Maryam Mahmood

Dual Versus Single Antiplatelet Therapy in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis

BACKGROUNDnAlthough dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve replacement (TAVR), this approach is not evidence based. We therefore sought to systematically review the current evidence for this practice in terms of 30-day outcome looking at stroke, MI, bleeding, and death.nnnMETHODSnRelevant studies were identified through electronic literature search. Studies involving single antiplatelet therapy (SAPT) and DAPT in patients undergoing TAVR were included. Study specific risk ratios were calculated and combined using random-effects model meta-analysis.nnnRESULTSnAnalysis of data from 410 patients, stroke occurred in seven (3.16%) of SAPT and six (3.17%) of DAPT RR=1.03 (95% CI, 0.36-2.96, P=0.96). In analysis of 530 patients, MI occurred in three (1.07%) of SAPT and one (0.40%) of DAPT RR=1.97 (95% CI, 0.29-13.29, P=0.49), significant bleeding (major, life threatening and bleeding requiring transfusion) occurred in 20 (7.11%) of SAPT and 43 (17.27%) of DAPT RR=0.41 (95% CI, 0.25-0.69, P=0.0006). Number needed to harm for major or life threatening bleeding was 10. Death occurred in 15 (6.78%) of SAPT and 15 (7.94%) of DAPT (RR 0.91; 95% CI 0.46-1.79, P=0.78).nnnCONCLUSIONnOur meta-analysis suggests that at 30 days following TAVR there is no difference between post-procedural SAPT versus DAPT for the risk of stroke or MI and DAPT may have a higher bleeding risk. Adequately powered RCTs are warranted to clarify the optimal antiplatelet treatment strategy following TAVR.

Meta-Analysis on Efficacy of Statins for Prevention of Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary Angiography

Contrast-induced acute kidney injury (CIAKI) is a leading cause of hospital-acquired acute kidney injury, and pretreatment with hydroxymethylglutaryl CoA reductase inhibitors (statins) have shown promise in prevention. A systematic review and meta-analysis was performed including randomized controlled trials of short-term high-dose statins (compared with either low-dose statin or placebo) for CIAKI prevention in patients undergoing coronary angiography. Study-specific odds ratios (ORs) were calculated, and between-study heterogeneity was assessed using the I(2) statistic. We used a random-effects model meta-analysis to pool the OR. Twelve RCTs, including 5,564 patients, were included. CIAKI occurred in 94 of 2,769 patients (3.4%) pretreated with high-dose statins and 213 of 2,795 patients (7.6%) in the low-dose or no-statin group (OR 0.43, 95% confidence interval [CI] 0.33 to 0.55, I(2)xa0= 19%, pxa0<0.001). Subgroup analysis showed that the occurrence of CIAKI did not differ in patients with diabetes (OR 0.60, 95% CI 0.43 to 0.85, I(2)xa0= 0%, pxa0= 0.004) or in patients with documented renal insufficiency (creatinine clearance <60xa0ml/min/m(2); OR 0.66, 95% CI 0.45 to 0.96, I(2)xa0= 0%, pxa0= 0.03). In conclusion, pretreatment with high-dose statins, compared with low-dose statins or placebo, in patients undergoing coronary angiography reduces the incidence of CIAKI. This benefit was seen irrespective of the presence of diabetes and chronic kidney disease. Future studies should identify optimum dosing protocols for each statin.

Youtube as a source of information on Ebola virus disease

Background: The current West Africa epidemic of Ebola virus disease (EVD), which began from Guinea in December 2013, has been the longest and deadliest Ebola outbreak to date. With the propagation of the internet, public health officials must now compete with other official and unofficial sources of information to get their message out. Aims: This study aimed at critically appraising videos available on one popular internet video site (YouTube) as a source of information for Ebola virus disease (EVD). Materials and Methods: Videos were searched in YouTube (http://www.youtube.com) using the keyword Ebola outbreak from inception to November 1, 2014 with the default relevance filter. Only videos in English language under 10 min duration within first 10 pages of search were included. Duplicates were removed and the rest were classified as useful or misleading by two independent reviewers. Video sources were categorized by source. Inter-observer agreement was evaluated with kappa coefficient. Continuous and categorical variables were analyzed using the Student t-test and Chi-squared test, respectively. Results: One hundred and eighteen out of 198 videos were evaluated. Thirty-one (26.27%) videos were classified as misleading and 87 (73.73%) videos were classified as useful. The kappa coefficient of agreement regarding the usefulness of the videos was 0.68 (P < 0.001). Independent users were more likely to post misleading videos (93.55% vs 29.89%, OR = 34.02, 95% CI = 7.55-153.12, P < 0.001) whereas news agencies were most likely to post useful videos (65.52% vs 3.23%, OR = 57.00, 95% CI = 7.40-438.74, P < 0.001). Conclusions: This study demonstrates that majority of the internet videos about Ebola on YouTube were characterized as useful. Although YouTube seems to generally be a useful source of information on the current outbreak, increased efforts to disseminate scientifically correct information is desired to prevent unnecessary panic among the among the general population.

Effect of statins on the mortality of bacteremic patients: A systematic review and meta-analysis of clinical trials

Background: Statins modify inflammatory cell signaling during the immune response to infection. This has been considered as a pleotropic effect. Effects of statins in inflammatory conditions such as bacteremia have been found to be controversial. Aims: We examined the effect of statins on the mortality of bacteremia patients. Material and Methods: Major databases were searched for the pertinent clinical trials. Results: Six cohort studies comprising 7553 patients were included. Hospital mortality was lower (15.36% vs 22.28%) in patients on statin. Conclusions: There may be a potential role of statins in similar inflammatory and infective conditions.

Utility of Serum Procalcitonin in Skin and Soft Tissue Infections: A Prospective Trial

BackgroundProcalcitonin (PCT) has been studied as a biomarker to assist in the diagnosis and treatment of severe bacterial infections, mostly in the context of respiratory tract infections and severe sepsis, where it has been shown to reduce antimicrobial use without worsening clinical outcomes. The utility of PCT in guiding duration of antibiotic therapy in skin and soft tissue infections (SSTIs) has not been established. Our aim was to evaluate the relationship between the duration of intravenous antibiotic therapy for SSTIs and serum PCT; as well as the relationship between PCT and conventional markers of inflammation. MethodsSerum PCT, leukocyte count, C-reactive protein and blood cultures laboratory, and body temperature were examined in 39 consecutive patients with SSTIs requiring inpatient intravenous antibiotic treatment. ResultsThirty-nine consecutive inpatients presenting with SSTIs were evaluated. Procalcitonin values on admission correlated with duration of intravenous antibiotic therapy (Pearson correlation, 0.475; P = 0.002) and length of hospital stay (Pearson correlation, 0.534; P = 0.001). Peak serum PCT values also correlate with peak leukocyte count (Pearson correlation, 0.529; P = 0.001), peak C-reactive protein during hospitalization (Spearman correlation, 0.457; P = 0.003), and presence of Systemic Inflammatory Response Syndrome criteria on admission (P = 0.030). ConclusionsProcalcitonin correlates with duration of intravenous antibiotic therapy in SSTIs; it may be a valuable adjunct in the initial diagnosis and management of antibiotic therapy in these infections.

Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature

Abstract Background Chronic Coxiella burnetii infections such as vertebral osteomyelitis caused by contiguous spread from an infected abdominal aortic graft or aneurysm have been rarely reported and are associated with significant morbidity and mortality. Methods We present the first four reported US acquired cases of Coxiella burnetii vertebral osteomyelitis caused by contiguous spread from an infected abdominal aortic graft or aneurysm. Results Presenting symptoms included progressive back pain, malaise, and weight loss with recent or remote animal exposure. Typical imaging findings demonstrated a peri-aortic collection with extension to the paraspinal muscles and vertebrae. Antibiotic regimens included doxycycline with either hydroxychloroquine or a quinolone for at least 2 years or as chronic suppression. Conclusions C. burnetii vertebral osteomyelitis is rare and can occur by contiguous spread from an abdominal aneurysm or vascular graft infection. It should be suspected in patients where pre-antibiotic cultures are negative with animal/farming exposure.

EFFICACY OF HIGH-DOSE STATIN FOR PREVENTION OF CONTRAST- INDUCED NEPHROPATHY (CIN) IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Contrast-induced nephropathy (CIN) is a leading cause of hospital-acquired acute kidney injury. Previous trials on statins for CIN prevention are conflicting and meta-analyses of these are inconclusive. We systematically reviewed randomized controlled trials (RCTs) comparing high-dose versus low-