115 results on '"Saad, Antonio F."'
Search Results
102. OxLDL immune complexes activate complement and induce cytokine production by MonoMac 6 cells and human macrophages
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Saad, Antonio F., primary, Virella, Gabriel, additional, Chassereau, Charlyne, additional, Boackle, Robert J., additional, and Lopes-Virella, Maria F., additional
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- 2006
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103. Digoxin Therapy of Fetal Superior Ventricular Tachycardia: Are Digoxin Serum Levels Reliable?
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Saad, Antonio F., Monsivais, Luis, and Pacheco, Luis D.
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- 2016
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104. Pregnancy-Associated Atypical Hemolytic-Uremic Syndrome
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Saad, Antonio F., Roman, Jorge, Wyble, Aaron, and Pacheco, Luis D.
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- 2016
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105. Corticosteroids in the Management of Pregnant Patients With Coronavirus Disease (COVID-19): In Reply.
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Saad, Antonio F., Chappell, Lucy, Saade, George R., and Pacheco, Luis D.
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- *
COVID-19 , *CORTICOSTEROIDS - Published
- 2021
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106. Reply: Ischemic heart disease in pregnancy: a practical approach to management.
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Saad AF, Kennedy JLW, and Sharma G
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- Humans, Pregnancy, Female, Pregnancy Complications, Cardiovascular therapy, Pregnancy Complications, Cardiovascular diagnosis, Pregnancy Complications, Cardiovascular physiopathology, Myocardial Ischemia diagnosis, Myocardial Ischemia therapy, Myocardial Ischemia physiopathology
- Published
- 2024
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107. Ischemic heart disease in pregnancy: a practical approach to management.
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Nguyen AH, Murrin E, Moyo A, Sharma G, Sullivan SA, Maxwell GL, Kennedy JLW, and Saad AF
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- Female, Humans, Pregnancy, Risk Factors, Risk Assessment, Myocardial Ischemia diagnosis, Myocardial Ischemia epidemiology, Myocardial Ischemia etiology, Myocardial Infarction diagnosis, Myocardial Infarction therapy, Vascular Diseases
- Abstract
Ischemic heart disease is a crucial issue during pregnancy. The term is composed of both preexisting conditions and acute coronary syndrome in pregnancy, including pregnancy-associated myocardial infarction, which can have a significant effect on maternal and fetal outcomes. This review provides a complete guide to managing ischemic heart disease in pregnant women, emphasizing the importance of multidisciplinary care and individualized treatment strategies. Cardiovascular disease, particularly ischemic heart disease, is now the leading cause of maternal mortality worldwide. Pregnancy introduces unique physiological changes that increase the risk of acute myocardial infarction, with pregnancy-associated myocardial infarction cases often associated with factors, such as advanced maternal age, chronic hypertension, and preexisting cardiovascular conditions. This review distinguishes between preexisting ischemic heart disease and pregnancy-associated myocardial infarction. It will emphasize the various etiologies of pregnancy-associated myocardial infarction, including coronary atherosclerosis and plaque rupture presenting as ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and other nonatherosclerotic causes, including spontaneous coronary artery dissection, vasospasm, and embolism. Our study discusses the practical management of ischemic heart disease in pregnancy, with a focus on preconception counseling, risk assessment, and tailored antenatal planning for women with preexisting ischemic heart disease. Moreover, this document focuses on the challenges of diagnosing cardiovascular disease, especially when presented with nonclassical risk factors and presentation. It provides insight into the appropriate diagnostic testing methods, such as electrocardiogram, cardiac biomarkers, and echocardiography. In addition, the review covers various treatment strategies, from medical management to more invasive procedures, including coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft. Special attention is given to medication safety during pregnancy, including anticoagulation, beta-blockers, and antiplatelet agents. The complexities of delivery planning in women with ischemic heart disease are discussed, advocating for a multidisciplinary team-based approach and careful consideration of the timing and mode of delivery. Furthermore, the roles of breastfeeding and postpartum care are explored, emphasizing the long-term benefits and the suitability of various medications during lactation. Lastly, this review provides crucial insights into the management of ischemic heart disease in pregnancy, stressing the need for heightened awareness, prompt diagnosis, and tailored management to optimize maternal and fetal health outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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108. Intrahepatic Cholestasis of Pregnancy: Toward Improving Perinatal Outcome.
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Saad AF, Pacheco LD, Chappell L, and Saade GR
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- Pregnancy, Infant, Newborn, Female, Humans, Bile Acids and Salts, Ursodeoxycholic Acid therapeutic use, Pregnancy Outcome, Cholestasis, Intrahepatic diagnosis, Cholestasis, Intrahepatic drug therapy, Pregnancy Complications diagnosis, Pregnancy Complications drug therapy
- Abstract
Intrahepatic cholestasis of pregnancy (ICP) is associated with poor perinatal outcomes in some women such as preterm delivery and fetal demise. Ursodeoxycholic acid (UDCA) is the main therapeutic agent for ICP, but recent evidence failed to show an impact on most perinatal outcomes. Our objective is to summarize the latest evidence in the management of ICP, with a focus on perinatal outcome. We propose a practical approach that combines pharmacotherapy with biochemical and fetal testing, as well as delivery planning., (© 2021. Society for Reproductive Investigation.)
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- 2022
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109. Timing of birth and adverse pregnancy outcomes in cases of prenatally diagnosed vasa previa: a systematic review and meta-analysis.
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Mitchell SJ, Ngo G, Maurel KA, Hasegawa J, Arakaki T, Melcer Y, Maymon R, Vendittelli F, Shamshirsaz AA, Erfani H, Shainker SA, Saad AF, Treadwell MC, Roman AS, Stone JL, and Rolnik DL
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- Birth Weight, Female, Gestational Age, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, Perinatal Death, Respiratory Distress Syndrome, Vasa Previa diagnostic imaging
- Abstract
Objective: The ideal time for birth in pregnancies diagnosed with vasa previa remains unclear. We conducted a systematic review aiming to identify the gestational age at delivery that best balances the risks for prematurity with that of pregnancy prolongation in cases with prenatally diagnosed vasa previa., Data Sources: Ovid MEDLINE, PubMed, CINAHL, Embase, Scopus, and Web of Science were searched from inception to January 2022., Study Eligibility Criteria: The intervention analyzed was delivery at various gestational ages in pregnancies prenatally diagnosed with vasa previa. Cohort studies, case series, and case reports were included in the qualitative synthesis. When summary figures could not be obtained directly from the studies for the quantitative synthesis, authors were contacted and asked to provide a breakdown of perinatal outcomes by gestational age at birth., Methods: Study appraisal was completed using the National Institutes of Health quality assessment tool for the respective study types. Statistical analysis was performed using a random-effects meta-analysis of proportions., Results: The search identified 3435 studies of which 1264 were duplicates. After screening 2171 titles and abstracts, 140 studies proceeded to the full-text screen. A total of 37 studies were included for analysis, 14 of which were included in a quantitative synthesis. Among 490 neonates, there were 2 perinatal deaths (0.4%), both of which were neonatal deaths before 32 weeks' gestation. In general, the rate of neonatal complications decreased steadily from <32 weeks' gestation (4.6% rate of perinatal death, 91.2% respiratory distress, 11.4% 5-minute Apgar score <7, 23.3% neonatal blood transfusion, 100% neonatal intensive care unit admission, and 100% low birthweight) to 36 weeks' gestation (0% perinatal death, 5.3% respiratory distress, 0% 5-minute Apgar score <7, 2.9% neonatal blood transfusion, 29.2% neonatal intensive care unit admission, and 30.9% low birthweight). Complications then increased slightly at 37 weeks' gestation before decreasing again at 38 weeks' gestation., Conclusion: Prolonging pregnancies until 36 weeks' gestation seems to be safe and beneficial in otherwise uncomplicated pregnancies with antenatally diagnosed vasa previa., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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110. Cervical Ripening Using Foley Balloon with or without Oxytocin: A Systematic Review and Meta-Analysis.
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Gallagher LT, Gardner B, Rahman M, Schoen C, Connolly KA, Hankins GD, Saade GR, and Saad AF
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- Female, Humans, Parity, Pregnancy, Pregnancy Outcome, Time Factors, Catheterization, Cervical Ripening drug effects, Cesarean Section statistics & numerical data, Labor, Induced methods, Oxytocics therapeutic use, Oxytocin therapeutic use
- Abstract
Objective: To assess available evidence regarding the use of oxytocin in conjunction with Foley balloon (FB) for cervical ripening., Methods: Databases from MEDLINE (U.S. National Library of Medicine, 1980-May 12, 2017), MEDLINE (Ovid, 1980-June 30, 2017), the Cochrane Library Controlled Trials Register, ClinicalTrials.gov, and Web of Science were queried for studies on FB cervical ripening with or without oxytocin in pregnant women. Search terms included: "balloon dilatation" OR "mechanical methods" OR "mechanical method" OR "mechanical dilation" OR "mechanical dilatation" OR "mechanical dilations" OR "mechanical dilatations" OR "balloon" OR "Foley" AND "Pitocin" OR "oxytocin." All relevant references were reviewed. Literature for inclusion and methodological quality were reviewed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines., Results: Out of 344 citations, six randomized clinical trials (1,133 patients) fulfilled our inclusion criteria. The pooled estimate showed that the cesarean delivery (CD) rate did not differ (relative risk [RR]: 0.91 (95% confidence interval [CI] [0.76-1.10]; p = 0.23) between patients who underwent preinduction cervical ripening with FB alone versus those who received oxytocin in addition to FB. Heterogeneity was not significant among studies ( I
2 0.0%; p = 0.64). Furthermore, no differences in other outcomes such as composite and maternal outcomes were detected between these two groups. Compared with simultaneous use of oxytocin with FB, the Foley alone cervical ripening group had a longer induction to delivery time, and lower deliveries within 12 and 24 hours. Subgroup analysis showed that only multiparous women in the Foley alone group had lower rate of vaginal delivery within 24 hours (RR: 0.74, 95% CI [0.61-0.89], p = 0.002) along with a trend toward higher CD rates., Conclusion: Adding oxytocin to FB at the time of preinduction cervical ripening does not reduce cesarean rates nor improve maternal or neonatal outcomes. Multiparous women who received FB alone seem to have lower rates of vaginal deliveries within 24 hours, but these results should be interpreted with caution., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)- Published
- 2019
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111. Progressive Devascularization: A Novel Surgical Approach for Placenta Previa.
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Saad AF, Kirsch N, Saade GR, and Hankins GDV
- Abstract
Background The gold standard for antenatal diagnosis of placenta previa is the transvaginal ultrasonography. In placenta previa cases, separation of placental and uterine tissues is challenging even for the most experienced surgeons. Life-threatening obstetrical complications from cesarean deliveries with placenta previa include peripartum hemorrhage, coagulopathy, blood transfusion, peripartum hysterectomy, and multiple organ failure. Cases We detailed the 3 cases of placenta previa that underwent bilateral uterine artery ligation; if hemostasis was not achieved, horizontal mattress sutures were placed in the lower uterine segment. All patients were discharged with minimal morbidity. Conclusion For patients with placenta previa and low risk for placenta creta, counseling should include the risk for maternal morbidity and criteria for pursuing peripartum hysterectomy. Our devascularization, a stepwise surgical approach, shows promising outcomes in placenta previa cases. Précis We propose a novel surgical approach, using a progressive devascularization surgical technique, for management of women with placenta previa, undergoing cesarean delivery.
- Published
- 2018
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112. Digoxin Therapy of Fetal Superior Ventricular Tachycardia: Are Digoxin Serum Levels Reliable?
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Saad AF, Monsivais L, and Pacheco LD
- Abstract
Background: Despite its seldom occurrence, fetal tachycardia can lead to poor fetal outcomes including hydrops and fetal death. Management can be challenging and result in maternal adverse effects secondary to high serum drug levels required to achieve effective transplacental antiarrhythmic drug therapy., Case: A 33-year-old woman at 33 weeks of gestation with a diagnosis of a fetal sustained superior ventricular tachycardia developed chest pain, shortness of breath, and bigeminy on electrocardiogram secondary to digoxin toxicity despite subtherapeutic serum drug levels. She required supportive care with repletion of corresponding electrolyte abnormalities. After resolution of cardiac manifestations of digoxin toxicity, the patient was discharged home. The newborn was discharged at day 9 of life on maintenance amiodarone., Conclusion: We describe an interesting case of digoxin toxicity with cardiac manifestations of digoxin toxicity despite subtherapeutic serum drug levels. This case report emphasizes the significance of instituting an early diagnosis of digoxin toxicity during pregnancy, based not only on serum drug levels but also on clinical presentation. In cases of refractory supportive care, digoxin Fab fragment antibody administration should be considered. With timely diagnosis and treatment, excellent maternal and perinatal outcomes can be achieved.
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- 2016
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113. Pregnancy-Associated Atypical Hemolytic-Uremic Syndrome.
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Saad AF, Roman J, Wyble A, and Pacheco LD
- Abstract
Introduction Early diagnosis of atypical uremic-hemolytic syndrome may be challenging during the puerperium period. Correct diagnosis and timely management are crucial to improve outcomes. Background Pregnancy-associated atypical hemolytic-uremic syndrome (p-aHUS) is a rare condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Triggered by pregnancy, genetically predisposed women develop the syndrome, leading to a disastrous hemolytic disease characterized by diffuse endothelial damage and platelet consumption. This disease is a life-threatening condition that requires prompt diagnosis and therapy. Case A 19-year-old G1P1 Caucasian female with suspicion of HELLP syndrome was treated at our facility for severe thrombocytopenia and acute kidney injury. A diagnosis of atypical uremic-hemolytic syndrome was later confirmed. The patient's condition improved with normalization of platelets and improvement in kidney function after 14 days of plasmapheresis. She was subsequently treated with eculizumab, a monoclonal antibody against C5. The patient tolerated well the therapy and is currently in remission. Conclusion Diagnosis of p-aHUS is challenging, as it can mimic various diseases found during pregnancy and the postpartum. Plasma exchange should be promptly initiated within 24 hours of diagnosis. Eculizumab has risen to become an important tool to improve long-term comorbidities and mortality in this group population.
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- 2016
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114. Amniotic Sac Herniation Through a Prior Cornual Scar in The Third Trimester.
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Saad AF, Costantine MM, Saade G, and Makhlouf M
- Abstract
Introduction Uterine rupture occurs in less than 0.1% of pregnancies. This complication can be detrimental to mother and fetus if not detected and managed in a timely manner. We report an unusual presentation of uterine scar rupture that was diagnosed on ultrasound in a completely stable patient with reassuring fetal status. Case Report A 24-year-old Gravida 5, Para 3 with history of cornual resection for ectopic pregnancy and two previous uterine ruptures presented at 30 weeks' gestation with worsening abdominal pain. Ultrasound identified herniation of the amniotic sac with fetal parts. The patient underwent cesarean delivery and cornual defect repair. Conclusion Close observation and early delivery remain vital to the patient's management.
- Published
- 2015
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115. The functional effects of acid ceramidase overexpression in prostate cancer progression and resistance to chemotherapy.
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Saad AF, Meacham WD, Bai A, Anelli V, Elojeimy S, Mahdy AE, Turner LS, Cheng J, Bielawska A, Bielawski J, Keane TE, Obeid LM, Hannun YA, Norris JS, and Liu X
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- Animals, Cell Line, Tumor, Cell Movement, Cell Proliferation, Cell Survival, Ceramides metabolism, Disease Progression, Humans, Male, Mice, Mice, Nude, Drug Resistance, Neoplasm, Galactosylgalactosylglucosylceramidase biosynthesis, Gene Expression Regulation, Neoplastic, Prostatic Neoplasms drug therapy, Prostatic Neoplasms enzymology
- Abstract
Among the many processes regulating cell death, ceramide signaling is a vital component. We previously determined that acid ceramidase (AC) is upregulated in 60% of primary prostate cancer (PCa) tissues, suggesting that AC may play a role in tumor development. In order to determine the significance of AC elevation, stable clones of DU145 cells with AC overexpression (AC-EGFP) were generated. Compared to controls (EGFP), AC-EGFP cells exhibited enhanced cell proliferation and migration. Subcutaneous injection of AC-EGFP cells into Nu/Nu mice resulted in larger tumor volumes compared to EGFP controls. Moreover, using the MTS viability assay, AC-EGFP cells were more resistant to cell death induced by doxorubicin, cisplatin, etoposide, gemcitabine or C6-ceramide. Conversely, knock down of AC using siRNA, sensitized AC-EGFP cells to these drugs. In addition, mass spectroscopic analysis of sphingolipids indicated that long chain ceramide levels were decreased in AC-EGFP cells treated with either doxorubicin or etoposide. In conclusion, this study implicates AC as a critical regulator of PCa progression by affecting not only tumor cell proliferation and migration but also responses to drug therapy, suggesting AC as a potential therapeutic target in advanced PCa.
- Published
- 2007
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