Primary cardiac schwannoma (PCS) is a neurogenic tumor that arises from Schwann cells. Malignant schwannoma (MSh) is an aggressive cancer comprising 2% of all sarcomas. Information on the proper management of these tumors is limited. Four... more
Primary cardiac schwannoma (PCS) is a neurogenic tumor that arises from Schwann cells. Malignant schwannoma (MSh) is an aggressive cancer comprising 2% of all sarcomas. Information on the proper management of these tumors is limited. Four databases were searched for case reports/series of PCS. The primary outcome was overall survival (OS). Secondary outcomes included therapeutic strategies and the corresponding outcomes. Among 439 potentially eligible studies, 53 met the inclusion criteria. The patients included had 43.72 ± 17.76 years and 28.3% were males. Over 50% of patients had MSh, with 9.4% also demonstrating metastases. Schwannoma commonly occurs in the atria (66.0%). Left-sided PCS were more common than right-sided ones. Surgery was performed in almost 90% of the cases; chemotherapy and radiotherapy were used in 16.9% and 15.1% of cases, respectively. Compared to benign cases, MSh occurs at a younger age and is commonly located on the left side. OS of the entire cohort at 1 ...
Research Interests:
Research Interests:
Hypercoagulability is strongly associated with cancer and may result in non-bacterial thrombotic endocarditis (NBTE). The aim of our meta-analysis was to explore the demographics and characteristics of this condition in cancer. Databases... more
Hypercoagulability is strongly associated with cancer and may result in non-bacterial thrombotic endocarditis (NBTE). The aim of our meta-analysis was to explore the demographics and characteristics of this condition in cancer. Databases were systematically searched. The outcomes were to identify the annual trend in premortem diagnosis among the entire cohort and different subgroups and to identify differences in characteristics and survival in the considered population. A total of 121 studies with 144 patients were included. The proportion of marantic endocarditis associated with lung cancer was 0.29 (95% CI, 0.21–0.37; p < 0.001), that associated with pancreatic cancer was 0.19 (95% CI, 0.13–0.27; p < 0.001), that associated with advanced cancer stage (metastasis) was 0.69 (95% CI, 0.61–0.76; p < 0.001), and that associated with adenocarcinoma was 0.65 (95% CI, 0.56–0.72; p < 0.001). Median and 6-month overall survival (OS) were 1.3 months and 32.3%, respectively, with...
Research Interests:
Research Interests:
IntroductionPrimary malignant cardiac tumors (PMCTs) are rare. Geographical distribution has been demonstrated to affect cancer outcomes, making the reduction of geographical inequalities a major priority for cancer control agencies.... more
IntroductionPrimary malignant cardiac tumors (PMCTs) are rare. Geographical distribution has been demonstrated to affect cancer outcomes, making the reduction of geographical inequalities a major priority for cancer control agencies. Geographic survival disparities have not been reported previously for PMCT and the aim of this study is to compare the prevalence and the long-term survival rate with respect to the geographic location of PMCTs using the Surveillance, Epidemiology, and End Results (SEER) research plus data 17 registries between 2000 and 2019.MethodsThe SEER database was queried to identify geographic variation among PMCTs. We classified the included states into 4 geographical regions (Midwest, Northeast, South and West regions) based on the U.S. Census Bureau-designated regions and divisions. Different demographic and clinical variables were analyzed and compared between the four groups. Kaplan Meier curves and Cox regression were used for survival assessment.ResultsA t...
Research Interests:
OBJECTIVES Repair of the isolated degenerative anterior mitral leaflet has been considered more challenging and associated with compromised durability compared with isolated posterior leaflet in major series. Implantation of neochordae or... more
OBJECTIVES Repair of the isolated degenerative anterior mitral leaflet has been considered more challenging and associated with compromised durability compared with isolated posterior leaflet in major series. Implantation of neochordae or Alfieri edge-to-edge is the most employed repair technique for isolated anterior repair currently, but little data exist comparing their relative durability. We sought to investigate this issue with this meta-analysis. METHODS A literature search was performed (Ovid MEDLINE, Ovid Embase and The Cochrane Library). The primary outcome was the incidence rate (IR) of reoperation, the secondary outcomes were recurrent moderately severe/severe mitral regurgitation (MR), in-hospital/30-day reoperation and mortality and follow-up mortality. A random-effect model was used. Leave-one-out, subgroup analysis (Alfieri versus neochordae) and meta-regression were done. RESULTS Seventeen studies (including 1358 patients) were included. At a weighted mean follow-up...
Research Interests:
OBJECTIVES The aim of this study was to perform a meta-analysis of studies reporting outcomes in patients with liver dysfunction addressed by the model of end-stage liver disease and Child–Turcotte–Pugh scores undergoing cardiac surgery.... more
OBJECTIVES The aim of this study was to perform a meta-analysis of studies reporting outcomes in patients with liver dysfunction addressed by the model of end-stage liver disease and Child–Turcotte–Pugh scores undergoing cardiac surgery. METHODS A systematic literature search was conducted to identify contemporary studies reporting short- and long-term outcomes in patients with liver dysfunction compared to patients with no or mild liver dysfunction undergoing cardiac surgery (stratified in high and low score group based on the study cut-offs). Primary outcome was perioperative mortality. Secondary outcomes were perioperative neurological events, prolonged ventilation, sepsis, bleeding and/or need for transfusion, acute kidney injury and long-term mortality. RESULTS A total of 33 studies with 48 891 patients were included. Compared with the low score group, being in the high score group was associated with significantly higher risk of perioperative mortality [odds ratio (OR) 3.72, 9...
Research Interests:
Research Interests:
Research Interests:
This is the data sheet in which we collected data from all included articles for the meta-analysis. You can find raw data extraction in the attached sheet which then allowed us to perform our statistical analysis.
Research Interests:
Background: Survivin is an anti-apoptotic protein and is considered as one of the principle inhibitors of apoptosis (IAP) family which has shown its role in cancer progression, tumor angiogenesis, tumor resistance to chemotherapeutics and... more
Background: Survivin is an anti-apoptotic protein and is considered as one of the principle inhibitors of apoptosis (IAP) family which has shown its role in cancer progression, tumor angiogenesis, tumor resistance to chemotherapeutics and radiation. Our goal was to prove the importance of survivin in NSCLC patients and to evaluate if the peripheral blood (PB) survivin level is as prognostic as tissue survivin over expression. Methods: We enrolled Non-small cell lung cancer patients in the advanced stage prospectively from (2015 to 2017). Real-time PCR was done to detect survivin expression in the blood. Determination of survival time, time to progression of the disease (TTP) and progression free survival (PFS) were the primary outcomes while the other outcomes were to identify the associations between different variables and survivin cutoff, determined by (ROC) curve. Mann Whitney-U and Chi (X2 ) were used. To estimate the survival, Kaplan-Meier curves were used and compared using L...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Medicine and Mesothelioma
Research Interests:
BackgroundAlthough it is traditionally regarded as a single entity, perioperative stroke comprises 2 separate phenomena (early/intraoperative and delayed/postoperative stroke). We aimed to systematically evaluate incidence, risk factors,... more
BackgroundAlthough it is traditionally regarded as a single entity, perioperative stroke comprises 2 separate phenomena (early/intraoperative and delayed/postoperative stroke). We aimed to systematically evaluate incidence, risk factors, and clinical outcome of early and delayed stroke after cardiac surgery.Methods and ResultsA systematic review (MEDLINE,EMBASE, Cochrane Library) was performed to identify all articles reporting early (on awakening from anesthesia) and delayed (after normal awakening from anesthesia) stroke after cardiac surgery. End points were pooled event rates of stroke and operative mortality and incident rate of late mortality. Thirty‐six articles were included (174 969 patients). The pooled event rate for early stroke was 0.98% (95%CI0.79% to 1.23%) and was 0.93% for delayed stoke (95%CI0.77% to 1.11%;P=0.68). The pooled event rate of operative mortality was 28.8% (95%CI17.6% to 43.4%) for early and 17.9% (95%CI14.0% to 22.7%) for delayed stroke, compared with...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Background: Accurate grading of aortic stenosis by aortic valve area (AVA) is crucial for timing of treatment and intervention. AVA is commonly determined from 2D transthoracic echo (TTE) by means ...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Background Survivin is a protein that inhibits apoptosis and has been shown its role in cancer progression, tumor angiogenesis, tumor cell resistance to chemotherapeutics and ionizing radiation. We aimed to evaluate the importance of... more
Background Survivin is a protein that inhibits apoptosis and has been shown its role in cancer progression, tumor angiogenesis, tumor cell resistance to chemotherapeutics and ionizing radiation. We aimed to evaluate the importance of survivin in lung cancer patients and identify its role in disease progression and outcome. Methods We prospectively enrolled advanced non-small cell lung cancer (NSCLC) patients (2015-2017). Serum survivin expression levels were detected in the peripheral blood using real-time RT-PCR. The primary outcomes were to identify overall survival (OS), progression free survival (PFS) and time to progression (TTP) while the secondary outcomes were to identify the associations between different variables and survivin cut-off determined by receiver operating characteristic (ROC) curve. Chi(X2) and Mann Whitney-U tests were used. Kaplan-Meier survival curves were used and compared using Log-rank. Cox regression was used to identify if survivin was a predictor of su...
Research Interests:
Research Interests:
Research Interests: Chemotherapy and Medicine
Summary This meta-analysis was designed to assess the effect of the use of arterial conduits (ACs) versus great saphenous vein (GSV) grafts as a third conduit for revascularization of the right coronary artery system, in addition to the... more
Summary This meta-analysis was designed to assess the effect of the use of arterial conduits (ACs) versus great saphenous vein (GSV) grafts as a third conduit for revascularization of the right coronary artery system, in addition to the bilateral internal mammary artery on the left coronary artery. PubMed and OVID’s version of MEDLINE were searched from January 2000 to September 2017 for relevant publications. The primary end point was the long-term mortality rate. The secondary end point was early mortality, defined as either in-hospital death or death within 30 days after the operation. Meta-regression was used to evaluate the effect of female gender and diabetes on the primary and secondary outcomes. A total of 10 studies (4121 patients) were selected for the systematic review and meta-analysis comparing ACs (1619) versus the GSV (2502), 6 (2548) comparing the GSV (2548) versus the right gastroepiploic artery (1023) and 5 comparing the GSV (2548) versus the radial artery (596). T...
Research Interests:
Data concerning age-related populations affected with primary malignant cardiac tumors (PMCTs) are still scarce. The aim of the current study was to analyze mortality differences amongst different age groups of patients with PMCTs, as... more
Data concerning age-related populations affected with primary malignant cardiac tumors (PMCTs) are still scarce. The aim of the current study was to analyze mortality differences amongst different age groups of patients with PMCTs, as reported by the National Cancer Database (NCDB). The NCDB was retrospectively reviewed for PMCTs from 2004 to 2017. The primary outcome was late mortality differences amongst different age categories (octogenarian, septuagenarian, younger age), while secondary outcomes included differences in treatment patterns and perioperative (30-day) mortality. A total of 736 patients were included, including 72 (9.8%) septuagenarians and 44 (5.98%) octogenarians. Angiosarcoma was the most prevalent PMCT. Surgery was performed in 432 (58.7%) patients (60.3%, 55.6%, and 40.9% in younger age, septuagenarian, and octogenarian, respectively, p = 0.04), with a corresponding 30-day mortality of 9.0% (7.0, 15.0, and 38.9% respectively, p < 0.001) and a median overall s...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Clinical practice guidelines are a valuable resource aiding medical decision-making based on scientific evidence. In anaesthesia, guidelines are increasing in both number and scope, influencing individual practice and shaping local... more
Clinical practice guidelines are a valuable resource aiding medical decision-making based on scientific evidence. In anaesthesia, guidelines are increasing in both number and scope, influencing individual practice and shaping local departmental policy. The aim of this review is to assess the quality of clinical practice guidelines published in high impact anaesthesia journals over the past 5 yr using the internationally validated Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. A literature search was conducted in Scopus to identify all guidelines published in the top 10 anaesthesia journals as per Clarivate Analytics Impact Factor from 2016 and 2020. Fifty-one guidelines were included for analysis by five independent appraisers using AGREE II. Each guideline was assessed across six domains and 23 items. Individual domain scores were calculated with a threshold agreed via consensus to represent high-quality guidelines. There was a significant increase in overall score over time (P=0.041), driven by Domain 3 (Rigour of Development, P=0.046). The raw overall score for Domain 3, however, was low. The other domains performed as expected based on previous studies, with Domains 1, 4, and 6 achieving high scores and Domains 2 and 5 incurring poor ratings. Most guidelines studied involved international collaboration but emerged from a single professional society. Use of an appraisal tool was stated as high but poorly detailed. The improvement in the overall score of guidelines and rigour of development is promising; however, only seven guidelines met high-quality criteria, suggesting room for improvement for the overall integrity of guidelines in anaesthesia.
Research Interests:
Research Interests:
BACKGROUND To determine the effect of atrial pacing on the rate of post-operative atrial fibrillation (POAF) following coronary artery bypass grafting. METHODS After a systematic literature search, randomized clinical trials (RCTs)... more
BACKGROUND To determine the effect of atrial pacing on the rate of post-operative atrial fibrillation (POAF) following coronary artery bypass grafting. METHODS After a systematic literature search, randomized clinical trials (RCTs) comparing any combination of no pacing (NP), bi-atrial (BiA) pacing, left-atrial (LA) pacing and right-atrial (RA) pacing were included. Pairwise and network meta-analyses were performed using the generic inverse variance method. The primary outcome was POAF incidence. Secondary outcomes were postoperative bleeding, infection, and operative mortality. Leave-one-out and meta-regression were done. RESULTS Fourteen RCTs were included with a total of 1727 patients. Compared with NP, any form of atrial pacing was significantly associated with lower incidence of POAF (odds ratio [OR]: 0.49; 95% confidence interval [CI]: 0.35-0.69). BiA pacing was associated with the larger risk reduction (OR: 0.36; 95% CI: 0.20-0.64 vs. 0.59; 95% CI: 0.34-1.02 for LA and 0.64; 95% CI: 0.38-1.07 for RA). Secondary outcomes were similar between the no pacing and pacing groups. On meta-regression, age and the use of continuous monitoring were associated with lower reduction of the incidence of POAF. In the network meta-analysis, BiA pacing ranked the best strategy for the prevention of POAF (OR: 0.34; 95% CI: 0.21-0.55). CONCLUSIONS Compared to other pacing modalities, BiA pacing is associated with lower rates of POAF following CABG.
Research Interests:
Cerebrospinal-fluid (CSF) drainage is recommended by current guidelines for spinal protection during open and endovascular repairs of thoracic and thoraco-abdominal aortic aneurysms. In the published literature, great variability exists... more
Cerebrospinal-fluid (CSF) drainage is recommended by current guidelines for spinal protection during open and endovascular repairs of thoracic and thoraco-abdominal aortic aneurysms. In the published literature, great variability exists in the rate of CSF-related complications and morbidity. Herein, we perform a systematic review and meta-analysis on the incidence of CSF drainage-related complications, and compare the complication rates between open and endovascular repairs. The systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. Thirty-four studies (4714 patients) were included in the quantitative analysis. The CSF drainage-related complications were categorised as mild, moderate, and severe. Pooled event rates for each complication category were estimated using a random-effect model. Random-effect uni- and multivariable meta-regression analyses were used to assess the effect of aortic-repair approach (open vs endovasc...
Research Interests:
We conducted this meta-analysis to address the outcomes in cancer patients after oncologic surgery during COVID-19 pandemic. The primary endpoint was the COVID-19-related mortality rate. Higher body mass index was significantly and... more
We conducted this meta-analysis to address the outcomes in cancer patients after oncologic surgery during COVID-19 pandemic. The primary endpoint was the COVID-19-related mortality rate. Higher body mass index was significantly and negatively associated with higher all-cause mortality and in-hospital COVID-19 infection rates. Male sex, preoperative respiratory disease, and smoking history were positively and significantly associated with increased all-cause mortality rates. Furthermore, male sex was positively and significantly associated with the COVID-19 infection rate.
Research Interests:
Research Interests:
Background This meta-analysis of randomized controlled trials (RCTs) was aimed at comparing coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for the treatment of unprotected left main coronary disease.... more
Background This meta-analysis of randomized controlled trials (RCTs) was aimed at comparing coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for the treatment of unprotected left main coronary disease. Methods All RCTs randomizing patients to any type of PCI with stents vs. CABG for left main disease (LMD) were included. Primary outcome was a composite of follow-up death/myocardial infarction/stroke/repeat revascularization. Secondary outcomes were peri-procedural mortality and the individual components of the primary outcome. Incidence rate ratio (IRR) or odds ratio (OR) and 95% confidence intervals (CIs) were pooled using a generic inverse variance method with random effects model. Subgroup analyses were done based on: (I) type of PCI [bare metal stents (BMS) vs. drug-eluting stents (DES)] and; (II) mean SYNTAX score tertiles. Leave one-out analysis and meta-regression were performed. Results Six trials were included (4,700 patients; 2,349 PCI a...
Research Interests:
Aortic stenosis (AS) has been associated with higher mortality in patients undergoing aortic root replacement (ARR). In this analysis, we compare the outcomes among patients with moderate to severe AS or aortic insufficiency (AI)... more
Aortic stenosis (AS) has been associated with higher mortality in patients undergoing aortic root replacement (ARR). In this analysis, we compare the outcomes among patients with moderate to severe AS or aortic insufficiency (AI) undergoing ARR in a tertiary aortic center.