involved malfunction prior to insertion of the OCT catheter, and 30.6% of reported events did not result in an associated patient-related adverse event. The most commonly reported adverse events included coronary dissection and difficulty removing the catheter within a previously stented segment. No events of contrast-induced nephropathy were reported. Conclusions Findings from the MAUDE database highlight the modes of device-related events associated with OCT. Device issues are uncommon, and as a result, users should be aware of optimal techniques to prevent and minimize adverse events related to device use.

Published
2019

27. Adverse Events and Modes of Failure Related to Impella RP: Insights from the Manufacturer and User Facility Device Experience (MAUDE) Database

Author

Micaela Iantorno, Rebecca Torguson, Anees Musallam, Evan Shlofmitz, Nelson L. Bernardo, Yuefeng Chen, Toby Rogers, Nauman Khalid, Ron Waksman, Hayder Hashim, Deepakraj Gajanana, and Jaffar M. Khan

Subjects
Time Factors, Databases, Factual, Ventricular Dysfunction, Right, medicine.medical_treatment, 030204 cardiovascular system & hematology, Prosthesis Design, computer.software_genre, Food and drug administration, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Product Surveillance, Postmarketing, Humans, Medicine, Decompensation, User Facility, 030212 general & internal medicine, Myocardial infarction, Thrombus, Adverse effect, Impella, Heart Failure, Database, business.industry, General Medicine, medicine.disease, Prosthesis Failure, Ventricular assist device, Ventricular Function, Right, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business, computer
Abstract

Background/purpose Right ventricular (RV) mechanical circulatory support remains an important adjunctive therapy for RV failure refractory to medical therapy. Impella RP (Abiomed, Danvers, MA) is approved for providing temporary RV support for patients with acute right heart failure or decompensation following left ventricular assist device implantation, myocardial infarction, heart transplant, or open-heart surgery. Robust data on the most commonly reported complications and failure modes for the Impella RP are lacking. We analyzed the post-marketing surveillance data from the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database to assess these endpoints. Materials/methods The MAUDE database was queried for the time period January 1, 2009, through December 31, 2018, for Impella devices by Searching for the following event types: “injury”, “malfunction”, “death”, and “other”. The search yielded 436 device reports. Impella RP medical device reports were screened, and 35 reports were included for the final analysis. Results In cases of reported complications, Impella RP was placed most commonly for right ventricular failure (RVF) developing in postcardiotomy patients (20%). The most commonly reported complications included bleeding (42.9%) and vascular complications (22.8%). The modes of failure included damage or fracture of the device elements (34.2%); thrombus, or clot in the system (17.1%); and device detachment (8.6%). Conclusions Findings from the MAUDE database highlight the failure modes of the Impella RP device that should be addressed in order to improve the device performance and obtain improved clinical outcomes when utilized for RVF.

Published
2019

28. Unprotected Left Main Percutaneous Coronary Intervention With or Without Hemodynamic Support

Author

Itsik Ben-Dor, Nauman Khalid, Hayder Hashim, Cheng Zhang, Ron Waksman, Toby Rogers, Evan Shlofmitz, Sarah Aftab Ahmad, Corey Shea, Jason P. Wermers, Nelson L. Bernardo, and Lowell F. Satler

Subjects
Male, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Hemodynamics, Coronary Artery Disease, law.invention, Percutaneous Coronary Intervention, Postoperative Complications, Randomized controlled trial, law, Internal medicine, medicine, Humans, Major complication, Hospital Mortality, Mortality, Aged, Retrospective Studies, Aged, 80 and over, Intra-Aortic Balloon Pumping, business.industry, Percutaneous coronary intervention, Length of Stay, Middle Aged, Intensive care unit, Intensive Care Units, Treatment Outcome, Anesthesia, Case-Control Studies, Conventional PCI, Cardiology, Population study, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Hemodynamic support is widely utilized for unprotected left main (ULM) percutaneous coronary interventions (PCI) despite lack of evidence from randomized studies and the risk of device-related complications. We aimed to compare ULMPCI with and without intra-aortic balloon pump (IABP) support. A single-center, retrospective analysis was performed for patients undergoing ULMPCI with and without IABP support. Clinical, procedural, in-hospital, and 30-day cardiovascular outcomes were compared. From 2003 through 2018, 217 patients underwent non-emergent ULMPCI, 55 with elective IABP support (IABP group), and 162 without support (No-IABP group). The study population comprised 56.4% men and 74.5% Caucasians in the IABP group and 53.7% men and 62.3% Caucasians in the No-IABP group. The mean age for IABP and No-IABP group patients was 75.75 ± 12.34 years and 73.47 ± 15.19 years, respectively (p = 0.315). Procedural success was achieved in 99% of IABP and 95.3% of No-IABP patients (p = 0.089). In-hospital and 30-day mortality was 5.5% for the IABP group and 5.6% for the No-IABP group (p = 0.977). Rates of major complications were statistically similar between the groups. Bailout IABP was required in 10% of No-IABP patients. Hospital and intensive care unit length of stay was statistically longer in the IABP group. In conclusion, ULMPCI without IABP support was not associated with increased mortality and major cardiovascular outcomes compared with supported patients and was associated with shorter hospital and intensive care unit stay. A randomized trial comparing unsupported versus supported ULMPCI is warranted to identify patients who would benefit from hemodynamic support.

Published
2021

29. Intravascular Lithotripsy-Facilitated Carotid Interventions

Author

Sarah Aftab Ahmad, Waleed T. Kayani, Nauman Khalid, and Brian C. Case

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Endovascular Procedures, MEDLINE, Psychological intervention, Lithotripsy, Carotid Arteries, Treatment Outcome, medicine, Humans, Radiology, Nuclear Medicine and imaging, Surgery, Stents, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published
2021

30. Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Author

Simachew Animen Bante, Carlo Eduardo Medina-Solís, Rodrigo Sarmiento-Suárez, Deniz Yuce, Ninuk Hariyani, Virginia Núñez-Samudio, Zhi-Jiang Zhang, Lucas Guimarães Abreu, Sindhura Lakshmi Koulmane Laxminarayana, Ejaz Ahmad Khan, Natalie Maria Cormier, Ghulam Mustafa, Arielle Wilder Eagan, Shirin Djalalinia, Jalal Arabloo, Bay Vo, Mukhammad David Naimzada, Farahnaz Joukar, Arvin Haj-Mirzaian, Julia Moreira Pescarini, Getinet Kassahun, Robert Ancuceanu, Mohammad Ali Mansournia, Amin Soheili, Félix Carvalho, Edgar Denova-Gutiérrez, Aubrey J. Cook, Jasvinder A. Singh, Maysaa El Sayed Zaki, Sergio I. Prada, Seyedeh Zahra Masoumi, Rajesh Sagar, Emmanuel Peprah, Fenta Hun Y. Beyene, Mikhail Sergeevich Zastrozhin, Dimas Ria Angga Pribadi, Yun Jin Kim, Maryam Adabi, Feleke Mekonnen Demeke, Valentin Yurievich Skryabin, Mathew M. Baumann, Bárbara Niegia Garcia de Goulart, Ali Kazemi Karyani, Nooshin Abbasi, Eyayou Girma Tadesse, Sanjay Basu, Hadi Hassankhani, Keyghobad Ghadiri, Keshab Deuba, Dilshad Manzar, Robert L. Thompson, Keivan Ahmadi, Rahmatollah Moradzadeh, Shaimaa I. El-Jaafary, Alessandra C. Goulart, Diana Fernanda Bejarano Ramirez, Samata Nepal, Marcos Roberto Tovani-Palone, Gebiyaw Wudie Tsegaye, Irina Filip, Ian D. Letourneau, Ramesh Holla, Neda Kianipour, Maha El Tantawi, Lucas Earl, Paul S. F. Yip, Miguel A Barboza, Rajan Nikbakhsh, Nauman Khalid, Kimberly B. Johnson, Iván Landires, Manasi Kumar, Babak Moazen, Rohol Lah Kalhor, Dinh-Toi Chu, Lauren E. Schaeffer, Nima Rezaei, Alexandre C. Pereira, Susan F. Rumisha, Mehdi Hosseinzadeh, Xuefeng Liu, Feng Sha, Mahaveer Golechha, Davood Anvari, Urvish K Patel, Bing-Fang Hwang, Samath D Dharmaratne, Muhammad Aqeel, Kebede Deribe, Nelsensius Klau Fauk, Lillian Mwanri, Nuruzzaman Khan, Yunquan Zhang, Paula Moraga, Ai Koyanagi, Abdallah M. Samy, Nithin Kumar, Rahul Gupta, Samad Azari, Soheil Hassanipour, Archith Boloor, Kiana Ramezanzadeh, Andrew J. Croneberger, Enrico Rubagotti, Jaykaran Charan, Khezar Hayat, Amir Masoud Rahmani, Kio Mars Sharafi, Ionut Negoi, Simon I. Hay, Deborah Carvalho Malta, Yasser Vasseghian, Yihienew M. Bezabih, Jean Jacques Noubiap, Nazir Fattahi, Adnan Kisa, Alok Atreya, Devasahayam J. Christopher, Ayenew Kassie Tesema, Nuwan Darshana Wickramasinghe, Jaffar Abbas, Daniel Diaz, Desta Debalkie Atnafu, Malke Asaad, Arief Hargono, Zahid A Butt, Dharmesh Kumar Lal, Pankaj Bhardwaj, Amir Radfar, Salman Rawaf, Vardhmaan Jain, Amir Almasi-Hashiani, Krittika Bhattacharyya, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Mohammad Rifat Haider, Emily Haeuser, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Jagadish Rao Padubidri, Carlos Alberto Marrugo Arnedo, Beatriz Paulina Ayala Quintanilla, Tomislav Mestrovic, Hawraz Ibrahim M. Amin, Bhaskaran Unnikrishnan, Seithikurippu R. Pandi-Perumal, Arash Ziapour, Samantha Perkins, Deepa Jahagirdar, Akshaya Srikanth Bhagavathula, Eduarda Fernandes, Nataliya Foigt, Audrey L. Serfes, Fissaha Tekulu Welay, Savita Lasrado, Saad M.A. Dahlawi, Segun Emmanuel Ibitoye, Hedayat Abbastabar, Om P Kurmi, Hung Chak Ho, Faheem Hyder Pottoo, Priya Rathi, Chukwuma David Umeokonkwo, Ali Bijani, Shanshan Li, Reza Rawassizadeh, Vishnu Renjith, Barthelemy Kuate Defo, Giang Thu Vu, Farah Daoud, Tudorel Andrei, Ricardo de Souza Kuchenbecker, Fakher Rahim, Adeyinka Emmanuel Adegbosin, Sezer Kisa, Rajesh Elayedath, Shafiu Mohammed, Vinod C. Nayak, Fisaha Haile Tesfay, Cuong Tat Nguyen, Masoud Foroutan, Mingyou Yang, Yousef Mohammad, Abdul-Aziz Seidu, Benjamin K. Mayala, Diego Augusto Santos Silva, Amin Mousavi Khaneghah, Nikha Bhardwaj, Masoud Moradi, Charles Ugochukwu Ibeneme, Olatunji O. Adetokunboh, Carlo La Vecchia, Tesfay B.B. Gebremariam, Ritesh G. Menezes, Olatunde Aremu, Bogdan Oancea, Mohiuddin Ahsanul Kabir Chowdhury, Stefanie Watson, Yousef Moradi, Souranshu Chatterjee, Ugo Gori, Isabela M. Benseñor, Khem Narayan Pokhrel, Hailay Abrha Gesesew, Paul Ward, Carlos A Castañeda-Orjuela, Usman Iqbal, Rekha Thapar, Naser Mohammad Gholi Mezerji, Yasir Waheed, Ziad A. Memish, Vijay Kumar Chattu, Daiane Borges Machado, Shrikant Pawar, Soosanna Kumary Chattu, Sanni Yaya, Ketema Bizuwork Gebremedhin, Naohiro Yonemoto, Ahmad Ghashghaee, Marcela Agudelo-Botero, Amber Sligar, Nicole Davis Weaver, Kenji Shibuya, Claudiu Herteliu, Andreea Mirica, André Karch, Asif Hanif, Atif Amin Baig, Salah Eddin Karimi, Gulfaraz Khan, David Laith Rawaf, Andrew T Olagunju, Chuanhua Yu, Darshan B B, Olayinka Stephen Ilesanmi, Takeshi Fukumoto, Neeraj Bedi, Claudio Alberto Dávila-Cervantes, Muktar Beshir Ahmed, Deepak Madi, Ione Jayce Ceola Schneider, Masood Ali Shaikh, Juwel Rana, Tanuj Kanchan, Mohamed M. Gad, Syed Amir Gilani, Victor Adekanmbi, Mu'awiyyah Babale Sufiyan, Harish Chander Gugnani, Tadele G. Adal, Mohammad Hifz Ur Rahman, Leila R Kalankesh, Gbenga A. Kayode, Bach Xuan Tran, Ana Isabel Ribeiro, Basavaprabhu Achappa, Andem Effiong, André Faro, Javad Nazari, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Vahid Alipour, Sowmya J. Rao, Rosario Cárdenas, Milena Ilic, Ravi Prakash Jha, Zebenay Workneh Bitew, Nelson Alvis-Guzman, Dian Kusuma, Yum Ing Guo, Mowafa Househ, Arya Haj-Mirzaian, Krista M. Steuben, Hadush Negash, Ahamarshan Jayaraman Nagarajan, Irena Ilic, Laura Dwyer-Lindgren, Godfrey Mutashambara Rwegerera, Florian Fischer, Gebreamlak Gebremedhn Gebremeskel, Kate E. LeGrand, Ravishankar Nagaraja, Reza Mohammadpourhodki, Mark Drew Crosland Guimarães, Kewal Krishan, Maryam Zamanian, Paul H. Lee, Emerito Jose A. Faraon, Rafael Alves Guimarães, Aziz Sheikh, Marwa Rashad Salem, Michael A. Cork, Francesco Saverio Violante, Bright Opoku Ahinkorah, Liliana Preotescu, Somayeh Bohlouli, Aziz Rezapour, Ana Melisa Pardo-Montaño, Huong Lan Thi Nguyen, Khaled Khatab, Teklehaimanot Gereziher Haile, Mohammad Ali Moni, Govinda Prasad Dhungana, Leonardo Roever, Carlos Magis-Rodriguez, Andre R. Brunoni, Nathaniel J. Henry, Brijesh Sathian, Bingyu Li, Maciej Banach, Hasan Yusefzadeh, Nikita Otstavnov, Bruno Ramos Nascimento, Fernando de la Hoz, Georges Nguefack-Tsague, Zulfiqar A Bhutta, Robert Kaba Alhassan, Jae Il Shin, Andre Rodrigues Duraes, Yuan-Pang Wang, Felix Akpojene Ogbo, Mihajlo Jakovljevic, Eman Abu-Gharbieh, Vaman Kulkarni, Anna Aleksandrovna Skryabina, Sait Mentes Birlik, Maarten J. Postma, Chhabi Lal Ranabhat, Walter Mendoza, Yanzhong Wang, Maryam Keramati, Mahesh P A, Ali H. Mokdad, Muhammad Naveed, Nitin Joseph, Ronny Westerman, Bill & Melinda Gates Foundation, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Cork M.A., Henry N.J., Watson S., Croneberger A.J., Baumann M., Letourneau I.D., Yang M., Serfes A.L., Abbas J., Abbasi N., Abbastabar H., Abreu L.G., Abu-Gharbieh E., Achappa B., Adabi M., Adal T.G., Adegbosin A.E., Adekanmbi V., Adetokunboh O.O., Agudelo-Botero M., Ahinkorah B.O., Ahmadi K., Ahmed M.B., Alhassan R.K., Alipour V., Almasi-Hashiani A., Alvis-Guzman N., Ancuceanu R., Andrei T., Anvari D., Aqeel M., Arabloo J., Aremu O., Asaad M., Atnafu D.D., Atreya A., Quintanilla B.P.A., Azari S., B D.B., Baig A.A., Banach M., Bante S.A., Barboza M.A., Basu S., Bedi N., Ramirez D.F.B., Bensenor I.M., Beyene F.-H.Y., Bezabih Y.M., Bhagavathula A.S., Bhardwaj N., Bhardwaj P., Bhattacharyya K., Bhutta Z.A., Bijani A., Birlik S.M., Bitew Z.W., Bohlouli S., Boloor A., Brunoni A.R., Butt Z.A., Cardenas R., Carvalho F., Castaldelli-Maia J.M., Casta-neda-orjuela C.A., Charan J., Chatterjee S., Chattu V.K., Chattu S.K., Chowdhury M.A.K., Christopher D.J., Chu D.-T., Cook A.J., Cormier N.M., Dahlawi S.M.A., Daoud F., Davila-Cervantes C.A., Weaver N.D., De la Hoz F.P., Demeke F.M., Denova-Gutierrez E., Deribe K., Deuba K., Dharmaratne S.D., Dhungana G.P., Diaz D., Djalalinia S., Duraes A.R., Eagan A.W., Earl L., Effiong A., Zaki M.E.S., Tantawi M.E., Elayedath R., El-Jaafary S.I., Faraon E.J.A., Faro A., Fattahi N., Fauk N.K., Fernandes E., Filip I., Fischer F., Foigt N.A., Foroutan M., Fukumoto T., Gad M.M., Gebremariam T.B.B., Gebremed-Hin K.B., Gebremeskel G.G., Gesesew H.A., Ghadiri K., Ghashghaee A., Gilani S.A., Golechha M., Gori U., Goulart A.C., Goulart B.N.G., Gugnani H.C., Guimaraes M.D.C., Guimaraes R.A., Guo Y.-I., Gupta R., Haeuser E., Haider M.R., Haile T.G., Haj-Mirzaian A., Hanif A., Hargono A., Hariyani N., Hassanipour S., Hassankhani H., Hayat K., Herteliu C., Ho H.C., Holla R., Hosseinzadeh M., Househ M., Hwang B.-F., Ibeneme C.U., Ibitoye S.E., Ile-Sanmi O.S., Ilic M.D., Ilic I.M., Iqbal U., Jahagir-Dar D., Jain V., Jakovljevic M., Jha R.P., Johnson K.B., Joseph N., Joukar F., Kalankesh L.R., Kalhor R.-L., Kanchan T., Matin B.K., Karch A., Karimi S.E., Kassahun G., Kayode G.A., Karyani A.K., Keramati M., Khalid N., Khan E.A., Khan G., Khan M.N.N., Khatab K., Kianipour N., Kim Y.J., Kisa S., Kisa A., Kosen S., Laxminarayana S.L.K., Koyanagi A., Krishan K., Defo B.K., Kuchenbecker R.S., Kulkarni V., Kumar N., Kumar M., Kurmi O.P., Kusuma D., Vecchia C.L., Lal D.K., Landires I., Lasrado S., Lee P.H., Legrand K.E., Li B., Li S., Liu X., Amin H.I.M., Machado D.B., Madi D., Magis-Rodriguez C., Malta D.C., Mansournia M.A., Manzar M.D., Arnedo C.A.M., Martins-Melo F.R., Masoumi S.Z., Mayala B.K., Medina-Solis C.E., Memish Z.A., Mendoza W., Menezes R.G., Mestrovic T., Mirica A., Moazen B., Mohammad Y., Mezerji N.M.G., Mohammadian-Hafshejani A., Mohammadpourhodki R., Mohammed S., Mokdad A.H., Moni M.A., Moradi M., Moradi Y., Moradzadeh R., Moraga P., Khaneghah A.M.-S., Mustafa G., Mwanri L., Nagaraja R., Nagarajan A.J., Naim-Zada M.D., Nascimento B.R., Naveed D.M., Nayak V.C., Nazari J., Negash H., Negoi I., Nepal S., Nguefack-Tsague G., Nguyen C.T., Nguyen H.L.T., Nikbakhsh R., Noubiap J.J., Nunez-Samudio V., Oancea B., Ogbo F.A., Olagunju A.T., Otstav-Nov N., A M.P., Padubidri J.R., Pandi-Perumal S.R., Pardo-Montano A.M., Patel U.K., Pawar S., Peprah E.K., Pereira A., Perkins S., Pescarini J.M., Pokhrel K.N., Postma M.J., Pot-Too F.H., Prada S.I., Preotescu L., Pribadi D.R.A., Radfar A., Rahim F., Rahman M.H.U., Rahmani A.M., Ramezanzadeh K., Rana J., Ranabhat C.L., Rao S.J., Rathi P., Rawaf S., Rawaf D.L., Rawassizadeh R., Renjith V., Rezaei N., Rezapour A., Ribeiro A.I., Roever L., Rubagotti E., Rumisha S.F., Rwegerera G.M., Sagar R., Sajadi S.M., Salem M.R., Samy A.M., Sarmiento-Suarez R., Sathian B., Schaeffer L.E., Schneider I.J.C., Seidu A.-A., Sha F., Shaikh M.A., Sharafi K.-M., Sheikh A., Shibuya K., Shin J.I., Silva D.A.S., Singh J.A., Skryabin V.Y., Skryabina A.A., Sligar A., Soheili A., Steuben K.M., Sufiyan M.B., Tadesse E.G., Tesema A.K.T., Tesfay F.H., Thapar R., Thompson R.L., Tovani-Palone M.R., Tran B.X., Tsegaye G.W., Umeokonkwo C.D., Unnikrish-Nan B., Vasseghian Y., Violante F.S., Vo B., Vu G.T., Waheed Y., Wang Y.-P., Wang Y., Ward P., Welay F.T., Westerman R., Wickramasinghe N.D., Yaya S., Yip P., Yonemoto N., Yu C., Yuce D., Yusefzadeh H., Zamanian M., Zastroz-Hin M.S., Zhang Z.-J., Zhang Y., Ziapour A., Hay S.I., Dwyer-Lindgren L., Local Burden of Disease HIV Collaborators, Clinicum, HUS Comprehensive Cancer Center, Cork, Michael A, Henry, Nathaniel J, Watson, Stefanie, Croneberger, Andrew J, Ahmed, Muktar B, Dwyer-Lindgren, Laura, Instituto de Saúde Pública da Universidade do Porto, and Collaborators, Local Burden of Disease HIV

Subjects
Male, Latin Americans, lcsh:Medicine, LOW-INCOME, HIV Infections, HIV mortality, HIV/AIDS, Latin America, Mapping, Small area estimation, Spatial statistics, Vital registration, Vital registrations, 0302 clinical medicine, ANTIRETROVIRAL THERAPY, Medicine, 030212 general & internal medicine, Registries, 11 Medical and Health Sciences, media_common, Mortality rate, 1. No poverty, DEATH, Regression analysis, General Medicine, Middle Aged, BRAZIL, Local Burden of Disease HIV Collaborators, 3. Good health, AIDS, SEX, A990 Medicine and Dentistry not elsewhere classified, Female, HEALTH, 0305 other medical science, Life Sciences & Biomedicine, Research Article, Adult, medicine.medical_specialty, Inequality, Adolescent, media_common.quotation_subject, TUBERCULOSIS, Small area estimations, 03 medical and health sciences, Medicine, General & Internal, Sex Factors, Acquired immunodeficiency syndrome (AIDS), HIV mortalities, General & Internal Medicine, Humans, Aged, Science & Technology, 030505 public health, business.industry, Public health, lcsh:R, Ecological study, HIV, Bayes Theorem, GLOBAL BURDEN, medicine.disease, TRENDS, Vital Statistics, Spatial statistic, 3121 General medicine, internal medicine and other clinical medicine, Human medicine, business, Demography
Abstract

Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

Published
2021

31. One-Year Outcomes After Treatment of Ostial In-Stent Restenosis in Left Circumflex Versus Left Anterior Descending or Right Coronary Artery

Author

Toby Rogers, Brian J. Forrestal, Anees Musallam, Itsik Ben-Dor, Rebecca Torguson, Hayder Hashim, Brian C. Case, Evan Shlofmitz, Ron Waksman, Jaffar M. Khan, Chava Chezar-Azerrad, Cheng Zhang, Corey Shea, Gary S. Mintz, Nelson L. Bernardo, Yuefeng Chen, Lowell F. Satler, Charan Yerasi, and Nauman Khalid

Subjects
Atherectomy, Coronary, Male, medicine.medical_specialty, Brachytherapy, Myocardial Infarction, Hemorrhage, Coronary Artery Disease, 030204 cardiovascular system & hematology, Lesion, Coronary Restenosis, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Postoperative Complications, Restenosis, Recurrence, Internal medicine, medicine.artery, Diabetes mellitus, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, Circumflex, Hospital Mortality, Angioplasty, Balloon, Coronary, Ultrasonography, Interventional, Aged, Proportional Hazards Models, business.industry, Drug-Eluting Stents, medicine.disease, Stroke, Treatment Outcome, Bypass surgery, Metals, Right coronary artery, Cardiology, Female, Stents, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

The prognosis of left circumflex (LC) versus non-LC in-stent restenosis (ISR) ostial lesions following treatment has not been assessed. We aimed to assess this prognosis. Anecdotally, treatment of ostial LC ISR has been associated with high recurrence rates. We performed a retrospective analysis of patients from our institution who underwent coronary intervention of an ostial ISR lesion between 2003 and 2018. The primary endpoint was target lesion revascularization (TLR) and major adverse cardiovascular events (MACE). Overall, 563 patients underwent ostial ISR lesion intervention, 144 for an ostial LC ISR lesion. Compared to patients with ostial ISR in non-LC lesions, patients with ostial LC ISR were older, had higher rates of diabetes mellitus and previous coronary bypass surgery. At 1-year follow-up, TLR-MACE rates were 26.6% in the LC group versus 18.4% in the non-LC group (p = 0.036). The TLR rate was also higher in the LC group compared to the non-LC group (p = 0.0498). Univariate and multivariate analyses demonstrated a higher TLR-MACE rate for LC versus non-LC ostial ISR lesions. In conclusion, our study shows increased event rates after treatment of LC versus non-LC ISR lesions. Further studies should be done to assess the optimal treatment approach for ostial LC ISR.

Published
2021

32. Application of Bioplastics in Agro-Based Industries and Bioremediation

Author

Sharjeel Ahmad, Ahmad Ali, Saira Abbas, Iftikhar Ahmed, and Nauman Khalid

Subjects
Food packaging, Polyhydroxybutyrate, Petroleum product, Waste management, business.industry, Biomass, Environmental science, Biodegradation, Raw material, business, Bioplastic, Polyhydroxyalkanoates
Abstract

Bioplastics are the plastics composed from the biomass of corn, sugarcane, etc., which nowadays form an eco-friendly system that saves fuel burning, CO2 emission, and plastic. There are emerging interests in agro-based research packaging for designing cost-effective bioplastics, thanks to the heavy burden of diseases from petroleum products. Plastic industries are among the foremost important and regularly applied industries within the globe, and they are widely employed due to its biodegradability nature. Polyhydroxybutyrate (PHB) and polyhydroxyalkanoate (PHA) are naturally produced by microorganisms that can be considered as a substitute for the standard plastics. These biodegradable materials are currently providing a sustainable alternative to petroleum feedstock. Mostly, biodegradable polymers get hydrolyzed into biomass, CH4, CO2, and other inorganic compounds. The utilization of bioorigin materials in food packaging has led to the tremendous innovation during last couple of years, which were obtained through microbial fermentations (e.g., starch and cellulose). The plant-based bioplastics are considered to be more durable, cost-effective, chemical independent, highly immune to microwaves, and less brittle. It is concluded that the assembly and use of bioplastics will aid in the sustainability of the environment by reducing greenhouse gases (GHGs), reduction in waste biomass, and as a substitute to petroplastics.

Published
2021

33. Prevention of Renal Stone Recurrence: Knowledge and Practice Patterns Among Medical Officers of DHQ Hospital, Faisalabad

Author

Muhammad Waqas Iqbal, Muhammad Akmal, Hanan Noor, Ghulam Mehboob Subhani, Muhammad Saifullah, Nauman Khalid, and Muhammad Sohail

Subjects
medicine.medical_specialty, Renal stone, Practice patterns, business.industry, General surgery, medicine, business
Abstract

Objective: To assess the knowledge and practice patterns among medical officers of DHQ Hospital, Faisalabad in the prevention of recurrent renal stones. Cross sectional study. DHQ hospital, Faisalabad during 01-01-2019 to 30-09-2019. Methods: In this study the medical officers of either gender and age more than 25 years and working in DHQ Hospital, Faisalabad were included. They were assessed on the basis of a designed questionnaire regarding their general practice and knowledge in order to prevent renal stone recurrence. The paper based questionnaire was circulated to medical officers in different departments of the hospital. Results: In this study total 225 medical officers that were included. 135 (60%) of these participants were males and 90 (40%) were females. The mean age of the participants was 29.70±3.21 years. The mean working experience was 4.40±2.18 years. On assessment, 65.67% medical officers had adequate knowledge regarding recurrent renal stone prevention according to latest practice guidelines. Unfortunately 62.22% respondents were not practicing their knowledge adequately. Conclusion: The knowledge regarding the clinical practices in light of recent guidelines was optimal, however the practice regarding the preventive strategies was below power. Keywords; Renal stone, Recurrence, Medical officer, prevention.

Published
2020

34. Right transradial coronary angiography in the setting of tortuous brachiocephalic/thoracic aorta ('elephant head'): Impact on fluoroscopy time and contrast use

Author

Hayder Hashim, Ron Waksman, Brian C. Case, Yuefeng Chen, Evan Shlofmitz, Brian J. Forrestal, Charan Yerasi, Jaffar M. Khan, Nauman Khalid, Chava Chezar-Azerrad, and Anees Musallam

Subjects
Coronary angiography, Male, medicine.medical_specialty, Cardiac Catheterization, Head impact, media_common.quotation_subject, Elephants, Aorta, Thoracic, 030204 cardiovascular system & hematology, Coronary Angiography, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, medicine, Contrast (vision), Fluoroscopy, Thoracic aorta, Animals, Humans, Radiology, Nuclear Medicine and imaging, In patient, 030212 general & internal medicine, media_common, Aorta, medicine.diagnostic_test, business.industry, General Medicine, Catheter, Treatment Outcome, Angiography, Radial Artery, Female, Radiology, Cardiology and Cardiovascular Medicine, Nuclear medicine, business
Abstract

Objectives Assess the impact on fluoroscopy time and contrast use in patients with tortuous brachiocephalic/thoracic aortas undergoing right transradial coronary angiography (RTCA) and provide strategies to manage. Background Unfavorable anatomy with severe brachiocephalic/thoracic tortuosity, referred to as an "elephant head," remains a significant obstacle for RTCA. Methods We reviewed the coronary angiograms of patients who underwent RTCA and had tortuous aortas. Angiography was attempted first using a universal catheter (Tiger) and switched to a left coronary specific catheter (Judkins Left [JL]) if challenging. Fluoroscopy time, contrast volume, and greatest distance from the patient's midline to the catheter in the aorta were recorded. Results Forty-nine patients (62.6 ± 12.0 years, 69.4% male) were included. Fifteen (30.6%) patients underwent successful angiography with a Tiger catheter; 34 (69.4%) patients required switching to JL catheter. The average distance of Tiger catheters to the midline of the spine was 0.78 ± 0.41 cm versus 1.28 ± 0.44 cm (p = .001) in JL catheters. Tiger catheter use resulted in less fluoroscopy time (6.48 ± 4.73 min) and contrast use (58.87 ± 43.53 ml) than in cases switched to JL (13.26 ± 10.76 min [p = .026]; 86.5 ± 69.95 ml [(p = .017]). Conclusions For patients undergoing RTCA with significant brachiocephalic/thoracic aorta tortuosity, "elephant head," a Tiger catheter can be used efficiently for curvatures 1 cm, operators should consider immediately switching to a JL catheter.

Published
2020

35. Abstract 16169: Modes of Failure and Patient Adverse Events of Fractional Flow Reserve Guidewires: Insights From the United States Food and Drug Administration Manufacturer and User Facility Device Experience Database

Author

Hassan Kamran, Waleed T. Kayani, Hani Jneid, Nasser Lakkis, Mirza Khalid, Hussain Ahmed Raza, Yagya Pandey, and Nauman Khalid

Subjects
Food and drug administration, business.industry, Physiology (medical), medicine, User Facility, Fractional flow reserve, Medical emergency, Cardiology and Cardiovascular Medicine, Adverse effect, medicine.disease, business
Abstract

Introduction: Fractional Flow Reserve (FFR) measurement is commonly used in the cardiac catheterization laboratory to assess functional significance of coronary arterial plaques. Robust real-world data on complications and modes of failure of FFR guidewires are limited. We analyzed the post-marketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to report these endpoints for commonly utilized FFR guidewire. Methods: MAUDE database was queried from January 1, 2010, to April 1, 2020, for 3 commonly used FFR guidewires (PressureWire TM X (Abbott), Comet TM (Boston Scientific) and Verrata TM (Philips)) by searching for following events: “injury”, “malfunction”, “death”, and “other” yielding 544 reports. After excluding incomplete reports and older devices not in current use, 486 reports were analyzed. Results: Figure 1 shows reported modes of failure and patient adverse events. Guidewire tip fracture was the most reported mode of failure in 174 (35.8%) cases. Guidewire kinking (n= 152 (31.3%)), communication failure (n= 141 (29.0%)), and shaft fracture (n= 67 (13.8%)) were also reported. 133 (27.4%) of total device failures resulted in patient adverse events. Most common patient adverse event was retained guidewire tip in 71 (53.4%) cases followed by freshly deployed stent dislodgment (n= 26 (19.6%)) and coronary artery dissection (n=23 (17.3%)) respectively. 6 patient deaths were reported. Conclusions: FFR guidewire failures can occur due to a variety of mechanisms and lead to patient adverse events. MAUDE database serves as an important platform for improved collaboration between clinicians, device manufacturers, and regulatory bodies to improve device performance and optimize patient outcomes. Our analysis provides insights into the mechanism of FFR guidewire failure and associated adverse events but cannot verify causality or provide a comparison among different guidewires.

Published
2020

36. Abstract 16040: High-risk Percutaneous Coronary Intervention Without Mechanical Circulatory Support in Acute Coronary Syndrome

Author

Brian J. Forrestal, Itsik Ben-Dor, Nelson L. Bernardo, Yuefeng Chen, Lowell F. Satler, Hayder Hashim, Brian Case, Charan Yerasi, Cheng Zhang, Chava Chezar Azerrad, Toby Rogers, Ron Waksman, Nauman Khalid, Anees Musallam, Corey Shea, Evan Shlofmitz, and Hasan Javed

Subjects
Acute coronary syndrome, medicine.medical_specialty, Interventional cardiology, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, medicine.disease, Physiology (medical), Internal medicine, Circulatory system, medicine, Cardiology, Cardiology and Cardiovascular Medicine, Complication, business
Abstract

Background: Use of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (HRPCI) remains controversial with lack of randomized evidence and associated complication risks from these devices. We investigated whether performing HRPCI without elective MCS in patients with acute coronary syndrome (ACS) is safe and feasible. Methods: A single-center, retrospective analysis was done for patients presenting with ACS meeting HRPCI criteria (defined by Interventional Council of American College of Cardiology) including unprotected left main disease, last remaining conduit, left ventricular ejection fraction Results: From 2003-2018, 1992 patients (2887 lesions) with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) and 920 patients (1328 lesions) with ST-segment elevation myocardial infarction (STEMI) underwent HRPCI. The study population had 64.8% men and 52.9% Caucasians in UA/NSTEMI-group and 64.3% men and 53.7% Caucasians in STEMI-group. Mean age for UA/NSTEMI and STEMI patients were 68.6+/-12.69 and 64.52+/-13.54 years respectively. Procedural success was achieved in 96.5% of UA/NSTEMI and 97.9% of STEMI patients. In-hospital and 30-day all-cause mortality was 2.1% for UA/NSTEMI and 4.7% for STEMI patients. Bailout MCS was required in 2.4% of UA/NSTEMI and 9.9% of STEMI patients. Rates of major complications for UA/NSTEMI and STEMI were low, except for renal failure (Panel A). Panel B provides HRPCI criteria distribution. Conclusions: HRPCI without elective MCS is safe and feasible in majority of ACS patients challenging the current practices of professional societies. A randomized trial comparing unprotected vs. protected HRPCI for ACS patients is warranted to identify patients that would benefit from MCS.

Published
2020

37. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. Parry, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Anna E. Torre, Vinod C Nayak, Jamileh Shadid, Susanne Breitner, Mohammad Khammarnia, Mathilde Touvier, Ensiyeh Jenabi, Hosna Janjani, Floriane Ausloos, Irmina Maria Michalek, Alexandra S. Boon-Dooley, Jessica A. Cruz, Syed Mohamed Aljunid, Abiodun M. Adeoye, André Faro, Bartosz Miazgowski, Jobert Richie Nansseu, Erin C Mullany, Giannina Ferrara, Martin McKee, Emmanuel Peprah, Oommen John, Reza Saeedi, Yasser Vasseghian, Dragos Virgil Davitoiu, Sarah Wulf Hanson, Yingxi Zhao, Omid Shafaat, Ali Rajabpour-Sanati, Farid Najafi, Ana Maria Mantilla Herrera, Fatemeh Rajati, Tarun Gupta, Łukasz Szumowski, Mohammed Ibrahim Mohialdeen Gubari, Peter Njenga Keiyoro, Dharmesh Kumar Lal, Zhi Jiang Zhang, Osayomwanbo Osarenotor, Tanvir M. Huda, Perminder S. Sachdev, Farhad Ghamari, Era Upadhyay, Vivek Kumar, Guoqing Hu, Vinay Nangia, Vladimir Andreevich Korshunov, Saeed Shahabi, Golnaz Heidari, Ashraf Nabhan, Robert C. 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Mini, Christian Razo, Manuela L. Ferreira, Diego De Leo, Francesco Saverio Violante, Aristidis Tsatsakis, Zahra Sadat Dibaji Forooshani, Tea Lallukka, Dickson A. Amugsi, Anna Poznańska, Graeme J. Hankey, Kewal Krishan, Maryam Zamanian, Eirini Skiadaresi, Jai K Das, Felix Greaves, Tessa M. Pilz, Sameer Vali Gopalani, Mansour Ghafourifard, M. DeLang, Morteza Mahmoudi, Alton Lu, Brian J. Hall, Ravi Prakash Jha, David Edvardsson, Xiu Ju George Zhao, Farshad Farzadfar, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Neeraj Bhala, Stefan Lorkowski, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Rashid Abdi Guled, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Afsaneh Arzani, Ayesha Humayun, Simin Liu, Maryam Khayamzadeh, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Paolo Lauriola, Abbas Mosapour, Sophia Emmons-Bell, Khurshid Alam, Rajat Das Gupta, Matilde Leonardi, Muktar Beshir Ahmed, Jeffrey V. Lazarus, Mohamed M. 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M, Jahani, M, Jakovljevic, M, Jalilian, F, James, S, Janjani, H, Javaheri, T, Javidnia, J, Jeemon, P, Jenabi, E, Jha, R, Jha, V, Ji, J, Johansson, L, John, O, John-Akinola, Y, Johnson, C, Jonas, J, Joukar, F, Jozwiak, J, Jurisson, M, Kabir, A, Kabir, Z, Kalani, H, Kalani, R, Kalankesh, L, Kalhor, R, Kanchan, T, Kapoor, N, Matin, B, Karch, A, Karim, M, Kassa, G, Katikireddi, S, Kayode, G, Kazemi Karyani, A, Keiyoro, P, Keller, C, Kemmer, L, Kendrick, P, Khalid, N, Khammarnia, M, Khan, E, Khan, M, Khatab, K, Khater, M, Khatib, M, Khayamzadeh, M, Khazaei, S, Kieling, C, Kim, Y, Kimokoti, R, Kisa, A, Kisa, S, Kivimaki, M, Knibbs, L, Knudsen, A, Kocarnik, J, Kochhar, S, Kopec, J, Korshunov, V, Koul, P, Koyanagi, A, Kraemer, M, Krishan, K, Krohn, K, Kromhout, H, Kuate Defo, B, Kumar, G, Kumar, V, Kurmi, O, Kusuma, D, La Vecchia, C, Lal, D, Lalloo, R, Lallukka, T, Lami, F, Landires, I, Lang, J, Langan, S, Larsson, A, Lasrado, S, Lauriola, P, Lazarus, J, Lee, P, Lee, S, Legrand, K, Leigh, J, Leonardi, M, Lescinsky, H, Leung, J, Levi, M, Li, S, Lim, L, Linn, S, Liu, S, Liu, Y, Lo, J, Lopez, A, Lopez, J, Lopukhov, P, Lorkowski, S, Lotufo, P, Lu, A, Lugo, A, Maddison, E, Mahasha, P, Mahdavi, M, Mahmoudi, M, Majeed, A, Maleki, A, Maleki, S, Malekzadeh, R, Malta, D, Mamun, A, Manda, A, Manguerra, H, Mansour-Ghanaei, F, Mansouri, B, Mansournia, M, Mantilla Herrera, A, Maravilla, J, Marks, A, Martin, R, Martini, S, Martins-Melo, F, Masaka, A, Masoumi, S, Mathur, M, Matsushita, K, Maulik, P, Mcalinden, C, Mcgrath, J, Mckee, M, Mehndiratta, M, Mehri, F, Mehta, K, Memish, Z, Mendoza, W, Menezes, R, Mengesha, E, Mereke, A, Mereta, S, Meretoja, A, Meretoja, T, Mestrovic, T, Miazgowski, B, Miazgowski, T, Michalek, I, Miller, T, Mills, E, Mini, G, Miri, M, Mirica, A, Mirrakhimov, E, Mirzaei, H, Mirzaei, M, Mirzaei, R, Mirzaei-Alavijeh, M, Misganaw, A, Mithra, P, Moazen, B, Mohammad, D, Mohammad, Y, Mohammad Gholi Mezerji, N, Mohammadian-Hafshejani, A, Mohammadifard, N, Mohammadpourhodki, R, Mohammed, A, Mohammed, H, Mohammed, J, Mohammed, S, Mokdad, A, Molokhia, M, Monasta, L, Mooney, M, Moradi, G, Moradi, M, Moradi-Lakeh, M, Moradzadeh, R, Moraga, P, Morawska, L, Morgado-Da-Costa, J, Morrison, S, Mosapour, A, Mosser, J, Mouodi, S, Mousavi, S, Khaneghah, A, Mueller, U, Mukhopadhyay, S, Mullany, E, Musa, K, Muthupandian, S, Nabhan, A, Naderi, M, Nagarajan, A, Nagel, G, Naghavi, M, Naghshtabrizi, B, Naimzada, M, Najafi, F, Nangia, V, Nansseu, J, Naserbakht, M, Nayak, V, Negoi, I, Ngunjiri, J, Nguyen, C, Nguyen, H, Nguyen, M, Nigatu, Y, Nikbakhsh, R, Nixon, M, Nnaji, C, Nomura, S, Norrving, B, Noubiap, J, Nowak, C, Nunez-Samudio, V, Oancea, B, Odell, C, Ogbo, F, Oh, I, Okunga, E, Oladnabi, M, Olagunju, A, Olusanya, B, Olusanya, J, Omer, M, Ong, K, Onwujekwe, O, Orpana, H, Ortiz, A, Osarenotor, O, Osei, F, Ostroff, S, Otoiu, A, Otstavnov, N, Otstavnov, S, Overland, S, Owolabi, M, Mahesh, P, Padubidri, J, Palladino, R, Panda-Jonas, S, Pandey, A, Parry, C, Pasovic, M, Pasupula, D, Patel, S, Pathak, M, Patten, S, Patton, G, Toroudi, H, Peden, A, Pennini, A, Pepito, V, Peprah, E, Pereira, D, Pesudovs, K, Pham, H, Phillips, M, Piccinelli, C, Pilz, T, Piradov, M, Pirsaheb, M, Plass, D, Polinder, S, Polkinghorne, K, Pond, C, Postma, M, Pourjafar, H, Pourmalek, F, Poznanska, A, Prada, S, Prakash, V, Pribadi, D, Pupillo, E, Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Rafiee, A, Raggi, A, Rahman, M, Rajabpour-Sanati, A, Rajati, F, Rakovac, I, Ram, P, Ramezanzadeh, K, Ranabhat, C, Rao, P, Rao, S, Rashedi, V, Rathi, P, Rawaf, D, Rawaf, S, Rawal, L, Rawassizadeh, R, Rawat, R, Razo, C, Redford, S, Reiner, R, Reitsma, M, Remuzzi, G, Renjith, V, Renzaho, A, Resnikoff, S, Rezaei, N, Rezapour, A, Rhinehart, P, Riahi, S, Ribeiro, D, Rickard, J, Rivera, J, Roberts, N, Rodriguez-Ramirez, S, Roever, L, Ronfani, L, Room, R, Roshandel, G, Roth, G, Rothenbacher, D, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, E, Sadeghi, M, Saeedi, R, Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.

Subjects
Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Published
2020

38. Therapeutic benefits of music-based synchronous finger tapping in Parkinson’s disease—an fNIRS study protocol for randomized controlled trial in Dalian, China

Author

Fengyu Cong, Joanne Ly, William C. Tang, Nauman Khalid Qureshi, Zhanhua Liang, Lanlan Pu, and Bingwei Zhang

Subjects
China, medicine.medical_specialty, Music therapy, Parkinson's disease, Psychological intervention, Medicine (miscellaneous), fNIRS, 050105 experimental psychology, law.invention, Motor-control, Study Protocol, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Randomized controlled trial, Rating scale, law, medicine, Humans, 0501 psychology and cognitive sciences, Pharmacology (medical), Prospective Studies, Randomized Controlled Trials as Topic, lcsh:R5-920, Explicit and implicit timing, Spectroscopy, Near-Infrared, business.industry, 05 social sciences, Montreal Cognitive Assessment, Parkinson Disease, Synchronous finger tapping, medicine.disease, Cohort, Finger tapping, Parkinson’s disease, Randomized controlled trials, lcsh:Medicine (General), business, Music, 030217 neurology & neurosurgery
Abstract

Background Music therapy improves neuronal activity and connectivity of healthy persons and patients with clinical symptoms of neurological diseases like Parkinson’s disease, Alzheimer’s disease, and major depression. Despite the plethora of publications that have reported the positive effects of music interventions, little is known about how music improves neuronal activity and connectivity in afflicted patients. Methods For patients suffering from Parkinson’s disease (PD), we propose a daily 25-min music-based synchronous finger tapping (SFT) intervention for 8 weeks. Eligible participants with PD are split into two groups: an intervention group and a control arm. In addition, a third cohort of healthy controls will be recruited. Assessment of finger tapping performances, the Unified Parkinson’s Disease Rating Scale (UPDRS), an n-back test, the Montreal Cognitive Assessment (MoCA), as well as oxygenated hemoglobin (HbO2), deoxygenated hemoglobin (HbR), and total hemoglobin activation collected by functional near-infrared spectroscopy (fNIRS) are measured at baseline, week 4 (during), week 8 (post), and week 12 (retention) of the study. Data collected from the two PD groups are compared to baseline performances from healthy controls. Discussion This exploratory prospective trial study investigates the cortical neuronal activity and therapeutic effects associated with an auditory external cue used to induce automatic and implicit synchronous finger tapping in patients diagnosed with PD. The extent to which the intervention is effective may be dependent on the severity of the disease. The study’s findings are used to inform larger clinical studies for optimization and further exploration of the therapeutic effects of movement-based music therapy on neural activity in neurological diseases. Trial registration ClinicalTrials.gov NCT04212897. Registered on December 30, 2019. The participant recruitment and study protocol have received ethical approval from the First Affiliated Hospital of Dalian Medical University. The hospital Protocol Record number is PJ-KY-2019-123. The protocol was named “fNIRS Studies of Music Intervention of Parkinson’s Disease.” The current protocol is version 1.1, revised on September 1, 2020.

Published
2020

39. Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Author

Giulio Castelpietra, Feng Sha, Khalid A Altirkawi, Seyedeh Zahra Masoumi, Gebreamlak Gebremedhn Gebremeskel, Ahmad Daryani, Ibrahim Abdollahpour, Simon I. Hay, Deborah Carvalho Malta, Erin B Hamilton, Kate E. LeGrand, Nikolay Ivanovich Briko, Ana-Laura Manda, Aziz Eftekhari, Irfan Ullah, Seth Christopher Yaw Appiah, Zichen Liu, Maida Umar, Shaimaa I. El-Jaafary, Marina Pinheiro, Farhad Ghamari, Milad Mohammadoo-Khorasani, Rajaram Yadav, Syed Mohamed Aljunid, Ramesh Holla, Farzad Jalilian, Jacek Jerzy Jozwiak, Omar Mukhtar Salman, Bayew Kelkay, Tanuj Kanchan, Irina Filip, Michael R. Phillips, Hamid Reza Tohidinik, Demelash Abewa Elemineh, Reza Malekzadeh, Tomasz Miazgowski, Diana Silva, Samath D Dharmaratne, Eleonora Dubljanin, Fatemeh Zare, Jasvinder A. Singh, Hagazi Gebremedhin Kassaye, Nathaniel J Henry, Venkatesh Maled, Girikumar Kumaresh, Alireza Rafiei, Zhi-Jiang Zhang, Arielle Wilder Eagan, Merhawi Gebremedhin Tekle, Gholamreza Roshandel, Jeevan Pereira, Tinuke O Olagunju, Olatunde Aremu, Mohammad Zamani, Mu'awiyyah Babale Sufiyan, Lidia Morawska, Bayisa Abdissa Baye, Eduarda Fernandes, Feleke Mekonnen Demeke, Beriwan Abdulqadir Ali, Ibrahim A Khalil, Hafte Kahsay Kebede, Songhomitra Panda-Jonas, Yuichiro Yano, Haileab Fekadu Wolde, Antonio Maria Borzì, Delia Hendrie, Azeem Majeed, Vahid Rashedi, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Derrick A Bennett, Roba Khundkar, Mohammed Madadin, Biniyam Sahiledengle Geberemariyam, Parul Puri, Lidia Sanchez Riera, Yetunde O. John-Akinola, Jennifer Rickard, Saeed Shahabi, Tiffany K. Gill, Jemal Abdu Mohammed, Alessandra C. Goulart, Mohiuddin Ahsanul Kabir Chowdhury, Roya Safari-Faramani, Pawan Faris, Farhad Moradpour, Guilherme Borges, Sadia Bibi, Bartosz Miazgowski, Wubalem Fekadu, Rakhi Dandona, Ali Reza Soltanian, Alaa Badawi, Amir Hasanzadeh, Hassan Haghparast Bidgoli, Carlos A Castañeda-Orjuela, Morteza Arab-Zozani, Vinay Nangia, Gaurav Gupta, Farkhonde Salehi, Isabela M. Benseñor, Rekha Thapar, Yasser S. Amer, Naohiro Yonemoto, Ahmad Ghashghaee, Amanda J. Mason-Jones, Marcela Agudelo-Botero, Ashraf Nabhan, Saeed Safari, Lorainne Tudor Car, Ayman Grada, Stanislav S. Otstavnov, Keyvan Pakshir, Nefsu Awoke, Ahamarshan Jayaraman Nagarajan, Adnan Kisa, Ghasem Azarian, Yogesh Sabde, Soufiane Boufous, Fatemeh Khosravi Shadmani, Ketema Bizuwork Gebremedhin, Heather Orpana, Narayan Bahadur Mahotra, Tripti Khanna, Peter Nyasulu, Tommi Vasankari, Reza Mohammadpourhodki, Peter Njenga Keiyoro, Andrea Werdecker, Sanghamitra Pati, Rajan Nikbakhsh, Sorin Hostiuc, Prateek Rastogi, Xuefeng Liu, Manasi Kumar, Josip Car, Chuanhua Yu, Aziz Rezapour, Narayana Manjunatha, Ritesh G. Menezes, Michael K. Hole, Asadollah Gholamian, Pascual R. Valdez, Lorenzo Monasta, Amit Arora, Marek Majdan, Abraham Getachew Kelbore, Irini Chatziralli, Rafael Alves Guimarães, Mohammad Hassan Emamian, Filippo Ariani, Jeadran N. Malagón-Rojas, Jae Il Shin, Aziz Sheikh, Garumma Tolu Feyissa, Ahmed Abdelalim, Babak Moazen, Smita Pakhale, Bija Soleymani, Mehdi Hosseinzadeh, Young Eun Kim, Yunquan Zhang, Guoqing Hu, Yousef Khader, Suzanne Barker-Collo, Rizwan Suliankatchi Abdulkader, Mahdi Safdarian, Arash Sarveazad, Maria Magdalena Constantin, Dhirendra N Sinha, Alireza Ansari-Moghaddam, Khezar Hayat, Ferrán Catalá-López, Shaun Wen Huey Lee, Susan M Sawyer, Soosanna Kumary Chattu, Salman Rawaf, Seyed Sina Naghibi Irvani, Eun-Kee Park, Nauman Khalid, Marwa Rashad Salem, Duduzile Ndwandwe, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Borhan Mansouri, Faramarz Shaahmadi, Rovshan Khalilov, Milena M Santric Milicevic, Pankaj Singh, Ashish Badiye, Ai Koyanagi, Priya Rathi, Sanni Yaya, Ali Bijani, Shanshan Li, Onome Bright Oghenetega, Manoochehr Karami, Huong Lan Thi Nguyen, Soheil Hassanipour, Chukwudi A Nnaji, Obinna Onwujekwe, Swayam Prakash, Animut Tagele Tamiru, Ted R. Miller, Rebecca Ivers, Paulo A. 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D., Eagan, A. W., Eftekhari, A., Ehsani-Chimeh, E., El Sayed Zaki, M., Elemineh, D. A., El-Jaafary, S. I., El-Khatib, Z., Ellingsen, C. L., Emamian, M. H., Endalew, D. A., Eskandarieh, S., Faris, P. S., Faro, A., Farzadfar, F., Fatahi, Y., Fekadu, W., Ferede, T. Y., Fereshtehnejad, S. -M., Fernandes, E., Ferrara, P., Feyissa, G. T., Filip, I., Fischer, F., Folayan, M. O., Foroutan, M., Francis, J. M., Franklin, R. C., Fukumoto, T., Geberemariyam, B. S., Gebre, A. K., Gebremedhin, K. B., Gebremeskel, G. G., Gebremichael, B., Gedefaw, G. A., Geta, B., Ghafourifard, M., Ghamari, F., Ghashghaee, A., Gholamian, A., Gill, T. K., Goulart, A. C., Grada, A., Grivna, M., Gubari, M. I. M., Guimaraes, R. A., Guo, Y., Gupta, G., Haagsma, J. A., Hafezi-Nejad, N., Bidgoli, H. H., Hall, B. J., Hamadeh, R. R., Hamidi, S., Haro, J. M., Hasan, M. M., Hasanzadeh, A., Hassanipour, S., Hassankhani, H., Hassen, H. Y., Havmoeller, R., Hayat, K., Hendrie, D., Heydarpour, F., Hijar, M., Ho, H. C., Hoang, C. L., Hole, M. K., Holla, R., Hossain, N., Hosseinzadeh, M., Hostiuc, S., Hu, G., Ibitoye, S. E., Ilesanmi, O. S., Ilic, I., Ilic, M. D., Inbaraj, L. R., Indriasih, E., Irvani, S. S. N., Islam, S. M. S., Mofizul Islam, M., Ivers, R. Q., Jacobsen, K. H., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Jalilian, F., Jayaraman, S., Jayatilleke, A. U., Jha, R. P., John-Akinola, Y. O., Jonas, J. B., Joseph, N., Joukar, F., Jozwiak, J. J., Jungari, S. B., Jurisson, M., Kabir, A., Kadel, R., Kahsay, A., Kalankesh, L. R., Kalhor, R., Kamil, T. A., Kanchan, T., Kapoor, N., Karami, M., Kasaeian, A., Kassaye, H. G., Kavetskyy, T., Kebede, H. K., Keiyoro, P. N., Kelbore, A. G., Kelkay, B., Khader, Y. S., Khafaie, M. A., Khalid, N., Khalil, I. A., Khalilov, R., Khammarnia, M., Khan, E. A., Khan, M., Khanna, T., Khazaie, H., Shadmani, F. K., Khundkar, R., Kiirithio, D. N., Kim, Y. -E., Kim, D., Kim, Y. J., Kisa, A., Kisa, S., Komaki, H., Kondlahalli, S. K. M., Korshunov, V. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Bicer, B. K., Kugbey, N., Kumar, V., Kumar, N., Anil Kumar, G., Kumar, M., Kumaresh, G., Kurmi, O. P., Kuti, O., Vecchia, C. L., Lami, F. H., Lamichhane, P., Lang, J. J., Lansingh, V. C., Laryea, D. O., Lasrado, S., Latifi, A., Lauriola, P., Leasher, J. L., Lee, S. W. H., Lenjebo, T. L., Levi, M., Li, S., Linn, S., Liu, X., Lopez, A. D., Lotufo, P. A., Lunevicius, R., Lyons, R. A., Madadin, M., El Razek, M. M. A., Mahotra, N. B., Majdan, M., Majeed, A., Malagon-Rojas, J. N., Maled, V., Malekzadeh, R., Malta, D. C., Manafi, N., Manafi, A., Manda, A. -L., Manjunatha, N., Mansour-Ghanaei, F., Mansouri, B., Mansournia, M. A., Maravilla, J. C., March, L. M., Mason-Jones, A. J., Masoumi, S. Z., Massenburg, B. B., Maulik, P. K., Meles, G. G., Melese, A., Melketsedik, Z. A., Memiah, P. T. N., Mendoza, W., Menezes, R. G., Mengesha, M. B., Mengesha, M. M., Meretoja, T. J., Meretoja, A., Merie, H. E., Mestrovic, T., Miazgowski, B., Miazgowski, T., Miller, T. R., Mini, G. K., Mirica, A., Mirrakhimov, E. M., Mirzaei-Alavijeh, M., Mithra, P., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, Y., Mohammad, K. A., Darwesh, A. M., Mezerji, N. M. G., Mohammadian-Hafshejani, A., Mohammadoo-Khorasani, M., Mohammadpourhodki, R., Mohammed, S., Mohammed, J. A., Mohebi, F., Molokhia, M., Monasta, L., Moodley, Y., Moosazadeh, M., Moradi, M., Moradi, G., Moradi-Lakeh, M., Moradpour, F., Morawska, L., Velasquez, I. M., Morisaki, N., Morrison, S. D., Mossie, T. B., Muluneh, A. G., Murthy, S., Musa, K. I., Mustafa, G., Nabhan, A. F., Nagarajan, A. J., Naik, G., Naimzada, M. D., Najafi, F., Nangia, V., Nascimento, B. R., Naserbakht, M., Nayak, V., Ndwandwe, D. E., Negoi, I., Ngunjiri, J. W., Nguyen, C. T., Nguyen, H. L. T., Nikbakhsh, R., Ningrum, D. N. A., Nnaji, C. A., Nyasulu, P. S., Ogbo, F. A., Oghenetega, O. B., Oh, I. -H., Okunga, E. W., Olagunju, A. T., Olagunju, T. O., Bali, A. O., Onwujekwe, O. E., Asante, K. O., Orpana, H. M., Ota, E., Otstavnov, N., Otstavnov, S. S., Mahesh, P. A., Padubidri, J. R., Pakhale, S., Pakshir, K., Panda-Jonas, S., Park, E. -K., Patel, S. K., Pathak, A., Pati, S., Patton, G. C., Paulos, K., Peden, A. E., Pepito, V. C. F., Pereira, J., Pham, H. Q., Phillips, M. R., Pinheiro, M., Polibin, R. V., Polinder, S., Poustchi, H., Prakash, S., Pribadi, D. R. A., Puri, P., Syed, Z. Q., Rabiee, M., Rabiee, N., Radfar, A., Rafay, A., Rafiee, A., Rafiei, A., Rahim, F., Rahimi, S., Rahimi-Movaghar, V., Rahman, M. A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Ranganathan, K., Rao, S. J., Rashedi, V., Rastogi, P., Rathi, P., Rawaf, S., Rawal, L., Rawassizadeh, R., Renjith, V., Renzaho, A. M. N., Resnikoff, S., Rezapour, A., Ribeiro, A. I., Rickard, J., Gonzalez, C. M. R., Ronfani, L., Roshandel, G., Saad, A. M., Sabde, Y. D., Sabour, S., Saddik, B., Safari, S., Safari-Faramani, R., Safarpour, H., Safdarian, M., Mohammad Sajadi, S., Salamati, P., Salehi, F., Zahabi, S. S., Rashad Salem, M. R., Salem, H., Salman, O., Salz, I., Samy, A. M., Sanabria, J., Riera, L. S., Santric Milicevic, M. M., Sarker, A. R., Sarveazad, A., Sathian, B., Sawhney, M., Sawyer, S. M., Saxena, S., Sayyah, M., Schwebel, D. C., Seedat, S., Senthilkumaran, S., Sepanlou, S. G., Seyedmousavi, S., Sha, F., Shaahmadi, F., Shahabi, S., Shaikh, M. A., Shams-Beyranvand, M., Shamsizadeh, M., Sharif-Alhoseini, M., Sharifi, H., Sheikh, A., Shigematsu, M., Shin, J. I., Shiri, R., Siabani, S., Sigfusdottir, I. D., Singh, P. K., Singh, J. A., Sinha, D. N., Smarandache, C. -G., Smith, E. U. R., Soheili, A., Soleymani, B., Soltanian, A. R., Soriano, J. B., Sorrie, M. B., Soyiri, I. N., Stein, D. J., Stokes, M. A., Mu'Awiyyah, B. S., Suleria, H. A. R., Sykes, B. L., Tabares-Seisdedos, R., Tabb, K. M., Taddele, B. W., Tadesse, D. B., Tamiru, A. T., Tarigan, I. U., Tefera, Y. M., Tehrani-Banihashemi, A., Tekle, M. G., Tekulu, G. H., Tesema, A. K., Tesfay, B. E., Thapar, R., Tilahune, A. B., Tlaye, K. G., Tohidinik, H. R., Topor-Madry, R., Tran, B. X., Tran, K. B., Tripathy, J. P., Tsai, A. C., Car, L. T., Ullah, S., Ullah, I., Umar, M., Unnikrishnan, B., Upadhyay, E., Uthman, O. A., Valdez, P. R., Vasankari, T. J., Venketasubramanian, N., Violante, F. S., Vlassov, V., Waheed, Y., Weldesamuel, G. T., Werdecker, A., Wiangkham, T., Wolde, H. F., Woldeyes, D. H., Wondafrash, D. Z., Wondmeneh, T. G., Wondmieneh, A. B., Wu, A. -M., Yadav, R., Yadollahpour, A., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yip, P., Yisma, E., Yonemoto, N., Yoon, S. -J., Youm, Y., Younis, M. Z., Yousefi, Z., Yu, Y., Yu, C., Yusefzadeh, H., Moghadam, T. Z., Zaidi, Z., Zaman, S. B., Zamani, M., Zamanian, M., Zandian, H., Zarei, A., Zare, F., Zhang, Z. -J., Zhang, Y., Zodpey, S., Dandona, L., Dandona, R., Degenhardt, L., Dharmaratne, S. D., Hay, S. I., Mokdad, A. H., Reiner, R. C., Sartorius, B., Vos, T., James, Spencer L, Castle, Chris D, Dingels, Zachary V, Fox, Jack T, Adema, Bereket Duko, Yisma, Engida, and Vos, Theo

Subjects
Dánarmein, Fötlun, Dánartíðni, Lífslíkur, Life expectancy, 1106 Human Movement and Sports Sciences, burden of disease, Global Health, Global Burden of Disease, 0302 clinical medicine, Quality-Adjusted Life Year, Global health, Medicine, LIFE EXPECTANCY, 030212 general & internal medicine, POPULATION, Cause of death, Original Research, RISK, education.field_of_study, Global disease burdens, Injuries, Sjúkdómar, Incidence (epidemiology), Incidence, Population health, Burden of disease, Global, global, 3142 Public health care science, environmental and occupational health, 3. Good health, Descriptive epidemiology, Lýðheilsa, Quality-Adjusted Life Years, Public Health, TERRITORIES, descriptive epidemiology, Human, Population, 195 COUNTRIES, Humans, Life Expectancy, Morbidity, Wounds and Injuries, 1117 Public Health and Health Services, 03 medical and health sciences, AGE, SYSTEMATIC ANALYSIS, Mortality, education, Disability, SEX-SPECIFIC MORTALITY, business.industry, Faraldsfræði, DISABILITY, Public Health, Environmental and Occupational Health, Quality-adjusted life year, Years of potential life lost, Áverkar, 1701 Psychology, Human medicine, business, 030217 neurology & neurosurgery, Demography
Abstract

Publisher's version (útgefin grein), Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care., Bill and Melinda Gates Foundation OPP1152504, "Peer Reviewed"

Published
2020

40. Fabrication of oil-in-water emulsions as shelf-stable liquid non-dairy creamers: effects of homogenization pressure, oil type, and emulsifier concentration

Author

Tai Boon Tan, Chin Ping Tan, Phui Yee Tan, Nauman Khalid, and Yuen Num Soo

Subjects
Oil type, Fabrication, food.ingredient, 030309 nutrition & dietetics, Food Handling, Color, Palm Oil, Homogenization (chemistry), Soybean oil, Oil in water, 03 medical and health sciences, chemistry.chemical_compound, 0404 agricultural biotechnology, food, Humans, Food science, Particle Size, Non dairy, 0303 health sciences, Nutrition and Dietetics, business.industry, Viscosity, Water, 04 agricultural and veterinary sciences, Chemical industry, Hydrogen-Ion Concentration, 040401 food science, Soybean Oil, chemistry, Food Storage, Emulsifying Agents, Taste, DATEM, Emulsions, Food Additives, business, Agronomy and Crop Science, Food Science, Biotechnology
Abstract

Background The popularity of coffee, the second most consumed beverage in the world, contributes to the high demand for liquid non-dairy creamer (LNDC). In this study, palm olein emulsions (as LNDCs) were investigated as alternatives to the more common soybean oil-based LNDCs. LNDCs were prepared via different homogenization pressures (100-300 bar) using different types of oil (palm olein and soybean oil) and concentrations of DATEM emulsifier (5-20 g kg-1 ). Results Increases in homogenization pressure and emulsifier concentration were observed to have significant (P 0.05) differences between the prepared and commercial LNDCs in terms of their color, appearance, and overall acceptability. Conclusion Shelf-stable LNDCs with qualities comparable to commercial LNDC were successfully fabricated. Valuable insights into the effects of homogenization pressure, oil type, and emulsifier concentration, as well as functionality and consumer acceptance of the LNDCs when added into black coffee, were obtained. © 2020 Society of Chemical Industry.

Published
2020

41. Real-world experience of suture-based closure devices: Insights from the FDA Manufacturer and User Facility Device Experience

Author

Anees Musallam, Charan Yerasi, Sant Kumar, Brian J. Forrestal, Chava Chezar-Azerrad, Itsik Ben-Dor, Jaffar M. Khan, Brian C. Case, Toby Rogers, Nelson L. Bernardo, Yuefeng Chen, Lowell F. Satler, Evan Shlofmitz, Ron Waksman, Nauman Khalid, and Hayder Hashim

Subjects
medicine.medical_specialty, Surveillance data, Adverse outcomes, 030204 cardiovascular system & hematology, Food and drug administration, 03 medical and health sciences, 0302 clinical medicine, Suture (anatomy), Medicine, Humans, Radiology, Nuclear Medicine and imaging, Vascular closure device, User Facility, 030212 general & internal medicine, Major complication, Closure (psychology), Sutures, business.industry, United States Food and Drug Administration, General surgery, General Medicine, United States, Femoral Artery, Treatment Outcome, Cardiology and Cardiovascular Medicine, business, Vascular Closure Devices
Abstract

Objectives We analyzed post-marketing surveillance data from the United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for suture-based vascular closure devices (VCDs) - Perclose ProGlide (Abbott, Chicago, Illinois) and Prostar XL (Abbott). Background Suture-based VCDs are mostly used for large-bore femoral arterial access-site closure. Real-world, contemporary experience on the most commonly reported complications and modes of failure associated with these devices is limited. Methods Post-marketing surveillance data from the FDA MAUDE database, for the ProGlide system and for the Prostar XL system, were analyzed, yielding 827 Perclose ProGlide reports and 175 Prostar XL reports. Results Of the 827 reports of major complications involving the Perclose ProGlide devices, 404 reports involved injury, and one involved death related to the device. In the Prostar XL analysis, 94 reports involved injury, and one involved death. Bleeding from vessel injury was the most common adverse outcome described with both devices, followed by hematoma and thrombus. Surgical repair was the most commonly used treatment strategy. In terms of device malfunction, suture-related malfunction (212 reports) was most commonly seen in the Perclose ProGlide group, while failed deployment was most commonly seen in the Prostar XL group. Conclusions Our analysis of the MAUDE database demonstrates that in real-world practice, suture-based VCDs were found to be associated with complications, including vascular injury, difficulties with the device itself, and even death. Ongoing user education and pre-procedural patient selection are important to minimize risks associated with suture-based vascular closure devices.

Published
2020

42. Letter by Khalid et al Regarding Article, 'The Evolving Landscape of Impella Use in the United States Among Patients Undergoing Percutaneous Coronary Intervention With Mechanical Circulatory Support'

Author

Nauman Khalid, Ron Waksman, and Evan Shlofmitz

Subjects
medicine.medical_specialty, business.industry, Physiology (medical), medicine.medical_treatment, Circulatory system, Emergency medicine, medicine, MEDLINE, Percutaneous coronary intervention, Cardiology and Cardiovascular Medicine, business, Impella
Published
2020

43. COVID-19 (SARS-CoV-2) and the Heart – An Ominous Association

Author

Brian C. Case, Evan Shlofmitz, Itsik Ben-Dor, Yuefeng Chen, Jason P. Wermers, Toby Rogers, Nauman Khalid, and Ron Waksman

Subjects
Acute coronary syndrome, medicine.medical_specialty, Myocarditis, Complications, medicine.medical_treatment, 030204 cardiovascular system & hematology, Pericardial effusion, Article, 03 medical and health sciences, Pericarditis, 0302 clinical medicine, Internal medicine, medicine, Severe acute respiratory syndrome coronavirus 2, 030212 general & internal medicine, Myocardial infarction, Cardiac catheterization, medicine.diagnostic_test, business.industry, COVID-19, General Medicine, medicine.disease, Infectious disease (medical specialty), Cardiology, business, Cardiology and Cardiovascular Medicine, Electrocardiography
Abstract

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cardiovascular manifestations of COVID-19 are diverse and complex and include acute coronary syndrome, myocarditis masquerading as ST-segment elevation myocardial infarction, pericarditis and pericardial effusion. We present 2 cases of COVID-19 infection with myocardial involvement with distinct mechanistic pathways and outcomes. Important decision strategies such as the timing of cardiac catheterization (when indicated) and requirement of early hemodynamic support in critically ill patients are discussed., Highlights • Cardiovascular manifestations of COVID-19 are diverse and complex. • We present 2 cases of COVID-19 infection with myocardial involvement. • We discuss strategies such as timing of cardiac catheterization (when indicated).

Published
2020
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44. A comprehensive review on chlorpyrifos toxicity with special reference to endocrine disruption: Evidence of mechanisms, exposures and mitigation strategies

Author

Mansur A. Sandhu, Wahab Nazir, Hafiz Ubaid ur Rahman, Anwaar Ahmed, Waqas Asghar, and Nauman Khalid

Subjects
Insecticides, Environmental Engineering, 010504 meteorology & atmospheric sciences, Physiology, 010501 environmental sciences, medicine.disease_cause, 01 natural sciences, Work related, chemistry.chemical_compound, Environmental Chemistry, Medicine, Endocrine system, Animals, Humans, Waste Management and Disposal, 0105 earth and related environmental sciences, business.industry, Organophosphate, Neurotoxicity, medicine.disease, Pollution, chemistry, Chlorpyrifos, Toxicity, Acetylcholinesterase, business, Reproductive toxicity, Oxidative stress
Abstract

Chlorpyrifos (CPF) is a broad-spectrum chlorinated organophosphate (OP) pesticide used for the control of a variety of insects and pathogens in crops, fruits, vegetables, as well as households, and various other locations. The toxicity of CPF has been associated with neurological dysfunctions, endocrine disruption, and cardiovascular diseases (CVDs). It can also induce developmental and behavioral anomalies, hematological malignancies, genotoxicity, histopathological aberrations, immunotoxicity, and oxidative stress as evidenced by animal modeling. Moreover, eye irritation and dermatological defects are also reported due to CPF toxicity. The mechanism of action of CPF involves blocking the active sites of the enzyme, acetylcholinesterase (AChE), thereby producing adverse nervous system effects. Although CPF has low persistence in the body, its active metabolites, 3,5,6-trichloro-2-pyridinol (TCP), and chlorpyrifos-oxon (CPO) are comparatively more persistent, albeit equally toxic, and thus produce serious health complications. The present review has been compiled taking into account the work related to CPF toxicity and provides a brief compilation of CPF-induced defects in animals and humans, emphasizing the abnormalities leading to endocrine disruption, neurotoxicity, reproductive carcinogenesis, and disruptive mammary gland functionality. Moreover, the clinical signs and symptoms associated with the CPF exposure along with the possible pharmacological treatment are reported in this treatise. Additionally, the effect of food processing methods in reducing CPF residues from different agricultural commodities and dietary interventions to curtail the toxicity of CPF has also been discussed.

Published
2020

45. Procedural Outcomes of Patients Undergoing Percutaneous Coronary Intervention for De Novo Lesions in the Ostial and Proximal Left Circumflex Coronary Artery

Author

Chava Chezar-Azerrad, Nelson L. Bernardo, Yuefeng Chen, Lowell F. Satler, Cheng Zhang, Hayder Hashim, Gary S. Mintz, Charan Yerasi, Nauman Khalid, Jaffar M. Khan, Rebecca Torguson, Itsik Ben-Dor, Ron Waksman, Anees Musallam, Toby Rogers, Brian J. Forrestal, Brian C. Case, and Evan Shlofmitz

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Coronary Artery Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Postoperative Complications, Internal medicine, medicine.artery, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Circumflex, Angina, Stable, Angina, Unstable, Aged, Aged, 80 and over, business.industry, Unstable angina, Percutaneous coronary intervention, Middle Aged, medicine.disease, Coronary Vessels, medicine.anatomical_structure, Treatment Outcome, Right coronary artery, Conventional PCI, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Mace, Artery
Abstract

Ostial coronary artery lesions can be challenging during percutaneous coronary intervention (PCI) because of elastic fiber content, calcium burden, and angulation. We assessed procedural and clinical major adverse cardiac events (MACE) associated with PCI for ostial lesions, focusing on ostial left circumflex (LC) lesions compared with ostial left anterior descending artery (LAD) and right coronary artery lesions. All patients with ostial or very proximal coronary artery lesions treated with PCI at MedStar Washington Hospital Center (Washington, DC) from 2003 to 2018 were included. The primary end point was target lesion revascularization (TLR)-MACE, defined as the composite of all-cause mortality, Q-wave myocardial infarction (MI), and TLR at 1 year. A total of 4,759 patients with available 1-year follow-up were included: 2,236 ostial/very proximal LAD, 980 ostial/very proximal LC, and 1,543 ostial/very proximal right. The presenting clinical syndrome for the LC group was mainly stable or unstable angina, whereas MI was more common in the LAD. At 1 year, the TLR-MACE rate was 16.7% in the LC group versus 12.5% in the LAD and 11.8% in the right group (p = 0.001). Mortality rates were 11.2% in the LC group versus 8.4% in the LAD and 6% in the right group (p0.001). A Cox model showed that dialysis had the highest impact on TLR-MACE. In conclusion, compared with PCI of ostial or very proximal LAD or right lesions, PCI of ostial or very proximal LC lesions was associated with higher rates of TLR-MACE.

Published
2020

46. Adverse Events and Modes of Failure Related to Rotational Atherectomy System: The Utility of the MAUDE Database

Author

Itsik Ben-Dor, Jaffar M. Khan, Toby Rogers, Brian J. Forrestal, Nelson L. Bernardo, Yuefeng Chen, Lowell F. Satler, Charan Yerasi, Hasan Javed, Chava Chezar-Azerrad, Anees Musallam, Brian C. Case, Jason P. Wermers, Aaphtaab Dheendsa, Evan Shlofmitz, Nauman Khalid, Hayder Hashim, and Ron Waksman

Subjects
Atherectomy, Coronary, Databases, Factual, medicine.medical_treatment, Perforation (oil well), Coronary Artery Disease, 030204 cardiovascular system & hematology, Rotational atherectomy, computer.software_genre, Atherectomy, Food and drug administration, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Medicine, Humans, User Facility, 030212 general & internal medicine, Adverse effect, Database, business.industry, United States Food and Drug Administration, General Medicine, United States, Dissection, Treatment Outcome, Coronary artery calcification, Cardiology and Cardiovascular Medicine, business, computer
Abstract

Background/purpose Coronary artery calcification is a marker of advanced atherosclerosis and a predictor of adverse clinical outcomes. Rotational atherectomy (RA) can effectively modify calcified lesions, optimizing procedural outcomes. We interrogated the most commonly reported adverse events involving rotational atherectomy systems (Rotablator and Rotapro) by analyzing post-marketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. Methods/materials We queried MAUDE from September 1, 2016, through December 31, 2019. After excluding duplicate reports, we included 363 reports for Rotablator and 63 reports for Rotapro in the final analysis. Results Percentages represent the proportion of total submitted MAUDE reports. The most commonly reported complications for Rotablator and Rotapro included dissection (2.7% and 6.3%, respectively) and perforation (4.1% and 19%, respectively). The most commonly reported device-related issues included detachment or structural damage, or both, for Rotablator (39.1%) and entrapment of the device component for Rotapro (47.6%). The most commonly damaged device component was the Rotawire, whereas the most commonly entrapped device component was the Rotaburr for both device configurations. Rotablator and Rotapro device-related complications were most commonly reported for the left anterior descending artery. Conclusion An analysis of the MAUDE database demonstrates that in real-world practice, RA devices are associated with important complications. Ongoing surveillance of safety profiles, patient outcomes, and failure modes of RA devices is warranted. Our analysis provides important insights into the mechanisms of failure of RA devices and associated complications but cannot verify causality. Summary We interrogated the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to summarize the most commonly reported adverse events and device-related issues associated with the rotational atherectomy systems (Rotablator and the newer iteration, Rotapro). The MAUDE database serves as an important tool for improved collaboration between clinicians, device manufacturers, and regulatory bodies to optimize device safety and patient outcomes.

Published
2020

47. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017

Author

Manisha Dubey, Fatemeh Rajati, Mehran Shams-Beyranvand, Amir Khater, Reza Shirkoohi, Segun Emmanuel Ibitoye, David C. Schwebel, Milena Ilic, Kebede Embaye Gezae, Ali Akbar Fazaeli, Ronny Westerman, Taye Abuhay Zewale, Ravi Mehrotra, Sezer Kisa, Junaid Khan, Jost B. Jonas, Dian Kusuma, Marcel Ausloos, Getnet Gedefaw, Hamed Zandian, Edward J Mills, Aparna Lal, Atalay Goshu Muluneh, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Jacqueline Elizabeth Alcalde Rabanal, Yousef Veisani, Sharath Burugina Nagaraja, Christopher Troeger, Ismael R. Campos-Nonato, Kidane Tadesse Gebremariam, Maysaa El Sayed Zaki, Oliver J. Brady, David Laith Rawaf, Tamer H. Farag, Simin Mouodi, Hafiz Ansar Rasul Suleria, Saleh Salehi Zahabi, Soumyadeep Bhaumik, Samad Azari, Getinet Ayano, Faris Lami, Raaj Kishore Biswas, Maryam Adabi, Alaa Badawi, Saravanan Muthupandian, Amir Hasanzadeh, Martin Amogre Ayanore, Maziar Moradi-Lakeh, Mohamad-Hani Temsah, Kavumpurathu Raman Thankappan, Bineyam Taye, Nader Jafari Balalami, Hamid Yimam Hassen, Karzan Abdulmuhsin Mohammad, Paul H. Lee, Emerito Jose A. Faraon, Kewal Krishan, Muhammad Ali, Ehsan Sadeghi, Richard C. Franklin, Dara K. Mohammad, Naznin Hossain, Lal B. Rawal, Alyssa N. Sbarra, Behnam Heidari, Dietrich Rothenbacher, Hagos Tasew Atalay, Eric L. Ding, Noushin Mohammadifard, Nihal Thomas, Man Mohan Mehndiratta, Sanghamitra Pati, Addisu Melese, Niranjan Kissoon, Farzad Manafi, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Meysam Behzadifar, Mohammad Reza Sobhiyeh, Frank B. Osei, Koku Sisay Tamirat, Yahya Salimi, Pranab Chatterjee, Gebreamlak Gebremedhn Gebremeskel, Olatunji O. Adetokunboh, Benjamin K. Mayala, Bhaskaran Unnikrishnan, Zahid A Butt, Olufemi Ajumobi, Fiseha Wadilo Wada, Shafiu Mohammed, Charles Shey Shey Wiysonge, Félix Carvalho, Masresha Tessema Anegago, Yun Jin Kim, Ai-Min Wu, Ketema Bizuwork Gebremedhin, Paulina A. Lindstedt, Ana-Laura Manda, Aziz Eftekhari, Rakhi Dandona, Mehdi Fazlzadeh, Nicole Davis Weaver, Muluken Bekele Sorrie, Marwa Rashad Salem, Kassawmar Angaw Bogale, Dongyu Zhang, Saeed Safari, Vivekanand Jha, Keivan Ahmadi, Turki Alanzi, Amir Jalali, Hamidreza Haririan, Chukwudi A Nnaji, Kebadnew Mulatu Mihretie, Lucas Guimarães Abreu, Gessessew Bugssa Hailu, Surendra Karki, Kirsten E. Wiens, Boikhutso Tlou, Soraya Siabani, Muluken Azage Yenesew, Asnakew Achaw Ayele, Ayalew Jejaw Zeleke, Osayomwanbo Osarenotor, Susanna Dunachie, Marcos Roberto Tovani-Palone, Daniel Bekele Ketema, Tissa Wijeratne, Dessalegn Ajema Berbada, André Karch, Ebrahim Babaee, Akram Pourshams, Seyyed Meysam Mousavi, Bal Govind Chauhan, Giuseppe Remuzzi, Vera Marisa Costa, Mehdi Yaseri, Tahereh Pashaei, Benn Sartorius, Helen Derara Diro, Anelisa Jaca, Mostafa Hosseini, Nikolay Ivanovich Briko, Franz Castro, Cuong Tat Nguyen, Chalachew Genet Akal, Natalie Maria Cormier, Ghulam Mustafa, Sonia Lewycka, Achala Upendra Jayatilleke, David L. Smith, Ibrahim A Khalil, Genet Melak Alamene, George C Patton, Andem Effiong, Gebrekiros Gebremichael Meles, Collins Chansa, Tsegaye Lolaso Lenjebo, Van C. Lansingh, Chabila C Mapoma, Olayinka Stephen Ilesanmi, Aso Mohammad Darwesh, Aubrey J. Levine, Miliva Mozaffor, Till Bärnighausen, Ali Rostami, André Faro, Rushdia Ahmed, Colm McAlinden, Duduzile Ndwandwe, Neeraj Bedi, Irfan Ullah, Winfried März, Rajeev Gupta, Masood Ali Shaikh, Catalina Liliana Andrei, Ali Kazemi Karyani, Shaimaa I. El-Jaafary, Abbas Mosapour, Javad Nazari, Obinna Onwujekwe, Narinder Pal Singh, Dabere Nigatu, Tanuj Kanchan, Jagdish Khubchandani, Aklilu Endalamfaw, Hajer Elkout, Michelle L. Bell, Beyene Meressa Adhena, Evanson Z. Sambala, Nelson Alvis-Guzman, Nefsu Awoke, Mohammad Ali Sahraian, Muki Shey, Christiane Dolecek, Kedir Hussein Abegaz, Syed Ather Hussain, Birhan Tamene Alemnew, Arash Etemadi, Anwar E. Ahmed, Vinay Nangia, Sachin R Atre, Roghiyeh Faridnia, Robert C. Reiner, Rajat Das Gupta, Aniruddha Deshpande, Sanjay Zodpey, Birhanu Geta, Amaha Kahsay, Muktar Beshir Ahmed, Kiana Ramezanzadeh, Jacek Jerzy Jozwiak, Chi Linh Hoang, Bahram Armoon, Manfred Accrombessi, Christopher J L Murray, Ebrahim M Yimer, Rashmi Gupta, Ahmed Omar Bali, Dadi Marami, Arash Tehrani-Banihashemi, Getnet Mengistu, Govinda Prasad Dhungana, Fereshteh Ansari, Dina Nur Anggraini Ningrum, Mu'awiyyah Babale Sufiyan, Harish Chander Gugnani, Ali S. Akanda, Satar Rezaei, Wondimeneh Shibabaw Shiferaw, Irina Filip, Mohammad Fareed, Hagos Degefa Hidru, Morteza Shamsizadeh, Mojtaba Hoseini-Ghahfarokhi, Yared A Asmare Aynalem, Gelin Xu, Zubair Kabir, Khalid A Altirkawi, Beatriz Paulina Ayala Quintanilla, Kenean Getaneh Tlaye, Devasahayam J. Christopher, Malede Mequanent Sisay, Yibeltal Alemu Bekele, Mika Shigematsu, Bryan L. Sykes, Quique Bassat, Jemal Abdu Mohammed, Seyed Mostafa Mir, Moslem Soofi, Nuruzzaman Khan, Ensiyeh Jenabi, Seyed-Mohammad Fereshtehnejad, Alireza Esteghamati, Paramjit Gill, Nathaniel J Henry, Meghnath Dhimal, Hosein Shabaninejad, Trang Huyen Nguyen, Amjad Mohamadi-Bolbanabad, Eugenio Traini, Mohammad Zamani, Arianna Maever L. Amit, Mehran Alijanzadeh, Florian Fischer, Rafael Moreira Claro, Pushpendra Kumar, Shai Linn, Lucas Earl, Haileab Fekadu Wolde, Getenet Dessie, Doris D. V. Ortega-Altamirano, John S. Ji, Moritz U. G. Kraemer, Saeed Amini, Ziad A. Memish, Aisha Elsharkawy, Ken Lee Chin, Mustafa Z. Younis, Daniel Diaz, Hebat Allah Salah A. Yousof, Seifadin Ahmed Shallo, Tomohide Yamada, Adrian Pana, Salman Rawaf, Amir Almasi-Hashiani, Platon D. Lopukhov, Alireza Rafiei, Dragos Virgil Davitoiu, Hossein Poustchi, Ayele Geleto Bali, Francesco Saverio Violante, Leonardo Roever, Giovanni Damiani, Maha El Tantawi, Nuworza Kugbey, Hadi Pourjafar, Michael R.M. Abrigo, Dinh-Toi Chu, Farkhonde Salehi, Phetole Walter Mahasha, Farnam Mohebi, Sathish Thirunavukkarasu, Dharmesh Kumar Lal, Senbagam Duraisamy, Demelash Woldeyohannes Handiso, Eleonora Dubljanin, Takeshi Fukumoto, Biruck Desalegn Yirsaw, Fakher Rahim, Jasvinder A. Singh, Jai K Das, Savita Lasrado, Ana Isabel Ribeiro, Santosh Varughese, Adnan Kisa, Laurie B. Marczak, Amira Shaheen, Peter Njenga Keiyoro, Nader Jahanmehr, Yuming Guo, Arash Ziapour, Alex Yeshaneh, Ninuk Hariyani, Seyed Sina Naghibi Irvani, Sameer Vali Gopalani, Joel M. Francis, Asmamaw Demis, Ahamarshan Jayaraman Nagarajan, Praveen Hoogar, Nicola Luigi Bragazzi, Yunquan Zhang, Yousef Mohammad, Iman El Sayed, Vafa Rahimi-Movaghar, Anbissa Muleta Senbeta, Subramanian Senthilkumaran, Marzieh Nojomi, Tewodros Eshete Wonde, Sameh Magdeldin, Anton Sokhan, Nauman Khalid, Nima Hafezi-Nejad, Ben Lacey, Luca Ronfani, James Albright, Senthilkumar Balakrishnan, Ejaz Ahmad Khan, Khanh Bao Tran, Guoqing Hu, Yousef Khader, Parvaneh Mirabi, Boris Bikbov, Feleke Mekonnen Demeke, Assefa Desalew, Yasir Waheed, Berhe Etsay Tesfay, Julio Cesar Campuzano Rincon, Ernoiz Antriyandarti, Brian J. Hall, James A Platts-Mills, Gbenga A. Kayode, Jan-Walter De Neve, Maria Jesus Rios-Blancas, Navid Manafi, Ravi Prakash Jha, Yilma Chisha Dea Geramo, Hamideh Salimzadeh, Fisaha Haile Tesfay, Abdullah Al Mamun, Ali Bijani, Hedley Quintana, Shanshan Li, Kebreab Paulos, Joan B. Soriano, Victor Adekanmbi, Oladimeji Adebayo, David Teye Doku, Brijesh Sathian, Bakhtiar Piroozi, MohammadBagher Shamsi, Netsanet Fentahun, Shymaa Enany, Ayman Grada, Salvatore Rubino, Kenji Shibuya, Norberto Perico, Sergio I. Prada, Andrea Farioli, Gebremicheal Gebreslassie Kasahun, Mohsen Afarideh, Maciej Banach, Andrey Nikolaevich Briko, Mohsen Asadi-Lari, Rakesh Lodha, David M. Pigott, Bárbara Niegia Garcia de Goulart, Hadi Hassankhani, Daniel Adane Endalew, Siamak Sabour, Yoshan Moodley, Preeti Dhillon, Dilaram Acharya, Anas M. Saad, Ibrahim Abdelmageed Ginawi, Theo Vos, Tuomo J. Meretoja, Ireneous N. Soyiri, Hasan Yusefzadeh, Mohammad Rabiee, Ajay Patle, Rahman Shiri, Girmay Teklay Weldesamuel, Sivan Yegnanarayana Iyer Saraswathy, Mekdes Tigistu Yilma, Davide Guido, Chuanhua Yu, Abdallah M. Samy, Ali Talha Khalil, Ashish Awasthi, Pascual R. Valdez, Nelson G.M. Gomes, Nejimu Biza Zepro, Taweewat Wiangkham, Anthony Masaka, Afsaneh Arzani, Ayesha Humayun, Michael Tamene Haile, Huyen Phuc Do, Krittika Bhattacharyya, Maryam Khayamzadeh, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Farah Daoud, QuynhAnh P Nguyen, Suleman Atique, Sheikh Mohammed Shariful Islam, Indang Trihandini, Mario Poljak, Bartosz Miazgowski, Huda Basaleem, Rafael Alves Guimares, Mina Anjomshoa, Peng Jia, Yafeng Wang, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Itamar S. Santos, Alireza Khatony, Desalegn Tadese Mengistu, Samath D Dharmaratne, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Konrad Pesudovs, Tina Beyranvand, Liliana Preotescu, Leticia Avila-Burgos, Enrico Rubagotti, Amira Hamed Darwish, Mahdi Safdarian, Ali Yadollahpour, Vijay Kumar Chattu, Moses K. Muriithi, Azmeraw T. Amare, Si Si, Joshua Longbottom, Somayeh Bohlouli, Khaled Khatab, Masoud Behzadifar, Anusha Ganapati Bhat, G Anil Kumar, Margaret Kosek, Mona M. Khater, Reta Tsegaye Gayesa, Ghobad Moradi, Srinivas Goli, Ruth W Kimokoti, Jalal Arabloo, Kimberly B. Johnson, Andrew T Olagunju, Mowafa Househ, In-Hwan Oh, Arya Haj-Mirzaian, Desta Haftu Hayelom, Jae Il Shin, Ahmed Abdelalim, Catherine A. Welgan, Veincent Christian Filipino Pepito, Andre Rodrigues Duraes, Yuan-Pang Wang, Rosario Cárdenas, Mohammad Khazaei, Sebastian Vollmer, Xiu-Ju Zhao, Mihajlo Jakovljevic, Degu Abate, Ali S. Shalash, Davide Rasella, Melese Abate Reta, Hedayat Abbastabar, Manu Raj Mathur, Aliasghar Ahmad Kiadaliri, Ritesh G. Menezes, Molly K. Miller-Petrie, Beriwan Abdulqadir Ali, Ahmed I. Hasaballah, Joseph Frostad, Eirini Skiadaresi, Aleksandra Barac, Simon I. Hay, Deborah Carvalho Malta, Brigette F. Blacker, Carlo La Vecchia, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Zewdie Aderaw Alemu, Foad Abd-Allah, Elias Merdassa Roro, Agus Sudaryanto, Fariba Ghassemi, Behzad Karami Matin, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Maheswar Satpathy, Mahesh P A, Carlos Miguel Rios González, Pallab K. Maulik, Amir Kasaeian, Ali H. Mokdad, Alemayehu Toma Mena, Tamirat Tesfaye Dasa, Abdur Razzaque Sarker, Andre M. N. Renzaho, Muhammad Aziz Rahman, Ali Kabir, Josephine W. Ngunjiri, Aberash Abay Tassew, Kala M. Mehta, Ionut Negoi, Hosni Salem, Hesham M. Al-Mekhlafi, Sharareh Eskandarieh, Rufus A. Adedoyin, Saleem M Rana, Engida Yisma, Sahel Valadan Tahbaz, Hossein Farzam, Krishna K. Aryal, Lalit Dandona, Masoud Moradi, Juan Sanabria, Gebre Teklemariam Demoz, Naser Mohammad Gholi Mezerji, Shirin Djalalinia, Suraj Bhattarai, Ammas Siraj Mohammed, Claudiu Herteliu, Dawit Zewdu Wondafrash, Mohsen Bayati, Arvin Haj-Mirzaian, Gulfaraz Khan, Mostafa Leili, Nasir Salam, Ehsan Khodamoradi, Jean Jacques Noubiap, Vahid Alipour, Mohammad Ali Mansournia, Rajesh Sagar, Jagadish Rao Padubidri, Manasi Kumar, Mehdi Sharif, Fatemeh Heydarpour, Navid Rabiee, Gvs Murthy, Hamed Kalani, Mayowa O. Owolabi, Claudio Alberto Davila, Oluchi Okpala, Shivakumar K.M. Kondlahalli, Mathew M. Baumann, Bereket Duko Adema, Lorenzo Monasta, Paul S. F. Yip, Mohammad Hossein Khosravi, Rizwan Suliankatchi Abdulkader, Ibrahim Abdollahpour, Dhirendra N Sinha, Farid Najafi, Kebede Deribe, Paula Moraga, Mehedi Hasan, Mohammad Moradi-Joo, Melkamu Merid Mengesha, Temesgen Yihunie Akalu, Vishnu Renjith, Syed Mohamed Aljunid, Zemenu Tadesse Tessema, Amir Radfar, Nuno Taveira, Masoud Foroutan, Demelash Abewa Elemineh, Chinwe Juliana Iwu, Kamarul Imran Musa, Getaneh Alemu Abebe, Farshad Pourmalek, Olatunde Aremu, Mohammad Reza Salahshoor, Derrick A Bennett, Ahmad Daryani, Alebachew Fasil Ashagre, Apurba Shil, Narayan Bahadur Mahotra, Nelson J. Alvis-Zakzuk, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Mehdi Hosseinzadeh, Rovshan Khalilov, Ai Koyanagi, Salman Khazaei, Jennifer Rickard, Ali Almasi, Sandra B. Munro, Carlos Zambrana-Torrelio, Naohiro Yonemoto, Ahmad Ghashghaee, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Instituto de Saúde Pública da Universidade do Porto, Local Burden Dis Diarrhoea, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, GeoHealth, Reiner, Robert C, Wiens, Kirsten E, Deshpande, Aniruddha, Baumann, Mathew M, Adema, Bereket Duko, Yirsaw, Biruck Desalegn, Yisma, Engida, Hay, Simon I, Local Burden of Disease Diarrhoea Collaborators, Tampere University, Health Sciences, University of Helsinki, Institute for Molecular Medicine Finland, Clinicum, HUS Comprehensive Cancer Center, Local Burden of Disease Diarrhoea Collaborator, and Violante FS

Subjects
Low income countries, medicine.medical_treatment, 030204 cardiovascular system & hematology, Global Health, THERAPY, Global Burden of Disease, 0302 clinical medicine, Prevalence, Global health, Medicine, WATER, 030212 general & internal medicine, Children, 11 Medical and Health Sciences, Incidence, Mortality rate, Incidence (epidemiology), 1. No poverty, General Medicine, 3142 Public health care science, environmental and occupational health, Diarrhoea, 3. Good health, Child, Preschool, Middle income countries, A990 Medicine and Dentistry not elsewhere classified, TERRITORIES, Life Sciences & Biomedicine, Infants, Diarrhea, AFRICA, medicine.medical_specialty, Childhood deaths, RJ, sanitation, Developing country, Childhood diarrhoeal morbidity, ITC-HYBRID, 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, Environmental health, SYSTEMATIC ANALYSIS, Life Science, Humans, Healthcare Disparities, Oral rehydration therapy, Risk factor, hand washing, Developing Countries, Disease burden, Global Nutrition, Wereldvoeding, Science & Technology, SEX-SPECIFIC MORTALITY, business.industry, CHOLERA, Public health, Bayes Theorem, diarrheal disease, Local Burden of Disease Diarrhoea Collaborators, ITC-ISI-JOURNAL-ARTICLE, NA, Human medicine, Diarrea, business
Abstract

Background: Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods: We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings: The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation: By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. This work was primarily supported by a grant from the Bill & Melinda Gates Foundation (OPP1132415). S Aljunid reports additional funding from the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Health Policy and Management, Faculty of Public Health, Kuwait University for the approval and support to participate in this research project outside of the study. A Awasthi is supported by the Department of Science and Technology, Government of India, New Delhi, through the INSPIRE Faculty Program outside of the study. A Badawi reports additional funding from the Public Health Agency of Canada outside of the study. A Barac reports additional funding from the Project of Ministry of Education, Science and Technology of the Republic of Serbia (no III45005) outside of the study. T Bärnighausen reports additional funding by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research outside of the study. F Carvalho and E Fernandez report additional funding from the Portuguese national funds (UID/MULTI/04378/2019 and UID/QUI/50006/2019) outside of the study. V M Costa reports additional funding from Fundação da Ciência e Tecnologia (FCT) for her grant (SFRH/BPD/110001/2015), which was funded by national funds through FCT – Fundação para a Ciência e a Tecnologia, IP, under the Norma Transitória – DL57/2016/CP1334/CT0006 outside of the study. J De Neve reports additional funding from the Alexander von Humboldt Foundation outside of the study. K Deribe reports additional funding from the Wellcome Trust (grant number 201900) as part of his International Intermediate Fellowship outside of the study. D Endalew and M Moradi report additional funding from Wolkite University. M Ausloos, C Herteliu, and A Pana report additional funding from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI (project number PN-III-P4-ID-PCCF-2016-0084) outside of the study. C Herteliu reports additional funding from the European Fund for Regional Development through Operational Program for Competitiveness (Project ID P_40_382) and the European Fund for Regional Development, through InterReg Romania-Hungary (project code EMS ROHU 217) outside of the study. P Hoogar reports additional funding from the Centre for Holistic Development and Research (CHDR), Kalaghatagi and The Department of Studies in Anthropology, Karnatak University, D S Islam reports additional funding from the National Heart Foundation of Australia and the Institute for Physical Activity and Nutrition, Deakin University outside of the study. A Khatony reports additional funding from the Clinical Research Development Center of Imam Reza Hospital in Kermanshah outside of the study. J Khubchandani reports additional funding from Merck Research Laboratories outside of the study. K Krishan reports additional funding from the UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India outside of the study. M Kumar reports additional funding from the Fogarty Foundation/NIH through a K43 award (TW010716-01A1) outside of the study. B Lacey reports additional funding from the National Institute for Health Research Oxford Biomedical Research Centre and the British Heart Foundation Centre of Research Excellence (Oxford, UK) outside of the study. A M Samy reports additional funding from the Egyptian Fulbright Mission Program (EFMP) outside of the study. S Seyedmousavi reports additional funding from the Intramural Program of National Institute of Health Clinical Center, Bethesda, MD, USA outside of the study. M Shey reports additional funding from the Wellcome Trust Kenji Shibuya reports additional funding from Japan's Ministry of Health, Labour and Welfare and Japan's Ministry of Education, Culture, Sport, Science and Technology outside of the study. M Sobhiyeh reports additional funding from the Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences outside of the study. J Soriano reports additional funding from Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain outside of the study. N Taveira reports additional funding from the LIFE study (RIA2016MC-1615) of the European and Developing Countries Clinical Trials Partnership (EDCTP) program supported by the European Union outside of the study. B Unnikrishnan reports additional funding from the Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India outside of the study. T Wijeratne reports additional funding from the Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Sri Lanka outside of the study. C S Wiysonge reports additional funding from the South African Medical Research Council and the National Research Foundation of South Africa outside of the study.

Published
2020

48. Intravascular Lithotripsy Facilitated Percutaneous Endovascular Intervention of the Aortic Arch: A Single-Center Experience

Author

Charan Yerasi, Ron Waksman, Itsik Ben-Dor, Toby Rogers, Brian C. Case, Brian J. Forrestal, Evan Shlofmitz, Nauman Khalid, Nelson L. Bernardo, and Lowell F. Satler

Subjects
Aortic arch, Male, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Subclavian Artery, Aorta, Thoracic, 030204 cardiovascular system & hematology, Lithotripsy, Single Center, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, medicine, Humans, Carotid Stenosis, 030212 general & internal medicine, Vascular Calcification, Brachiocephalic Trunk, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Endovascular Procedures, Percutaneous coronary intervention, General Medicine, Middle Aged, Surgery, Coronary arteries, Clinical trial, medicine.anatomical_structure, Treatment Outcome, cardiovascular system, Carotid stenting, Cardiology and Cardiovascular Medicine, business
Abstract

Background Intravascular lithotripsy (IVL) (Shockwave Medical, Inc., Fremont, California, USA) is a novel technology used to modify heavily calcified atherosclerotic plaque in vessels to help facilitate percutaneous coronary intervention and has been shown to be effective in treating critical lesions within the lower limbs. In addition, studies are currently underway evaluating IVL's feasibility in de novo calcified stenotic coronary arteries before stenting. The use and associated complications of IVL in other vascular territories are underreported. We report our institution's initial experience using IVL for the treatment of complex, heavily calcified lesions within the aortic arch vessels. Methods and results We treated five patients with IVL of the aortic arch vessels, including the carotid (2), subclavian (2), and innominate arteries. Four of the five patients underwent successful IVL treatment and intervention without complications. One patient (carotid intervention) developed acute right eye blindness post-procedure, thought to be due to an embolic plaque, which was successfully treated with tissue plasminogen activator and intravenous heparin. Conclusion IVL offers promising technology to facilitate the treatment of complex lesions in the vessels of the aortic arch. We do not promote the use of IVL but promote prospective clinical trials to assess the safety and efficacy of this technology in this vascular territory.

Published
2020

49. Guidelines for Balancing Priorities in Structural Heart Disease During the COVID-19 Pandemic

Author

Anees Musallam, Charan Yerasi, Nauman Khalid, Brian C. Case, Toby Rogers, Evan Shlofmitz, Brian J. Forrestal, Chava Chezar-Azerrad, Ron Waksman, and Jaffar M. Khan

Subjects
Heart disease, Psychological intervention, LAA, left atrial appendage, Comorbidity, 030204 cardiovascular system & hematology, Global Health, MR, mitral regurgitation, Health administration, 0302 clinical medicine, Pandemic, Health care, Global health, COVID-19, novel coronavirus disease 2019, 030212 general & internal medicine, Disease management (health), Structural heart disease, Societies, Medical, TAVR, transcatheter aortic valve replacement, MitraClip, Disease Management, TEE, transesophageal echocardiography, General Medicine, ICU, intensive care unit, BAV, balloon aortic valvuloplasty, Practice Guidelines as Topic, Transcatheter mitral valve repair, Cardiology and Cardiovascular Medicine, Coronavirus Infections, PPE, personal protective equipment, LOS, length of stay, medicine.medical_specialty, Heart Diseases, AS, aortic stenosis, PFO, patent foramen ovale, Pneumonia, Viral, Cardiology, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, Article, CAIC, Canadian Association of Interventional Cardiology, 03 medical and health sciences, Betacoronavirus, medicine, EF, ejection fraction, Humans, NYHA, New York Heart Association, Intensive care medicine, Pandemics, Mitral regurgitation, Transcatheter aortic valve repair, business.industry, ASD, atrial septal defect, SARS-CoV-2, Aortic stenosis, Novel coronavirus disease 2019, COVID-19, medicine.disease, SCAI, Society for Cardiovascular Angiography and Interventions, ACC, American College of Cardiology, business, ECMO, extracorporeal membrane oxygenation
Abstract

During the novel coronavirus disease 2019 (COVID-19) pandemic, many hospitals have been asked to postpone elective and surgical cases. This begs the question, “What is elective in structural heart disease intervention?” The recently proposed Society for Cardiovascular Angiography and Interventions/American College of Cardiology consensus statement is, unfortunately, non-specific and insufficient in its scope and scale of response to the COVID-19 pandemic. We propose guidelines that are practical, multidisciplinary, implementable, and urgent. We believe that this will provide a helpful framework for our colleagues to manage their practice during the surge and peak phases of the pandemic. General principles that apply across structural heart disease interventions include tracking and reporting cardiovascular outcomes, “healthcare distancing,” preserving vital resources and personnel, shared decision-making between the heart team and hospital administration on resource-intensive cases, and considering delaying research cases. Specific guidance for transcatheter aortic valve replacement and MitraClip procedures varies according to pandemic phase. During the surge phase, treatment should broadly be limited to those at increased risk of complications in the near term. During the peak phase, treatment should be limited to inpatients for whom it may facilitate discharge. Keeping our patients and ourselves safe is paramount, as well as justly rationing resources., Highlights • Many elective and surgical cases have been postponed during the COVID-19 pandemic. • We propose guidelines for managing structural heart disease during the pandemic. • General principles include preserving vital resources and personnel. • Specific guidance for TAVR and mitral valve repair changes with pandemic phase. • Keeping our patients and ourselves safe and justly rationing resources is paramount.

Published
2020

50. Review of ACC 2020 late-breaking trials in interventional cardiology

Author

Brian C. Case, Jaffar M. Khan, Charan Yerasi, Brian J. Forrestal, Ron Waksman, Jason P. Wermers, Nauman Khalid, Chava Chezar-Azerrad, and Evan Shlofmitz

Subjects
medicine.medical_specialty, Clinical Trials as Topic, Interventional cardiology, Peripheral artery disease, business.industry, medicine.medical_treatment, Antiplatelet therapy, Cardiology, Percutaneous coronary intervention, General Medicine, Congresses as Topic, Transcatheter aortic valve replacement, Article, Anticoagulation, Treatment Outcome, Cardiovascular Diseases, Emergency medicine, Medicine, Renal denervation, Humans, Cardiology and Cardiovascular Medicine, business
Abstract

Highlights • ACC Scientific Sessions 2020 shared the latest research in cardiology. • We highlight results from 14 late-breaking trials. • Areas covered include TAVR, coronary, and peripheral artery disease.

Published
2020

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